Girl, 2, died in Royal Oldham with Strep A, inquest hears

Sienna Daisy Barber, of Rochdale Road East, Heywood, died on January 29 last year of Group A streptococcus sepsis.

Giving evidence at an inquest into her death at Rochdale Coroner’s Court on Wednesday, Sienna’s mother Alexandria Edmonds described her daughter as a “regular two-year-old” who was “caring”, “affectionate” and “full of life”.

She added that Sienna “loved life” and was “never a poorly child” prior to becoming ill last January.

The court heard that on Sunday, January 23 Sienna had a raised temperature of 40.1C and seemed “more tired than normal”.

Alexandria told the court that she gave Sienna Calpol that day and took her to doctor on Monday morning as her temperature was still high.

The doctor found that Sienna’s chest was clear and that her temperature had dropped to 38C and advised that she had a viral infection.

In the early hours of Tuesday morning (January 25), Sienna woke up and was sick.

Alexandria said Sienna was “hot to touch” and that her temperature had risen. She called 111 and a call back from a doctor was scheduled.

Alexandria then took Sienna to A&E at North Manchester General Hospital and Sienna saw a doctor who suspected that Sienna might have a viral infection and gave Alexandria some ibuprofen to take home for her. There were no signs that Sienna was septic.

In a review completed after Sienna’s visit by Dr Catherine Lenton, the paediatric clinical lead at North Manchester General Hospital, it was found that a Pennine Acute Trust (PAT) Paediatric Observation Priority Score (PAT-POPS) score was not recorded.

A PAT-POPS score indicates how likely it is a child has an underlying illness.

Dr Lenton said Sienna’s score should have been four out of 20 based on her temperature and heart rate which was high.

Following Sienna being given that score, Dr Lenton said a sepsis screening tool should have been carried out but that it would not have changed Sienna’s diagnosis.

Dr Lenton also noted that a fever advice leaflet ought to have been given to Sienna’s parents but doubted that any advice on the leaflet would have prevented Sienna’s “catastrophic decline” in health as she had shown signs of improvement.

Over the next four days, Alexandria continued to check on Sienna, monitoring her temperature regularly, including throughout the night, and ensuring she ate and drank.

On one day Sienna went to Alexandria’s mother for two or three hours over lunch and ate a bowl of soup.

At that point Alexandria thought she was “on the mend”.

On Friday, January 28, 2022, Sienna’s temperature had gone down, but her cough continued. Alexandria got her some cough mixture and said she thought Sienna’s throat was sore because at one point she held her hand against it.

When Alexandria went to wake Sienna the following day, on Saturday, January 29, she noticed that Sienna was not stood in her cot as she normally would but remained lying down and seemed “lethargic”.

She rang 111 and a doctor called her back and said it was likely Sienna had a viral affection and advised her to continue giving her ibuprofen and Calpol.

Alexandria said that around an hour later Sienna started “flinging her arms and legs like they were irritating her” and “seemed very uncomfortable”.

She took her to Rochdale Urgent Care Centre and Sienna suddenly started getting “paler and paler” while in the waiting room.

Alexandria then noticed “blue veins” on Sienna’s hand. She lifted her sleeve and saw the “blue veins” were also on her arm and chest.

She called for a nurse and pointed at Sienna as she “could not get her words out”.

Alexandria told the court that the nurse shouted “help”, took Sienna off her, and “bolted”.

“Ten people flooded in, I’ve never seen anything like it. I heard meningitis being mentioned a couple of times”, she added.

Sienna was transferred to the Royal Oldham Hospital where she died later that day.

A postmortem examination found Sienna was suffering with an infection and had inflammation around her airways and haemorrhages in her lungs.

Dr Sophie Stenton, consultant paediatric and perinatal pathologist at Sheffield Children’s Hospital, told the court that Sienna’s lungs were double the weight expected of a child her age.

Senior coroner for Manchester North, Joanne Kearsley, said Sienna had suffered a “catastrophic overwhelming decline” in health.

Addressing Sienna’s parents, she said: “You never in a million years expect to lose your daughter in such a short period of time.

“There was nothing more you could have done.”

She offered her condolences and added: “It’s an absolute tragedy what happened to your daughter, you have been immensely brave coming here today.”

Ms Kearsley concluded that Sienna died of natural causes.

She issued a Regulation 28 Report and will be writing to England’s health secretary, the Royal College of Paediatricians and Child Health, and the National Institute for Health and Care Excellence (NICE) to raise concerns over the lack of guidance on Strep A.

Following the inquest, a spokesperson from Manchester University NHS Foundation Trust, which runs  North Manchester General Hospital, said: “We again offer our deepest condolences to Sienna’s family for their loss. 

"While the coroner ruled that the missed opportunities in Sienna’s care would not have prevented her tragic death, we can still learn lessons to help other patients. 

"We carried out a very detailed investigation, thoroughly examining Sienna’s care and treatment, and have shared this with her family and the coroner. 

"This highlighted that Sienna did not receive the high standard of care we pride ourselves on delivering and we apologise unreservedly for this. 

"As a result, we have introduced new measures, including enhancing staff training to improve patient management and safety prior to discharge throughout the organisation. 

"We are committed to taking the learning extremely seriously and to providing the highest standards of patient care.”