The hours and days after delivery are a period of rapid change for a newborn.

Most babies make the transition from life inside the uterus to breathing, feeding, maintaining body temperature, and regulating circulation without serious difficulty.

Some babies need immediate resuscitation.

Others initially appear well but later develop:

• Severe jaundice
• Infection
• Breathing problems
• Low oxygen levels
• Feeding difficulties
• Abnormal weight loss
• Seizures
• Heart disease
• Metabolic disease
• Hearing loss
• Other medical problems

That is why newborn care does not end once delivery is complete.

Hospitals, newborn nursery teams, pediatricians, neonatologists, nurses, laboratories, and follow-up providers can all play roles in identifying problems, performing required or appropriate screening, communicating results, arranging follow-up, and escalating care when the newborn becomes ill.

A poor outcome does not automatically mean neonatal care was negligent.

A Kentucky neonatal-care investigation may instead ask:

• Was the baby’s condition appropriately assessed after birth?
• Were resuscitation needs recognized?
• Were Kentucky newborn screenings completed?
• Were abnormal screening results acted on?
• Was bilirubin measured and interpreted appropriately?
• Were feeding and weight loss evaluated?
• Were signs of infection recognized?
• Was follow-up arranged before discharge?
• Were critical lab results communicated?
• Should the baby have remained hospitalized?
• Was NICU consultation or transfer appropriate?
• Did any delay actually cause or worsen the child’s injury?

The answers usually require a detailed medical timeline and qualified expert review.

What Does “Neonatal Care” Include?

The neonatal period refers to the first 28 days after birth.

Care during this period may involve:

• Delivery-room assessment
• Neonatal resuscitation
• Newborn physical examinations
• Vital-sign monitoring
• Feeding assessment
• Weight monitoring
• Bilirubin screening
• Blood-spot newborn screening
• Critical congenital heart disease screening
• Hearing screening
• Infection-risk assessment
• Glucose testing when medically indicated
• NICU care
• Discharge planning
• Communication with the outpatient pediatrician
• Early post-discharge follow-up

Not every newborn requires the same testing.

A healthy term newborn without risk factors may receive very different care from a premature infant, a newborn with respiratory distress, or a baby exposed to maternal infection.

Immediate Newborn Care and Resuscitation

The American Heart Association and American Academy of Pediatrics issued updated Neonatal Resuscitation Guidelines in 2025.

Those guidelines address both newborns making a normal transition and babies who need assistance.

They emphasize that every birth setting should be prepared to provide newborn resuscitation.

At least one person at every birth should have primary responsibility for the newborn and be capable of performing initial resuscitation steps and providing ventilation when needed.

When Does a Newborn Need Assisted Ventilation?

The newborn’s medical team assesses:

• Breathing
• Heart rate
• Muscle tone
• Gestational age
• Other clinical findings

For newborns who are:

• Apneic,
• Gasping, or
• Persistently bradycardic with a heart rate below 100 despite appropriate initial steps,

the 2025 AHA/AAP guideline emphasizes effective ventilation.

Ventilation is the most important intervention for many newborns who fail to transition normally.

Meconium and Suctioning

Current resuscitation guidance does not recommend routine oral, nasal, or endotracheal suctioning merely because meconium is present.

Suctioning can be appropriate when material is actually obstructing the airway and interfering with ventilation.

This distinction matters because outdated routine suctioning can delay effective ventilation.

A neonatal-care case involving a difficult transition may therefore require review of:

• Resuscitation record
• Heart-rate measurements
• Respiratory effort
• Ventilation start time
• Oxygen use
• Intubation
• Suctioning
• Apgar components
• Early blood gases

Kentucky Newborn Screening Requirements

Kentucky operates a statewide newborn screening program through the Cabinet for Health and Family Services.

Several different screening programs are involved, and they should not all be treated as though one regulation governs every test.

Important screening areas include:

1. Newborn blood-spot screening
2. Pulse-oximetry screening for critical congenital heart disease
3. Newborn hearing screening

Kentucky Blood-Spot Newborn Screening

Under current 902 KAR 4:030, covered hospitals and providers must administer or verify newborn blood-spot screening.

The heel-stick specimen tests for a panel of inherited, metabolic, endocrine, hematologic, and other disorders.

A newborn can appear completely healthy while having one of these conditions.

Early diagnosis can sometimes prevent:

• Brain injury
• Developmental disability
• Serious illness
• Organ damage
• Death

When Is the Kentucky Blood-Spot Sample Collected?

For a newborn who does not require an extended hospital stay because of illness or prematurity, current Kentucky regulations generally call for the capillary blood-spot specimen to be obtained between:

24 and 48 hours of age.

If a baby remains hospitalized because of illness or prematurity, the regulation provides a different timing framework, generally after 24 hours and before 72 hours.

If discharge occurs before 24 hours, Kentucky has special provisions requiring screening as close to 24 hours as possible.

The exact procedure can vary in special circumstances.

A Newborn Screen Is Not a Diagnosis

A newborn blood-spot screen identifies babies who may need additional testing.

An abnormal screen does not automatically mean the child has the condition.

Likewise, a normal screen does not eliminate every possible medical disorder.

Potential neonatal-care problems can arise when:

• The specimen is never collected
• Collection occurs improperly
• A specimen is inadequate
• A repeat specimen is requested but not obtained
• An abnormal result is not communicated
• Follow-up testing is not arranged
• A specialist referral is delayed

The state laboratory records, hospital records, pediatric records, and communication logs can all become relevant.

Kentucky CCHD Pulse-Oximetry Screening

Kentucky’s newborn-screening regulation also requires pulse-oximetry screening for critical congenital heart disease, commonly called CCHD screening.

Certain serious congenital heart defects can be difficult to detect by physical examination alone before a newborn leaves the hospital.

