The Health Ministry announced Thursday it would be forming two separate commissions of inquiry into the "miracle baby" case at the Western Galilee Hospital in Nahariya.

Earlier this week, the hospital's medical staff was shocked to find that a premature baby girl pronounced stillborn exhibited spontaneous signs of breathing several hours later. Though immediately rushed to the hospital's neonatal intensive care unit, the baby died the next day.

"The Health Ministry doesn’t believe in miracles," a source in the ministry said after the hospital stated the case was a "medical miracle."

"The problem emanates from the decision to have the baby transferred to the cryolab (cryogenics laboratory). That is when the baby should have undergone the necessary tests to verify whether she was alive. 

"This isn’t a case of making the wrong judgment call. They either checked to see if she was alive or not – those are the only two options. In my opinion," added the source, "they just didn’t check properly."

'Impossible to know what really happened'

A senior neonatologist in another hospital, however, said that in his experience there are cases in which premature infants exhibit an irregular heartbeat, which at times can be mistaken for no heartbeat at all: "If the heartbeat is extremely slow, the (physician's) exam could have missed it.

"There is no way to know or prove if what the doctor' heard was indeed a very slow heartbeat or prolonged (cardiac) arrest that recovered." The main problem, added the specialist, lies with the fact that the preemie's postnatal assessment was done by the obstetrician and not by a neonatologist: "An OBGYN doesn’t know anything about the postnatal exam of a premature baby," he stated.

Nahariya Hospital's Neonatal ICU (Photo: Ido Beker)

A second neonatologist told Ynet he believed things went wrong much earlier, when the medical staff determined the case a second-trimester termination procedure, rather then a premature delivery.

"Once you decided to terminate (a pregnancy) the fetus becomes the minor priority. When going into (an early) delivery everyone in geared to resuscitate the baby; but when a procedure is deemed a termination, you don't take resuscitative measures.

"I can only assume that some respiratory effort and movements were evident, but it was lost on the situation… determining death in cases involving preemies is a highly complex matter," he concluded.

The subject of cardiopulmonary resuscitation in premature babies and its applicability according to the Hippocratic Oath, is a highly sensitive one, not only in Israel; with every nation having independent criteria as to what stages in the pregnancy constitute a viable fetus.

The Israeli code of medical ethics states that a fetus can be viable as early as 24 week into the pregnancy. Japan, for instance, set the bar at 22 weeks, and in most European countries it is considered to be 25 weeks.

Such premature babies, however, have slim chances of surviving, and should they pull through they are most likely to suffer severe birth defects.

Difficult questions

The Health Ministry's investigation is expected to focus on several key questions revolving around the medical staff's decisions:

• Were the parents consulted?  Since the pregnancy was terminated at 23 weeks – just one week shy of the 24-weeks viability mark, the parents should have been consulted on whether or not they wanted the doctors to use extreme measures to save the baby. Were the parents consulted, or did the medical staff make an independent decision?
  

• What were the fetal monitor's readings? Since the baby was able to survive for several hours after birth, is it likely she presented a pulse at the time of the birth. Why is it, then, that the fetal monitor failed to indicate a pulse? Was there a technical malfunction or some other equipment failure, or was this a case of sinus bradycardia – a fetal heartbeat so slow that the obstetrician could have mistaken it for a cardiac arrest?
  

• Was the postnatal assessment done correctly? Since it is highly unlikely that the baby was born with no heartbeat at all – was her postnatal examination preformed correctly, or is this a case of gross negligence? 
  

• Did the baby exhibit any signs of breathing? Premature babies often present very shallow breathing signs, because their lungs are not fully developed. Was the baby born in full respiratory arrest, or was her breathing so shallow it escaped the medical staff altogether?
  

• What was the medical catalyst for the decision to terminate the pregnancy? Despite the early stages of the pregnancy, the baby's birth weight was 1.34 lbs, which is considered a good weight for such a young preemie, and it should have been a contributing factor in saving her life. What, then, caused the baby to exhibit in-utero symptoms which would make the medical staff decide on the termination procedure?
  

Dr. Itay Gal contributed to this report