Neonatal Failures & Birth Injury Risks: Dr Ujwal Kariholu Shares His Medico-Legal Expertise

Ardent Expert Chambers Member Dr Ujwal Kariholu, Consultant Neonatologist, joined INNEG for a specialist webinar examining where neonatal care can break down and how those failures may become significant in complex birth injury and neonatal negligence cases.

Drawing on his clinical and medico-legal experience, Dr Kariholu explored the management of babies at risk of neurological injury, including the recognition of fetal compromise, neonatal resuscitation, early treatment decisions and the importance of complete contemporaneous evidence.

The session demonstrated why expert review of neonatal care often requires more than identifying an isolated clinical error. The wider pathway of care, communication between teams, documentation and the information available at the time may all influence the expert’s assessment.

Recognising Fetal and Neonatal Compromise

A central theme of Dr Kariholu’s webinar was the importance of recognising deterioration at the earliest possible stage.

Babies requiring neonatal care may present with a combination of antenatal, intrapartum and postnatal risk factors. For the neonatologist, these factors need to be considered together rather than as isolated events.

Where neurological injury is later identified, an expert may need to examine when signs of compromise first became apparent, how the baby presented following delivery and whether the subsequent clinical response was appropriate.

Dr Kariholu highlighted the importance of reconstructing that chronology carefully when considering neonatal care retrospectively.

Neonatal Resuscitation and Early Management

The period immediately following birth can be critical where a baby requires resuscitation or demonstrates signs of compromise.

Dr Kariholu explored how an expert may assess the sequence of neonatal resuscitation, including the observations recorded, interventions undertaken and the baby's response.

The review does not simply ask whether the outcome was poor.

It considers whether the treatment provided reflected the clinical presentation at the time, whether escalation occurred appropriately and whether subsequent management responded to the baby’s evolving condition.

This distinction is particularly important in cases where several professionals or clinical teams were involved during the first minutes and hours of life.

Timing of Treatment and Neurological Injury

Early management decisions may become particularly significant where hypoxic-ischaemic encephalopathy or other forms of neurological injury are suspected.

In these cases, timing can matter.

An expert may need to consider when the clinical features indicated neurological compromise, whether further investigation or specialist intervention was required and whether treatment was initiated within an appropriate timeframe.

Dr Kariholu’s discussion demonstrated why neonatal causation often involves detailed assessment of the baby's condition before, during and after delivery rather than relying on one investigation or clinical event.

Missing Evidence and the Importance of Cord Gases

The quality of the available evidence can significantly affect retrospective analysis.

Dr Kariholu highlighted the importance of umbilical cord blood gases, which can provide valuable information about a baby's metabolic condition around the time of birth.

Where cord gases are absent, incomplete or were not obtained, the expert may have less objective information available when considering the timing and severity of any hypoxic insult.

The absence of a particular investigation does not automatically determine the medico-legal conclusion, but it may alter the strength of the evidence from which an opinion can be formed.

For the expert witness, it is therefore important to explain both what the available records demonstrate and where important evidential limitations remain.

The Role of Placental Evidence

Placental examination may also provide valuable information in complex birth injury cases.

Histopathological findings can sometimes help identify evidence of infection, inflammation, vascular abnormalities or other pathology that may contribute to understanding the baby's condition.

Dr Kariholu explored why placental evidence should be considered alongside the wider clinical picture rather than treated as a standalone explanation.

An expert may need to integrate these findings with fetal monitoring, the circumstances of delivery, neonatal presentation and subsequent investigations before reaching conclusions about the likely mechanism and timing of injury.

When Process Failures Matter

Dr Kariholu also addressed an important point: medico-legal concerns in neonatal care are not always driven by a dramatic single clinical error.

Cases may instead involve process failures, such as inadequate communication, unclear escalation, consent issues, incomplete documentation or a lack of transparency surrounding decision-making.

These issues can make the clinical pathway more difficult to reconstruct and may raise separate questions about the standard of care.

For an expert reviewing the case, understanding how the neonatal team operated as a whole can therefore be just as important as analysing an individual intervention.

Documentation and Transparency

Contemporaneous records are particularly important in neonatal care, where events can develop rapidly.

Clear documentation helps establish what clinicians knew, what decisions were made and why particular actions were taken.

Dr Kariholu highlighted how gaps in the records can make retrospective analysis considerably more difficult, particularly where there is disagreement about the timing of deterioration or intervention.

An expert opinion must work from the evidence that exists while remaining transparent about any uncertainties created by incomplete documentation.

That ability to distinguish between established facts, reasonable inference and unresolved uncertainty is fundamental to robust expert evidence.

Specialist Expertise in Neonatal Care

As a Consultant Neonatologist, Dr Kariholu brings specialist expertise in the assessment and management of critically unwell newborn babies and the neurological consequences that can follow complicated pregnancies and deliveries.

His webinar demonstrated how that expertise is applied when reviewing difficult questions involving fetal compromise, neonatal resuscitation, hypoxia, delayed treatment, cord gases, placental findings and neonatal brain injury.

Rather than focusing solely on outcome, Dr Kariholu’s approach considers the complete clinical pathway, from the antenatal and intrapartum evidence through to the baby’s condition following delivery and subsequent neonatal management.

Dr Ujwal Kariholu is a member of Ardent Expert Chambers. View his full member profile to learn more about his specialist expertise and medico-legal practice.

Watch Dr Ujwal Kariholu’s webinar, Neonatal Failures & Birth Injury Risks >