Pulse oximetry measures oxygen saturation.

When Is CCHD Screening Performed in Kentucky?

Current Kentucky regulations generally provide that CCHD pulse-oximetry screening should occur:

• When the infant is 24 hours old or older, and
• Before discharge

If a newborn will be discharged before 24 hours, special early-discharge timing provisions apply.

NICU infants are screened when medically appropriate after 24 hours and before discharge, subject to exceptions such as a heart defect already diagnosed before the screening would otherwise occur.

How Is the Test Performed?

Kentucky’s current regulation uses oxygen-saturation measurements from:

• The baby’s right hand, and
• Either foot

This compares preductal and postductal oxygen saturation.

A passing screen does not prove that a child has no heart defect.

CCHD screening is intended to improve detection of certain critical defects, not identify every congenital heart condition.

What Happens After a Failed Kentucky CCHD Screen?

Kentucky’s regulation contains specific follow-up provisions for a failed screen.

Depending on the screening result, the regulation provides for evaluation that can include:

• Diagnostic echocardiography without delay
• Prompt interpretation
• Pediatric cardiology consultation before discharge if the echocardiogram is abnormal

A potential case involving an undiagnosed critical heart defect may therefore require review of:

• Pulse-ox values
• Screening times
• Repeat testing
• Physician notification
• Echocardiogram order
• Echocardiogram images and report
• Cardiology consultation
• Discharge decision

Kentucky Newborn Hearing Screening

Kentucky’s Early Hearing Detection and Intervention program, or EHDI, is administered through the Office for Children with Special Health Care Needs.

Kentucky CHFS states that newborn hearing screening is intended to ensure babies are screened before leaving the hospital.

Approved physiologic screening methods include tests such as:

• Automated auditory brainstem response, or AABR
• Otoacoustic emissions, or OAE

What if a Baby Does Not Pass the Hearing Screen?

A failed newborn hearing screen does not necessarily mean permanent hearing loss.

Additional testing is needed.

Kentucky’s EHDI program follows the familiar early-detection framework of:

• Screening by 1 month
• Diagnostic evaluation by 3 months
• Early intervention for confirmed hearing loss by 6 months

Follow-up can be particularly important because congenital hearing loss may not be obvious to parents during the newborn period.

Potential evidence in a hearing-delay case can include:

• Initial screening result
• Repeat screening
• Risk factors
• Referral
• Audiology appointment
• Diagnostic ABR
• ENT records
• Early-intervention referral

Is Every Missing Screening Test Malpractice?

No.

A missing or delayed screening result does not automatically prove negligence.

Possible considerations can include:

• Statutory exceptions
• Parent refusal where legally permitted
• Medical instability
• Prematurity
• Transfer before screening
• Whether another facility completed the test
• Whether repeat testing was medically required
• Whether the missed screening actually caused a delay in diagnosis
• Whether an earlier diagnosis would have changed the outcome

A legal case requires both a departure from appropriate care and causation.

Newborn Jaundice and Bilirubin Monitoring

Jaundice is one of the most common newborn conditions.

More than 80% of newborns develop some degree of jaundice.

Most cases do not cause permanent harm.

Very high unconjugated bilirubin, however, can enter the brain and cause:

• Acute bilirubin encephalopathy
• Permanent bilirubin neurological injury, or kernicterus

The American Academy of Pediatrics updated its major hyperbilirubinemia guideline in 2022.

When Should Bilirubin Be Measured?

For newborns at least 35 weeks’ gestation, the AAP recommends at least one objective bilirubin measurement:

• Between 24 and 48 hours after birth, or
• Before discharge if the baby leaves earlier

The initial measurement may be:

• Transcutaneous bilirubin, or TcB
• Total serum bilirubin, or TSB

TSB is the definitive measurement for important treatment decisions such as:

• Starting phototherapy
• Escalating care
• Exchange transfusion

Visual inspection alone is not an adequate replacement for objective bilirubin measurement.

Why the Baby’s Age in Hours Matters

A bilirubin number cannot be interpreted responsibly without knowing the newborn’s age in hours.

Treatment thresholds depend on factors including:

• Gestational age
• Postnatal age
• Bilirubin level
• Neurotoxicity risk factors

A result that may be acceptable at four days of age could be much more concerning early after birth.

That makes timestamps important.

The Current AAP Follow-Up Approach

Older materials often describe the Bhutani risk-zone nomogram.

The AAP’s 2022 guideline changed the routine follow-up approach.

Post-discharge follow-up is now based largely on how far the baby’s bilirubin is below the applicable phototherapy threshold.

A bilirubin level close to the treatment threshold generally requires earlier reassessment than one well below it.

Other factors also matter, including:

• Gestational age
• Feeding
• Weight
• Hemolysis
• Bruising or cephalohematoma
• G6PD deficiency
• Clinical stability

When Jaundice Care May Raise Negligence Questions

Potential issues can include:

• No objective predischarge bilirubin measurement
• Failure to act on a bilirubin close to treatment level
• Delayed repeat testing
• Inadequate follow-up after discharge
• Failure to recognize hemolysis
• Failure to evaluate significant feeding problems
• Delay in phototherapy
• Delay in escalation of care
• Delay in transfer for exchange transfusion capability

Kernicterus requires a detailed bilirubin timeline.

The diagnosis alone does not prove malpractice.

Feeding and Weight Loss Before Discharge

Newborn feeding is another important part of discharge readiness.

The medical team may evaluate:

• Breastfeeding effectiveness
• Formula intake when applicable
• Latch
• Swallowing
• Wet diapers
• Stool output
• Birth weight
• Discharge weight
• Percentage of weight loss
• Hydration

Poor intake can contribute to significant jaundice and dehydration.

