Belfast Telegraph

Little Adam endured more in his short years than most people go through in a lifetime

Mother’s tribute to son as hospital deaths inquiry re-opens

By Anna Maguire

The mother of a four-year-old boy who tragically died in hospital following surgery said he “endured more in his short ... years than most people go through in a lifetime”, an inquiry heard on Monday.

The inquiry into the hyponatraemia-related deaths of five children in hospital between 1995 and 2003 re-opened on Monday.

It will focus on record-keeping and fluid management.

Hyponatraemia, which occurs when there is a low amount of sodium in the blood stream, is the common thread connecting the deaths. The inquiry will also look at the extent to which critical guidelines were shared between professionals.

Established in 2004, it has been postponed several times, including last month when an expert witness raised doubts over whether one of the children died from hyponatraemia. Over the coming days it will focus on the circumstances surrounding the death of Adam Strain, who died in the Royal Belfast Hospital for Sick Children in November 1995.

Adam did not recover from his transplant surgery. He died the following day (November 28).

At a subsequent inquest, Coroner John Leckey found that the four-year-old had died from cerebral oedema — excess fluid in and around the brain cells. He said dilutional hyponatraemia and impaired blood flow to the brain during the kidney transplant contributed to his death.

Solution No 18 is at the heart of criticisms of the fluid management in the cases of Adam, Claire Roberts, Lucy Crawford, and Raychel Ferguson. The type, volume and rate of the administration of intravenous fluids are issues which the inquiry will focus on.

On Monday, the inquiry heard nurses and doctors involved in Adam’s care were asked if they had received adequate training in fluid management or record keeping. Family members of the deceased — gathered in Banbridge Courthouse — also heard that one doctor involved in the care of Adam was aware of the findings of a 1992 article.

The article — published in the British Medical Journal — was based on 16 children hospitalised for minor conditions. All 16 suffered respiratory arrest with symptoms of hyponatraemia.

The 1992 article recommended that hypotonic fluids — fluids with sodium concentrations of less than the concentration found normally in the blood — should not be used with hospitalised children unless there is a clear need.

David Hunter QC, counsel for the Strain family, read out a description of Adam (4) penned by his mother, Debra Slavin, after his death.

“He was a lovely little boy. He was a happy little boy who endured more in his short four years than most people go through in their lifetime,” she said

“No matter what life threw at him, he embraced it with a smile.”

Background

Adam Strain (4) from Holywood, Co Down, is one of three children — including Claire Roberts (9) and Raychel Ferguson (9) — whose deaths are being investigated by the inquiry. Over the coming eight months, it will also investigate events following the death of Lucy Crawford (17 months), as well as specific issues arising from the treatment of Conor Mitchell (15).

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