A COUPLE tragically lost their five-year-old girl hours after a GP said she likely just had a "tummy bug".
Little Esma Guzel died in the car as her parents drove her to an out-of-hours doctors when her condition worsened.
Esma in fact had an undetected birth defect whereby she had a hole in her diaphragm – congenital diaphragmatic hernia (CDH).
A full day of evidence was heard at Hull Coroners' Court yesterday at the inquest into her heartbreaking death, which occurred on May 10, 2019.
HullLive reported that Esma suffered a cardiac arrest as a result of her pre-existing condition, which is normally diagnosed before or shortly after birth.
But Esma, a child of three, appeared "fit as a fiddle" until the day before her death.
Mum Kerry said at the time of Esma’s death: "This has happened and it will never go away and will die with us. The spark of life she made has gone.
"She came home from school and was normal, went to my mum’s for her tea and just said, ‘Nanna, I feel sick’ and she was sick at my mum’s house.
“Later on, her sick went a brown colour and we kept her in bed and kept giving her fluids. She was exhausted.
“The next day she slept and we took her to the doctor and she checked her and said she thought she had a sickness bug.”
On the evening of May 9, a GP said Esma likely had a tummy bug and advised to contact NHS 111 if Esma’s condition worsened.
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Kerry called NHS 111 in the early hours May 10 and was advised to take Esma to an out-of-hours GP service in Beverley.
Tragically, by the time Esma and her dad reached there, she had died.
A doctor carried out CPR and Esma was taken to Hull Royal Infirmary, but there was nothing more that could be done.
Kerry said: "[Dad] Erkan took her in the car to hospital, carried her in and she never made it. She had already passed away.”
Kerry sought answers as to why Esma’s CDH was never picked up before or after she was born.
David Crabbe, a consultant paediatric surgeon, explained to Hull Coroners’ Court that CDH is a condition which affects around one in 2,500 births.
CDH occurs when the diaphragm, the muscle that separates the chest from the abdomen, fails to close in the womb, which can allow parts of the abdomen to move into the chest.
The defect can usually be detected in ultrasound scans.
Radiology evidence indicated that it was simply not possible to have identified Esma's condition on the three pre-natal scans.
Had Esma’s condition ever been found, she would likely have had surgery with success.
Mr Crabbe made clear that the GP's assessment of May 9 could not have foreseen the cardiac arrest.
The hole in Esma’s diaphragm was small, and part of her bowel had become stuck inside it, consistent with her symptoms.
The obstruction led to life-threatening hypovolemic shock – fluid loss in the body which impairs the heart’s function.
Mr Crabbe said he could not identify a specific trigger for the bowel's sudden incarceration.
He also said that, had Esma gone into cardiac arrest at the hospital, it was likely she would have survived.
Dr Lynette Hykin provided an independent assessment of the GP's interaction with Esma, saying there were “no GP assessment features that dictated hospital referral”.
Dr Hykin expressed potential concerns of care falling below the standard of a reasonably competent GP with regard to assessment of the abdominal pain Esma suffered and the colour of the vomit.
Assistant coroner Dr Dominic Bell indicated that the inquest would resume on Wednesday afternoon with a conclusion expected.
Kerry’s mum has been keen to raise awareness of the symptoms of CDH, which may include difficulty breathing, fast heart rate, blue colouring of the skin and an abdomen which appears caved in.
To find out more, visit CDH UK.
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