But breastfeeding itself should not be treated as a medical error.

The issue is whether the newborn’s actual feeding, weight, hydration, bilirubin, and clinical condition were evaluated appropriately.

Early-Onset Neonatal Sepsis

Early-onset sepsis, or EOS, is a serious bacterial infection arising during the newborn period, generally from organisms acquired before or during birth.

Potential organisms include:

• Group B Streptococcus
• E. coli
• Other bacteria

Signs can be nonspecific.

A sick newborn may develop:

• Respiratory distress
• Temperature instability
• Poor feeding
• Lethargy
• Abnormal blood pressure or perfusion
• Apnea
• Abnormal heart rate
• Other signs of clinical illness

Does Every Newborn Need a CBC and CRP for Sepsis?

No.

This is an important distinction.

The AAP’s clinical report for newborns at least 35 weeks’ gestation recognizes several acceptable strategies for early-onset-sepsis risk assessment.

They include:

• Categorical risk-factor assessment
• Multivariate risk assessment, such as a validated EOS risk calculator
• Serial clinical examinations

No one strategy identifies every baby who will develop sepsis.

Each hospital should have a documented approach appropriate to its patient population and resources.

CBC and CRP Have Important Limitations

The AAP specifically states that laboratory tests such as:

• Complete blood count
• CRP

are not sensitive or specific enough to diagnose EOS by themselves.

A baby should not be declared infected—or infection-free—based solely on a CBC or CRP.

When bacterial sepsis is suspected, blood culture is central to diagnosis.

Cerebrospinal-fluid testing may also be appropriate in selected high-risk or critically ill newborns.

When Are Antibiotics Used?

Whether empiric antibiotics are appropriate depends on:

• Clinical illness
• Maternal infection risk
• Gestational age
• Sepsis-risk assessment
• Blood culture
• Other medical findings

For many newborns requiring empiric treatment for EOS, the AAP identifies ampicillin plus gentamicin as the usual initial regimen.

Critically ill infants may require a different or broader approach based on the circumstances.

Antibiotics should not be delayed merely to obtain a test when doing so would endanger a critically ill newborn.

When Sepsis Care May Raise Negligence Questions

A potential case may examine:

• Maternal fever
• Suspected intraamniotic infection
• GBS status
• Duration of membrane rupture
• Intrapartum antibiotics
• Newborn respiratory distress
• Temperature instability
• Serial examinations
• Sepsis-risk calculation when used
• Blood culture
• Time antibiotics were ordered
• Time antibiotics were administered
• NICU escalation

The presence of sepsis does not establish negligence.

Even appropriate care cannot prevent every case.

Newborn Hypoglycemia and Other Risk-Based Testing

Not every hospital test is a universal screening requirement.

For example, blood-glucose monitoring is generally targeted to newborns with clinical symptoms or recognized risk factors rather than performed identically for every healthy infant.

Potential risk groups can include certain:

• Premature infants
• Infants of diabetic mothers
• Small-for-gestational-age infants
• Large-for-gestational-age infants
• Symptomatic newborns

This distinction matters legally.

The correct question is not:

“Why didn’t the hospital perform every available test?”

It is:

“Based on the newborn’s actual condition and known risks, what assessment and testing were reasonably indicated?”

How Long Should a Healthy Newborn Stay in the Hospital?

There is no single mandatory hospital-stay duration that is medically correct for every baby.

The AAP’s policy on healthy term newborns emphasizes individualized discharge readiness.

Factors include:

• Stable newborn vital signs
• Feeding success
• Urine and stool output
• Bilirubin risk
• Physical examination
• Required screenings
• Family readiness
• Safe home situation
• Identified outpatient provider
• Ability to obtain follow-up care

A discharge is not safe simply because a particular number of hours has passed.

Likewise, a relatively early discharge is not automatically negligent if appropriate criteria and follow-up are satisfied.

Follow-Up After Early Discharge

AAP materials emphasize prompt newborn follow-up.

Its policy for healthy term newborns states that a baby discharged before 48 hours should have an appointment for examination within 48 hours after discharge.

A more recent AAP 2025 newborn-visit reference describes the initial healthy-newborn visit as generally occurring:

• 48–72 hours after leaving the hospital, or
• At 3–5 days of age

depending on the circumstances.

Some newborns need earlier follow-up.

For example, a baby whose bilirubin is close to the phototherapy threshold may need bilirubin reassessment sooner than an otherwise healthy newborn.

A safe discharge plan therefore depends on the baby’s individual risks.

What Should Be Completed or Addressed Before Discharge?

Depending on the newborn and applicable Kentucky requirements, discharge planning can include:

• Physical examination
• Stable vital signs
• Feeding evaluation
• Weight assessment
• Bilirubin measurement
• Blood-spot screening
• CCHD pulse-ox screening
• Hearing screening
• Review of pending results
• Follow-up appointment
• Parent education
• Emergency instructions
• Communication with the outpatient pediatric provider

The important issue is not merely whether a discharge checklist was signed.

The question is whether the baby was medically ready and whether unresolved issues had an appropriate follow-up plan.

Pending Test Results After Discharge

Some newborn-screening results are not final while the baby remains in the hospital.

That makes result tracking and communication systems important.

A potential neonatal-care case may involve:

• An abnormal metabolic screen returned after discharge
• A repeat specimen requested by the state laboratory
• A positive culture
• A laboratory result sent to the wrong provider
• A failed hearing screen without follow-up
• A CCHD screening concern not escalated
• A bilirubin result not communicated

Relevant evidence can include:

• Laboratory timestamps
• Electronic result-routing logs
• Telephone notes
• Fax records
• Patient-portal messages
• Pediatrician records
• State program correspondence

When Might Discharge Be Unsafe?

