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Drawing on both clinical and medico-legal experience, this article explores where neonatal care most commonly breaks down, and how those failures translate into clinical negligence claims.

Foetal Compromise and Perinatal Failures

One of the most frequent issues in birth injury litigation is the delayed recognition or response to foetal distress. In practice, this often centres on CTG monitoring - where interpretation can vary, and subtle warning signs are missed or not escalated quickly enough.

Delays in decision-making, particularly around delivery, can have serious consequences. When intervention is not carried out in time, babies may suffer hypoxic-ischaemic encephalopathy (HIE), leading to outcomes ranging from mild developmental concerns to severe brain injury or death.

Neonatal Resuscitation Under Scrutiny

Resuscitation is one of the most heavily scrutinised stages in neonatal care. These cases often turn on timing, decision-making, and adherence to established guidelines.

Delays in initiating resuscitation, failure to follow Neonatal Life Support protocols, or difficulties in airway management can all come under review. A key medico-legal distinction emerges here: not every failed intubation is negligent - but failing to recognise that repeated attempts are causing ongoing hypoxia may well be.

“Minutes can make a huge difference in neonatal outcomes.”

Establishing Negligence in Neonatal Cases

Like all clinical negligence claims, neonatal cases must establish duty, breach, causation, and damage. However, these elements are often more complex in neonatal contexts, particularly where timing is critical and multiple factors may be involved.

A recurring challenge is incomplete or missing data. The absence of cord blood gases, placental histopathology, or timely imaging can make it extremely difficult to determine when an injury occurred.

“Without arterial cord gases, determining the timing of hypoxia becomes extremely difficult.”

This lack of clarity can significantly weaken (or complicate) arguments around causation.

Communication, Consent and the Human Factor

Not all claims are driven purely by clinical error. In many cases, the trigger is a breakdown in communication.

Where families feel they have not been listened to, or that information has been withheld, this can lead to a perception of “cover-up” - even where care may have been clinically appropriate.

“Claims are often driven by process and relationship failures rather than technical error.”

This highlights the importance of clear, transparent communication and properly documented consent throughout neonatal care.

Case Insights from Practice

Real-world cases often bring these issues into sharper focus.

In one example, a delay of several hours in escalating care for reduced foetal movements led to an emergency caesarean section, with the baby subsequently diagnosed with severe HIE. The central question became whether earlier intervention could have prevented the outcome.

In another case, concerns arose around consent after a baby received antibiotics in NICU despite parental objections. On closer review, the documentation showed refusal applied only to specific treatments, not all medications, and the clinical decision was ultimately considered justified. Here, the clarity of documentation proved critical.

What Solicitors Should Look For

Neonatal claims require a careful and often multidisciplinary approach. Timing is central - particularly in hypoxia-related injuries - and expert input is usually needed across obstetrics, neonatology, and radiology.

Equally, the quality of documentation can be decisive. Missing data or unclear records can make or break a case. It is also important to recognise that not all adverse outcomes indicate negligence, particularly in cases involving prematurity, where baseline risks are already elevated.

Early expert screening can play a valuable role in clarifying breach and causation, helping firms assess viability before costs escalate.

Key Reflections

“Neonatal medicine involves decisions that may only be questioned years later - when the child can speak for themselves.”

“Minutes matter - both before and after birth.”

“It is often the process, not just the clinical act, that leads to litigation.”

Watch the full webinar here >