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England and Wales High Court (Queen's Bench Division) Decisions
You are here: BAILII >> Databases >> England and Wales High Court (Queen's Bench Division) Decisions >> Paling (A Child) v Sherwood Forest Hospitals NHS Foundation Trust  EWHC 3266 (QB) (07 December 2021)
Cite as:  EWHC 3266 (QB)
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QUEEN'S BENCH DIVISION
Strand, London, WC2A 2LL
B e f o r e :
| FREDERICK HEATH PALING (a child proceeding by his Mother and Litigation Friend MICHELLE PALING)
|- and -
|SHERWOOD FOREST HOSPITALS NHS FOUNDATION TRUST
Charles Bagot QC (instructed by Browne Jacobson LLP) for the Defendant
Hearing dates: 18 October 2021
Crown Copyright ©
Master Sullivan :
The basis of the application
i) Perhaps 40% of neonatal seizures have a genetic basis. Most, but not all such patients require ongoing treatment for such disorders. Characteristics of many of those conditions described as genetic forms of neonatal seizures involve significant developmental impairment, often severe mental retardation. In an unbiased population of babies presenting with neonatal seizures, genetic profiling can have a beneficial value in identifying underlying diagnosis and modifying management in about 20% of all cases, including seizure presentation. He was of the view that is not how this claimant presents and on the balance of probability it would be more likely than not to result in negative test results. He also notes that DNA changes can occasionally be found that are uninterpretable as they haven't previously been reported.
ii) If the seizures were caused by hypoglycaemia, the fact of normal family history, non dysmorphic presentation and absence of neurological signs would count against the hypothesis of another genetic disorder. But genetic investigation would offer the possibility of identifying a mild mutation in a known syndromic disorder. However, not many children with the sort of functional deficits the claimant presents with have been analysed and there are no publications to assist with the likelihood of a positive finding.
iii) There are estimates which suggest upwards of 50-60% of neonatal hypoglycaemia may be genetically attributable however the basic facts of this case tend to suggest this generalisation would not apply.
iv) Overall he is of the view that there is a 20-25% chance of identifying a causal mutation for his deficits. He says this is only an estimate but is one which is based on experience and published findings.
The claimant's position
Should the evidence be allowed before a defence?
(i) Do the interests of justice require that the claim be stayed if the tests are not undertaken
(ii) Has the claimant advanced a substantial reason as to why the test should not be undertaken?
Note 1 Intra uterine growth retardation [Back] Note 2 the exome is a part of the genome [Back]
Note 1 Intra uterine growth retardation [Back]
Note 2 the exome is a part of the genome [Back]