A possible case may involve discharge despite unresolved concerns such as:

• Significant respiratory distress
• Abnormal oxygen saturation
• Poor feeding with dehydration concern
• Significant weight loss
• Bilirubin requiring earlier reassessment or treatment
• Temperature instability
• Unexplained lethargy
• Suspected infection
• Unresolved abnormal screening
• Other unstable medical findings

Whether hospitalization should have continued requires expert review of the actual clinical circumstances.

Failure to Arrange Appropriate Follow-Up

Sometimes the inpatient care itself is appropriate, but the handoff fails.

Questions may include:

• Was a pediatrician identified?
• Was the follow-up appointment actually scheduled?
• Did the outpatient provider receive the bilirubin result?
• Were pending tests communicated?
• Did the family receive understandable instructions?
• Was transportation or another access barrier known?
• Was a specialty referral arranged?

The medical record may contain more than one discharge document.

Nursing instructions, physician orders, appointment records, and after-visit summaries should all be preserved.

When Is NICU Admission Appropriate?

There is no universal diagnosis list requiring NICU admission.

The level of care depends on the newborn’s:

• Gestational age
• Respiratory status
• Oxygen need
• Neurological status
• Infection risk
• Blood pressure
• Feeding ability
• Need for IV therapy
• Need for advanced monitoring
• Need for subspecialty care

Some babies can be safely managed in a normal newborn nursery or special-care nursery.

Others need Level III or Level IV neonatal intensive care.

Failure to Transfer a Newborn

A hospital does not have to provide every pediatric subspecialty service on site.

But if a newborn needs treatment beyond a facility’s capabilities, transfer may become appropriate.

A legal investigation may consider:

• When deterioration became apparent
• Hospital capabilities
• When neonatology was consulted
• When a receiving facility was contacted
• Whether transfer was accepted
• When the transport team was activated
• Care provided while waiting
• Care during transport

A transfer itself does not imply that the referring hospital did anything wrong.

The question is whether the baby’s condition was recognized and escalation occurred appropriately.

Advanced Neonatal Care in Kentucky

The facilities below are listed as examples of current Kentucky neonatal resources.

Their inclusion does not suggest that any hospital or provider caused a particular child’s injury.

Golisano Children’s at UK — Lexington

Kentucky Children’s Hospital is now Golisano Children’s at UK.

UK HealthCare operates a Level IV NICU in Lexington for critically ill and premature newborns.

UK also provides developmental follow-up through its NICU Graduate Clinic.

Kentucky Kids Crew

The Kentucky Kids Crew provides specialized neonatal and pediatric hospital-to-hospital critical-care transportation.

UK states that a dedicated transport team is available 24 hours a day, seven days a week, using specialized ground and air equipment.

Baptist Health Lexington

Baptist Health identifies Lexington as a Level III NICU location.

Level III neonatal units provide advanced care for critically ill newborns, including babies who require respiratory or other intensive medical support.

Norton Children’s Hospital — Louisville

Norton Children’s Hospital in downtown Louisville operates a Level IV NICU.

Its Level IV unit provides advanced neonatal medical and surgical subspecialty care.

“Just for Kids” Transport Team

Norton Children’s operates the “Just for Kids” Transport Team for neonatal and pediatric inter-hospital transport.

The service operates around the clock using specialized ambulances and aircraft.

What Records Matter in a Neonatal-Care Case?

A neonatal-care case can involve records from the birth hospital, state screening programs, outpatient pediatrician, laboratory, NICU, transport team, and specialists.

Delivery and Resuscitation Records

Request:

• Delivery note
• Apgar scores
• Neonatal resuscitation record
• Heart-rate documentation
• Ventilation
• Oxygen
• Intubation
• Suctioning
• Cord gases
• Early blood gases

Newborn Nursery Records

Request:

• Admission examination
• Daily examinations
• Nursing flowsheets
• Vital signs
• Temperature
• Oxygen saturation
• Feeding
• Urine output
• Stool output
• Daily weights
• Medication administration
• Progress notes

Newborn Blood-Spot Screening

Preserve:

• Date and time specimen was collected
• Specimen identification
• State-laboratory report
• Unsatisfactory-specimen notice
• Repeat-screen request
• Repeat result
• Provider notification
• Specialist referral

CCHD Screening

Request:

• Right-hand oxygen saturation
• Foot oxygen saturation
• Exact screening time
• Repeat results
• Failed-screen notification
• Echocardiogram
• Cardiology consultation

Hearing Screening

Request:

• OAE or AABR result
• Repeat screen
• EHDI referral
• Audiology records
• Diagnostic ABR
• ENT consultation
• Early-intervention referral

Jaundice Records

Request every:

• TcB result
• TSB result
• Date and time
• Phototherapy threshold
• Phototherapy order
• Start and stop time
• Discharge bilirubin plan
• Follow-up bilirubin
• Readmission record

Feeding and Weight Records

Preserve:

• Birth weight
• Daily weights
• Discharge weight
• Percentage of weight loss
• Nursing feeding documentation
• Lactation consultation
• Intake
• Wet diapers
• Stool records
• Supplementation discussions

Infection Records

Potentially relevant records include:

• Maternal infection records
• GBS status
• Duration of ruptured membranes
• Maternal temperature
• Newborn serial examinations
• Vital signs
• EOS-risk assessment if used
• Blood culture
• CBC
• CRP
• Antibiotic orders
• Antibiotic administration times
• Lumbar puncture when performed

Remember that CBC and CRP alone do not diagnose EOS.

