A four-week-old baby died after being left for hours under cold, damp bedsheets in an “understaffed” hospital, an inquest has heard.
A court was told that Lakshith Guptha Nalla was found to be malnourished and dehydrated before his death at the University Hospital of Wales last year.
Pontypridd Coroners’ Court heard the baby's devastated parents have had their lives “changed forever” by the ordeal.
Shortly before the infant's death in May 2024, a variety of medical failures were identified.
Lakshith Guptha Nalla was found to be malnourished and dehydrated before his death at the University Hospital of Wales
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Coroner Rachel Knight said chronic and severe staffing shortages in the neonatal unit resulted in the baby receiving no nutrition for four hours.
The inquest also heard that the lack of available staff meant his developing infection went unnoticed and the baby had been left on cold, damp bedding.
The coroner said the "vulnerable" infant was "entirely dependent on the NICU".
Two days prior to four-week-old's death, nurse Pasqualina Mollo had taken out his feeding tube to allow the parents to hold him, the court was told.
Pontypridd Coroners’ Court heard the baby's devastated parents have had their lives 'changed forever'
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However, the infant was left without a feeding tube for more than an hour and a half due to shortages in the unit.
When a replacement was eventually fitted, it was not connected correctly and staff failed to spot the issue for several hours, according to Wales Online.
Staff on the unit were caring for twice the recommended number of patients at the time of the baby’s death, the court heard.
Between 4pm and 5pm on the day he died, crucial observations were not carried out and were missing from his medical notes.
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By 6pm, nursing staff discovered he had gone four hours without receiving adequate nutrition.
Tests revealed his blood sugar had dropped to dangerously low levels.
The infant was found to be suffering from metabolic and respiratory acidosis and was cold and dehydrated when he died.
Ms Knight condemned the standard of care as “wholly inadequate”, but concluded there was insufficient evidence to formally classify the failings as neglect.
However, the coroner said that even if he had been fed as instructed, it may not have prevented the four-week-old's death.
Ms Knight told the court: “Due to staffing levels on the ward and missing equipment, he was not nursed to the standard he should have been and was not fed for four hours.
“He was showing signs of necrotising enterocolitis, which is likely his cause of death.”
The infant's family have since returned to their home country of India following the loss of their son.
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