Baby found dead in her cot a day after being sent home from A&E with temperature

A baby sent home from hospital after being diagnosed with a virus tragically died from a bacterial infection the following day, an inquest heard.

Luna Ellora Thomas was first taken unwell on March 24, the week of the initial coronavirus lockdown, when she developed several symptoms.

The 13-month-old was rushed to hospital two days later as her condition worsened, where she was treated for suspected bronchiolitis – described as “a blockage of the small airways in the lungs caused by a virus”.

A decision was made to discharge little Luna after tests, with mum Hannah Thomas given safety advice and told the case would be referred to a community nurse.

But, in the early hours of March 27, Miss Thomas was woken up by strange noises coming from her daughter’s room, an inquest heard.

She found Luna had been sick so took her to her own bed.

Miss Thomas, from Bolton, Greater Manchester, then returned her young daughter to her own cot at around 7am – before tragically discovering her unresponsive just three hours later.

She said the heartbreaking death has left her feeling “broken and empty” – describing Luna as “one of a kind”.

A police investigation concluded that there were no third party involvement or suspicious circumstances and a coroner gave a verdict of death by natural causes yesterday, ruling that the infection would have been difficult to diagnose earlier.

An inquest into her death at Bolton Coroner’s Court heard that Luna first started feeling unwell on March 24.

She developed a runny nose before showing a temperature, refusing food and sticking her tongue out the next day.

Miss Thomas told the court that she believed this was because Luna had a sore throat.

The mum then gave her daughter Calpol every four hours, but in the early hours of March 26, Luna’s breathing became quicker and she had a temperature of 38.8C.

After ringing the BARDOC out of hours service, Miss Thomas was advised to take Luna straight to the A&E department of Royal Bolton Hospital.

Upon arriving at hospital at around 4.20am on March 26, Luna was triaged by paediatric nurse Mollie Nuttall.

Miss Nuttall recorded that Luna’s temperature was now normal, her oxygen saturation was normal, her respiratory rate was raised and her heart rate was 200.

A Paediatric Early Warning Score was completed by Miss Nuttall to check for signs of sepsis – however only two out of the six criteria were met.

Miss Nuttall also noted that Luna showed signs of tug and recession – meaning that she had to work harder than usual to breathe.

At around 5.30am, Luna was assessed by Dr Mustapa.

Miss Thomas told Dr Mustapa that Luna had a fever, had been struggling to breathe, was eating less than usual but was still taking on fluids. Luna was also found to have a blanching rash on her torso. Dr Mustapa told the court that she would be more concerned if a rash was non blanching.

Dr Mustapa said that there was no signs of tug and recession during the assessment and added that Luna was “settled” while with her mother. Luna’s tonsils were red according to Dr Mustapa but no signs of pus were spotted.

Luna was diagnosed with suspected bronchiolitis, described as “a blockage of the small airways in the lungs caused by a virus”.

Dr Mustapa told the court that before discharging Luna, she reassured Miss Thomas, gave her ‘safety netting’ advice, and told her that the case would be referred to the Community Children’s Nursing Service.

After going back to their home in Farnworth, Miss Thomas said that Luna was sleeping on and off but was ‘lethargic’.

At 10am, Miss Thomas rang her GP Dr Rebecca Cruickshank.

Due to the Covid-19 restrictions, Dr Cruickshank completed a telephone consultation.

Dr Cruickshank recorded that Luna’s symptoms were no worse than they had been when she was assessed at the hospital.

Luna’s temperature was recorded by Miss Thomas at 37.8C, which Dr Cruickshank described as being “on the higher side of the normal”.

Dr Cruickshank also told the court that a face-to-face assessment would have been offered if it was not for the lockdown restrictions.

Miss Thomas continued giving Luna Calpol every four hours and bathed her at around 6.30pm, before putting her to bed, in her cot, at 7pm. She also gave her a drink in a ‘sippy cup’.

Some time between 3am and 4am on March 27, Miss Thomas woke up when she heard noises coming from Luna’s room.

She found that Luna had been sick so Miss Thomas took Luna to bed with her. Luna’s breathing still consisted of ‘panting breaths’ according to Miss Thomas.

At around 7am, Miss Thomas took Luna back to her cot. The next time she checked on her – around three and a half hours later – she was unresponsive, the inquest was told.

After ringing an ambulance and attempting CPR, Luna was taken to the Royal Bolton Hospital, where she was pronounced dead at 11.22am on March 27.

Following a post mortem, pathologist Dr Melanie Newbould recorded the medical cause of death as “invasive, hemolytic streptococcus (group A) (emm1.0) infection, characterised by empyema, bronchopneumonia, mediastinitis and disseminated sepsis”.

Assistant coroner for Manchester West Catherine Cundy said: “I have no evidence which would allow me to conclude that Luna’s bacterial infection could have been diagnosed at an earlier stage.

“I note the pathologist’s evidence that it is probable that Luna already had streptococcal A infection when she was assessed but I also find it as a fact that her presenting symptoms were not such as to suggest the presence of a bacterial rather than a viral infection, or to suggest that admission to hospital was required.”

Reaching a conclusion of natural causes, she added: “In the circumstances of the evidence I’ve heard, of this being a naturally occurring bacterial infection, which was severe and invasive, I conclude that her death was natural causes.

“I extend my heartfelt condolences. It is a heartbreaking case to lose a child at such a young age to what was clearly such a severe illness that took hold so quickly.

“She was clearly a much loved child and I’m sure she will be much missed by the family.”

Following a previous hearing, Miss Thomas said that Luna’s death had left her feeling “broken and empty”.

She said: “She was one of a kind. She was always laughing and even when she was crying you’d look at her and she would burst out with her cheesy grin. She was such a funny, clever, and beautiful little girl.

“Food was her life, she was only happy when she was eating. Every time you saw her, she had either food in her hand or around her mouth. She was always pinching her brother and sister’s teas after she’d just eaten hers.

“She always had everyone laughing. She was such a big character, taken away way too soon. She is missed and loved by many.”