Discharge Records

Request:

• Discharge examination
• Discharge summary
• Instructions
• Follow-up appointment
• Pediatrician identification
• Pending-test list
• Jaundice instructions
• Feeding instructions
• Emergency warning signs
• Copies of screening results

Communication Records

Potentially important evidence includes:

• Telephone notes
• Provider pages
• Patient-portal messages
• Laboratory alerts
• Fax confirmations
• State-screening notifications
• Appointment scheduling records

NICU and Transport Records

If the baby deteriorated or was transferred, preserve:

• NICU consultation
• Transfer request
• Accepting physician
• Transport activation
• Transport-team record
• Treatment during transport
• Arrival time
• Receiving NICU records

Why Exact Timestamps Matter

Many neonatal-care cases turn on chronology.

For example:

• 8:00 a.m. — bilirubin collected
• 9:14 a.m. — result available
• 11:00 a.m. — infant discharged
• 1:20 p.m. — provider notified
• Following morning — family contacted

Or:

• 2:10 a.m. — temperature instability documented
• 3:05 a.m. — respiratory distress begins
• 4:00 a.m. — physician notified
• 5:30 a.m. — blood culture ordered
• 6:10 a.m. — antibiotics given

Those times do not decide negligence by themselves.

But they allow experts to determine:

• What information was available
• Who knew it
• What action followed
• Whether any interval caused additional harm

What Kentucky Parents Can Do After a Newborn-Care Concern

1. Seek Medical Care for Current Symptoms

If a newborn is currently:

• Difficult to wake
• Feeding poorly
• Breathing abnormally
• Blue or pale
• Feverish or unusually cold
• Increasingly jaundiced
• Having seizure-like activity
• Otherwise seriously unwell

seek appropriate medical evaluation promptly.

A legal investigation should never delay necessary medical treatment.

2. Ask for the Exact Diagnosis

Ask the medical team:

• What problem occurred?
• When did it begin?
• What tests showed it?
• Was it present before discharge?
• Was a screening abnormal?
• What treatment is needed now?

3. Obtain the Complete Hospital Record

Do not rely only on a portal download.

Ask for:

• Full newborn chart
• Nursing flowsheets
• Laboratory results
• Screening reports
• Medication administration
• Discharge records
• Communications

4. Get Records From the Outpatient Pediatrician

A neonatal-care timeline often continues after discharge.

Outpatient records can show:

• When the pediatrician first learned of the concern
• Weight
• Feeding
• Jaundice
• Abnormal screening results
• Referrals
• Readmission decisions

5. Preserve State-Screening Communications

Save any:

• Letters
• Calls
• Electronic messages
• Repeat-screen notices
• Audiology referrals
• Specialty-clinic communications

6. Write Down a Timeline

Document:

• Birth
• Screening dates
• Bilirubin levels you were told about
• Feeding concerns
• Discharge
• Calls to the pediatrician
• Symptoms at home
• Emergency visits
• Readmission

7. Keep Long-Term Medical Records

If the child suffered permanent injury, preserve:

• Neurology
• Cardiology
• Audiology
• Developmental pediatrics
• PT
• OT
• Speech therapy
• Feeding therapy
• Early intervention
• School records
• Medical equipment

8. Have Kentucky Legal Deadlines Evaluated Early

Do not assume that every claim involving a newborn automatically remains open until the child reaches adulthood.

Kentucky timing rules depend on:

• The claimant
• The defendant
• The legal forum
• The nature of the claim

Kentucky Law and Neonatal-Care Malpractice Claims

Kentucky’s Current Medical Malpractice Deadline

The current version of KRS 413.140, effective July 15, 2026, generally provides a one-year limitations period for covered negligence or malpractice actions against physicians, surgeons, dentists, and hospitals licensed under KRS Chapter 216.

For covered medical-malpractice claims, the statute provides that the cause of action is deemed to accrue when the injury is:

• First discovered, or
• In the exercise of reasonable care should have been discovered

The statute also contains a five-year outside period measured from the alleged negligent act or omission.

The correct deadline depends on the specific facts, claimant, and defendant.

Does Kentucky Toll an Injured Newborn’s Claim?

KRS 413.170 provides tolling protection for certain actions when the person entitled to bring the claim was an infant—meaning a minor—when the cause of action accrued.

Because KRS 413.140 falls within the statutory range identified by KRS 413.170, minority can significantly affect a child’s own medical-malpractice claim.

But families should not interpret this as:

“Every newborn malpractice claim can wait until age 18.”

Separate rules may apply to:

• A parent’s independent claim
• Wrongful death
• Estate claims
• State institutions
• State employees
• Other governmental defendants
• Claims under a different statutory procedure

Each potential claim should be evaluated separately.

Special Rules Can Apply to UK HealthCare and Other State Institutions

This issue is particularly important in Kentucky because the University of Kentucky is a state institution of higher education.

Under KRS 49.070, state institutions of higher education are treated as state agencies for purposes of the applicable Board of Claims statutes.

The Kentucky Board of Claims has primary and exclusive jurisdiction over certain negligence claims involving:

• The Commonwealth
• State agencies
• Officers
• Agents
• Employees acting within the scope of state employment

KRS 49.120 imposes a separate filing framework.

For medical-malpractice claims before the Board:

• Claims generally must be filed within one year after accrual.
• Medical malpractice receives a discovery rule.
• The statute contains a three-year outside period.
• A guardian, next friend, or other qualified representative must bring a minor’s claim within the Board’s applicable period.

Critically, KRS 49.120 states that its disability rule applies notwithstanding KRS 413.170.

Families therefore should not assume that ordinary minority tolling automatically applies to a possible claim involving a state institution.

This does not mean every claim involving UK HealthCare belongs before the Board of Claims.

The particular:

• Entity
• Provider
• Employment status
• Contractor relationship
• Scope of employment
• Alleged negligent act

must be analyzed.

