Vomiting and aspiration — over-feeding re-read

What the jury heard

The jury heard specific feed-volume figures described as excessive. The context — that neonatal feed tolerance varies widely between babies and even between feeds in the same baby — was given less prominence.

What the Panel says

The Panel reviewed the feed records and concluded that volumes were within observed ranges. The post-aspiration deteriorations seen were entirely consistent with the babies' gestation and underlying condition.

What independent experts add

• Child G was born at approximately 23 weeks — the edge of viability. Severe complications at this gestation are the expected trajectory, not an anomaly.
• Feed-chart records showing volumes at the high end of tolerance are not evidence of deliberate over-feeding in the absence of contemporaneous clinical concern about the feed.
• Gastroesophageal reflux of prematurity is well documented as a cause of post-feed deterioration in extremely preterm infants and routinely produces aspiration events without any deliberate cause.
• BAPM feeding guidance explicitly notes the wide variability in feed tolerance between extremely preterm infants and between feeds in the same infant on the same day, undermining any 'standard volume' against which deviation can be characterised as deliberate.