Kentucky’s Certificate-of-Merit Requirement

Kentucky also has a pre-filing requirement associated with many medical-malpractice lawsuits.

Under KRS 411.167, a claimant commencing a covered medical-malpractice action generally must file a certificate of merit with the complaint.

The certificate ordinarily states that:

• The claimant reviewed the facts
• The claimant or attorney consulted with at least one qualified expert
• The expert is knowledgeable about the relevant issues
• The consultation supports a reasonable basis for commencing the action

The statute contains exceptions and alternative procedures.

It also addresses situations in which medical records were requested but have not yet been produced.

That provision can make early, complete record requests important.

Does Kentucky Require a Medical Review Panel?

No.

Kentucky formerly required covered malpractice claims to proceed through a mandatory medical review panel.

The Kentucky Supreme Court held that system unconstitutional in Commonwealth ex rel. Meier v. Claycomb.

The old panel process therefore does not apply.

It should not be confused with Kentucky’s separate certificate-of-merit requirement under KRS 411.167.

Do Neonatal-Care Cases Require Medical Experts?

Usually.

These cases can involve specialized questions concerning:

• Neonatology
• Newborn pediatrics
• Hyperbilirubinemia
• Infectious disease
• Cardiology
• Screening systems
• Audiology
• Neurology
• Discharge readiness
• Transfer decisions
• Causation
• Long-term prognosis

Potential experts may include:

• Neonatologists
• Pediatricians
• Pediatric infectious-disease physicians
• Pediatric cardiologists
• Pediatric neurologists
• Audiologists
• Neuroradiologists
• Other specialists

Kentucky’s KRE 702, amended effective July 1, 2024, governs admissibility of expert testimony.

The expert usually needs to address more than the fact that a diagnosis was delayed.

The analysis often asks:

1. What should reasonably have been done?
2. When should it have been done?
3. What actually happened?
4. Would earlier diagnosis or treatment more likely than not have changed the outcome?

Do AAP Guidelines or Kentucky Screening Rules Automatically Prove Negligence?

No.

Professional guidelines and state requirements are important evidence and context.

But they do not automatically establish every element of medical malpractice.

For example:

• A failed hearing screen is not a diagnosis of deafness.
• A normal CCHD screen does not eliminate every congenital heart defect.
• A baby can develop sepsis even after appropriate risk assessment.
• Severe jaundice can occasionally develop despite reasonable screening and follow-up.
• Some inherited disorders may not be detectable on a routine newborn screen.

Experts must connect the alleged failure to the actual injury.

Who Could Be Responsible for a Preventable Neonatal-Care Injury?

Depending on the evidence, an investigation may involve:

• Pediatrician
• Neonatologist
• Family physician
• Newborn nursery nurse
• NICU nurse
• Labor and delivery staff
• Emergency physician
• Laboratory personnel or systems
• Hospital or health system
• Outpatient pediatric practice

Potential institutional issues can include:

• Newborn-screening processes
• Critical-result notification
• Discharge procedures
• Follow-up scheduling
• Staffing
• Sepsis protocols
• Bilirubin protocols
• Transfer systems
• Communication between inpatient and outpatient providers

The involvement of a provider or hospital does not itself establish liability.

Can the Hospital Be Responsible for a Screening or Discharge Failure?

Potentially.

An investigation may determine whether the problem involved:

• Individual medical judgment
• Nursing care
• A laboratory communication failure
• An electronic-result-routing problem
• An inadequate discharge system
• Failure to schedule follow-up
• Failure to communicate pending results
• A transfer delay
• A combination of individual and institutional factors

Employment relationships and provider status also affect potential liability.

What Injuries Can Follow a Serious Neonatal-Care Failure?

The possible consequences depend entirely on the underlying condition.

Examples can include:

• Kernicterus
• Cerebral palsy
• Hearing loss
• Neurological injury
• Brain injury from severe infection
• Septic shock
• Meningitis
• Cardiac collapse from undiagnosed CCHD
• Metabolic brain injury
• Developmental disability
• Death

These conditions can also occur despite appropriate medical care.

A legal case requires evidence that preventable care contributed to the outcome.

What Damages Could Be Involved?

If a supported Kentucky malpractice claim involves permanent injury, potential legally compensable losses may include:

• Past medical expenses
• Future medical care
• Neurology
• Cardiology
• Audiology
• Hearing devices
• Therapy
• Rehabilitation
• Assistive communication
• Mobility equipment
• Home modifications
• Educational support
• Personal-care assistance
• Lost or reduced earning capacity
• Pain, suffering, and other recognized harms

Serious cases can require:

• Physicians
• Therapists
• Life-care planners
• Economists
• Vocational experts

There is no responsible way to value a neonatal-care case simply from the diagnosis.

What if a Neonatal-Care Failure Results in Death?

Kentucky wrongful-death claims are governed in part by KRS 411.130.

The statute provides that a wrongful-death action is prosecuted by the deceased person’s personal representative.

Wrongful-death claims have deadline and procedural questions different from an injured child’s own malpractice claim.

Parents therefore should not rely on the ordinary minority-tolling discussion when evaluating a fatal case.

Frequently Asked Questions About Neonatal Care in Kentucky

What newborn screenings are required in Kentucky?

Kentucky’s newborn screening system includes:

• Blood-spot screening for specified inherited and congenital conditions
• Pulse-oximetry screening for critical congenital heart disease
• Newborn hearing screening through the state’s EHDI program

The specific timing, exceptions, follow-up requirements, and governing legal provisions differ among the programs.

When is Kentucky’s heel-stick newborn screen done?

For most newborns not requiring an extended hospital stay, current Kentucky regulations generally call for the capillary blood-spot specimen between 24 and 48 hours after birth.

Different provisions apply to premature or ill infants and babies discharged before 24 hours.

When is CCHD pulse-ox screening done in Kentucky?

Current Kentucky regulation generally provides for screening at 24 hours of age or older and before discharge.

Special provisions apply to earlier discharge and certain NICU or prenatally diagnosed infants.

What happens if a newborn fails the CCHD screen?

Kentucky’s regulation provides for prompt further evaluation, including diagnostic echocardiography under specified failed-screen circumstances and pediatric cardiology consultation when the echocardiogram is abnormal.

Is newborn hearing screening required before hospital discharge?

Kentucky’s EHDI program states that newborns are screened before leaving the hospital.

Covered facilities operate under Kentucky’s newborn-hearing statutory and regulatory framework.

What if my baby did not pass the hearing screen?

A failed screen does not establish permanent hearing loss.

Additional audiological testing should be arranged.

Kentucky’s program aims for screening by one month, diagnosis by three months, and intervention by six months.

Should every newborn have a bilirubin test?

For newborns at least 35 weeks’ gestation, the AAP’s 2022 guideline recommends at least one objective bilirubin measurement between 24 and 48 hours after birth or before earlier discharge.

Is jaundice diagnosed just by looking at the baby’s skin?

No.

Visual assessment can help identify jaundice, but objective TcB or TSB measurement is important.

TSB is the definitive test for treatment decisions.

Does every newborn at risk for sepsis need a CBC and CRP?

No.

AAP guidance recognizes multiple approaches to EOS risk assessment.

CBC and CRP alone are not reliable enough to diagnose or exclude early-onset sepsis.

What tests prove neonatal sepsis?

Blood culture is central to diagnosis of bloodstream infection.

CSF culture may be appropriate in selected babies when meningitis is a concern.

Other tests provide supporting clinical information but do not independently prove EOS.

Does every newborn with a maternal infection risk need antibiotics?

No.

Management depends on gestational age, maternal factors, the newborn examination, the hospital’s risk-assessment strategy, and clinical condition.

A clinically ill newborn presents a different situation from a well-appearing infant with one isolated risk factor.

How soon should a newborn see a pediatrician after discharge?

Timing depends on the child.

AAP guidance emphasizes prompt follow-up, particularly after early discharge.

A healthy term newborn discharged before 48 hours generally should have follow-up arranged within approximately 48 hours of discharge, while jaundice, feeding problems, prematurity, or other risks may require earlier evaluation.

Does a hospital have to keep every baby for 48 hours?

No.

Discharge readiness is individualized.

A shorter stay can be appropriate for some healthy newborns when discharge criteria and follow-up are satisfied.

When should a newborn be transferred to a NICU?

There is no universal rule.

Transfer depends on the newborn’s stability, diagnosis, treatment needs, hospital capabilities, and access to neonatal specialists.

Where is advanced NICU care available in Kentucky?

Current Kentucky resources include:

• Golisano Children’s at UK in Lexington — Level IV NICU
• Baptist Health Lexington — Level III NICU
• Norton Children’s Hospital in Louisville — Level IV NICU

UK and Norton Children’s also operate specialized neonatal transport services.

What records matter most in a neonatal-care case?

Commonly important evidence includes:

• Newborn nursery chart
• Vital-sign flowsheets
• Feeding and weight records
• Bilirubin results
• Newborn screening results
• CCHD pulse-ox readings
• Hearing screening
• Sepsis assessments
• Blood cultures
• Medication records
• Discharge instructions
• Follow-up scheduling
• Lab notifications
• NICU and transport records

What is Kentucky’s deadline for a neonatal-care malpractice claim?

KRS 413.140 generally provides a one-year limitations period for covered medical-malpractice claims against private physicians and hospitals and contains discovery language and a five-year outside period.

KRS 413.170 can materially affect certain claims belonging to minors.

Different rules can apply to state entities, parents’ claims, wrongful death, and other proceedings.

There is no single safe deadline for every newborn injury case.

Does Kentucky require a certificate of merit?

For many covered medical-malpractice actions, yes.

KRS 411.167 generally requires a certificate of merit when the complaint is filed, subject to statutory exceptions and alternative procedures.

Does Kentucky require a medical review panel?

No.

Kentucky’s former mandatory medical review panel law was held unconstitutional.

Do neonatal-care malpractice cases need medical experts?

Usually.

The standard of care, timing of diagnosis, treatment decisions, and causation generally involve specialized medical knowledge.

How Morrin Law Office Evaluates a Neonatal-Care Case

A neonatal-care investigation should begin with the actual clinical timeline rather than an assumption that a bad outcome means the newborn should not have been discharged.

Our review may involve:

1. Obtaining the complete birth and newborn nursery record.
2. Reviewing delivery-room resuscitation when relevant.
3. Obtaining all newborn blood-spot screening records and follow-up notices.
4. Reviewing CCHD pulse-ox screening and any cardiac evaluation.
5. Obtaining newborn hearing-screening and EHDI follow-up records.
6. Building a complete bilirubin timeline.
7. Reviewing feeding, hydration, and weight loss.
8. Reviewing maternal and neonatal infection risks.
9. Evaluating serial newborn examinations and vital signs.
10. Obtaining blood cultures, antibiotic records, and sepsis evaluations when applicable.
11. Reviewing discharge readiness and pending results.
12. Determining what information was communicated to the outpatient pediatrician.
13. Reviewing post-discharge calls, visits, emergency treatment, and readmission.
14. Reviewing NICU consultation and transfer timing.
15. Obtaining actual imaging, EEG, echocardiography, and other studies when relevant.
16. Consulting qualified neonatology, pediatric, infectious-disease, cardiology, neurological, audiological, and other experts as appropriate.
17. Determining whether an alleged delay actually caused or materially worsened the child’s injury.
18. Identifying potentially responsible providers and healthcare entities.
19. Determining whether ordinary Kentucky court procedures or Board of Claims rules may apply.
20. Evaluating Kentucky’s certificate-of-merit requirement and filing deadlines.
21. Documenting the child’s long-term medical, developmental, educational, and care needs.

Some newborn disorders are difficult to detect early.

Some babies deteriorate despite appropriate screening, monitoring, and follow-up.

Other cases may support a conclusion that a missed screening, uncommunicated result, unsafe discharge, delayed diagnosis, delayed treatment, or delayed transfer caused preventable harm.

The purpose of the investigation is to determine what the complete medical record and qualified experts actually support.

Talk With Morrin Law Office About a Neonatal-Care Injury

If your child suffered a serious injury after concerns about jaundice, infection, newborn screening, hospital discharge, or other post-birth care, Morrin Law Office can review the available information and discuss whether further medical and legal investigation makes sense.

Morrin Law Office
214 W. Main St.
Richmond, KY 40475
Phone: 859-358-0300

Sources

• American Heart Association / American Academy of Pediatrics — 2025 Neonatal Resuscitation Guidelines:
  https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/neonatal-resuscitation
• American Academy of Pediatrics — Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation:
  https://publications.aap.org/pediatrics/article/150/3/e2022058859/188726/Clinical-Practice-Guideline-Revision-Management-of
• American Academy of Pediatrics — Frequently Asked Questions About the 2022 Hyperbilirubinemia Guideline:
  https://www.aap.org/en/patient-care/hyperbilirubinemia/frequently-asked-questions-about-the-2022-aap-guideline-on-the-management-of-hyperbilirubinemia/
• American Academy of Pediatrics — Management of Neonates Born at ≥35 Weeks With Suspected or Proven Early-Onset Bacterial Sepsis:
  https://publications.aap.org/pediatrics/article/142/6/e20182894/37522/Management-of-Neonates-Born-at-35-0-7-Weeks
• American Academy of Pediatrics — Hospital Stay for Healthy Term Newborn Infants:
  https://publications.aap.org/pediatrics/article/135/5/948/33740/Hospital-Stay-for-Healthy-Term-Newborn-Infants
• American Academy of Pediatrics — The Newborn Visit (2025):
  https://publications.aap.org/pediatriccare/article/doi/10.1542/aap.ppcqr.396517/201568/The-Newborn-Visit
• Kentucky Cabinet for Health and Family Services — Newborn Screening Program:
  https://www.chfs.ky.gov/agencies/dph/dmch/cfhib/Pages/newbornscreening.aspx
• Kentucky Administrative Regulations — 902 KAR 4:030, Newborn Screening Program:
  https://apps.legislature.ky.gov/law/kar/titles/902/004/030/
• Kentucky Cabinet for Health and Family Services — Newborn Hearing Screening / EHDI:
  https://www.chfs.ky.gov/agencies/ocshcn/Pages/newbornscreening.aspx
• Kentucky Cabinet for Health and Family Services — EHDI Information for Providers:
  https://www.chfs.ky.gov/agencies/ocshcn/Pages/ehdiprov.aspx
• Kentucky Administrative Regulations — 911 KAR 1:085, Early Hearing Detection and Intervention Program:
  https://apps.legislature.ky.gov/law/kar/titles/911/001/085/
• Kentucky Revised Statutes — KRS 413.140, Current Medical Malpractice Limitations and Discovery Rule:
  https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=58050
• Kentucky Revised Statutes — KRS 413.170, Infancy and Disability Tolling:
  https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=17873
• Kentucky Revised Statutes — KRS 411.167, Certificate of Merit for Medical Malpractice Actions:
  https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=49312
• Kentucky Revised Statutes — KRS 411.130, Wrongful Death:
  https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=17769
• Kentucky Revised Statutes — KRS 49.070, Board of Claims and State Institutions:
  https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=51456
• Kentucky Revised Statutes — KRS 49.120, Board of Claims Filing Deadlines:
  https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=51461
• Kentucky Supreme Court — Order 2024-19, Amendment of KRE 702:
  https://www.kycourts.gov/Courts/Supreme-Court/Supreme%20Court%20Orders/202419.pdf
• Kentucky Supreme Court — Commonwealth ex rel. Meier v. Claycomb:
  https://law.justia.com/cases/kentucky/supreme-court/2018/2017-sc-000614-tg.html
• UK HealthCare — Golisano Children’s at UK Neonatal Intensive Care Unit:
  https://ukhealthcare.uky.edu/golisano-childrens-uk/services/neonatal-intensive-care-unit
• UK HealthCare — Kentucky Kids Crew Neonatal and Pediatric Transport:
  https://ukhealthcare.uky.edu/golisano-childrens-uk/services/emergency-urgent-care/emergency-transport
• Baptist Health — Mother & Baby Care and Kentucky NICU Levels:
  https://www.baptisthealth.com/care-services/services/mother-baby-care
• Norton Children’s — NICU Locations:
  https://nortonchildrens.com/services/nicu/locations/
• Norton Children’s — “Just for Kids” Transport Team:
  https://nortonchildrens.com/services/transport-team/

Disclaimer

This page provides general public information about newborn screening, jaundice, early-onset sepsis, neonatal care, hospital discharge, and Kentucky medical-malpractice law. It is not medical advice or legal advice.

Newborn illness can develop even when appropriate screening, monitoring, and follow-up are provided. Screening tests also have limitations and do not diagnose or exclude every disease.

Medical guidance, Kentucky regulations, screening panels, laws, filing requirements, and deadlines can change. If a newborn is currently ill or showing concerning symptoms, seek appropriate medical care. If you have questions about possible legal rights or filing deadlines, consider obtaining individualized legal advice promptly.