A Suffolk coroner has said there were a "number of failures" during the care of a 10-year-old boy who died from chickenpox. 

It comes after a two day inquest into the death of Nuel-Junior Dzernjo, from Stowmarket, who died suddenly after contracting chickenpox and sepsis in February.

Coroner Catherine Wood said she would be writing to NICE and to the Royal College of Paediatricians to express concerns in the lack of guidance available to clinicians.

On the first day of the inquest, those gathered at Suffolk Coroners’ Court heard that Nuel-Junior had contracted the infection on Friday, February 17, five days before he died. 

He was examined by nurse practitioner Harriet Piper at the Stowhealth GP practice in Stowmarket on Monday (February 20), and attended an appointment at Ipswich Hospital the following day after being referred there by Dr Awais Khan, a consultant community paediatrician.

Nuel-Junior‘s parents said that he had become so weak he could not walk, needing both of them to support him.

He was examined by Dr Kirsten Phillip, who was the registrar at the paediatric unit at Ipswich Hospital. She gave evidence before the court on Thursday.

Dr Phillip said she had spoken with Dr Khan and was aware that Nuel-Junior had been prescribed steroids. However, she was not aware that the dose had been lowered from 60mg to 20mg, and therefore considered him a low risk of immunosuppression. 

Dr Phillip said that she examined Nuel-Junior, and that he remained under observation for several hours before being discharged.

However, Nuel-Junior’s parents said that they felt his care had been “substandard”, and that the impression they had from the paediatric unit was that “he didn’t matter at all”.

Dr Phillip said that this was not the case. “He is a child, he is important,” she said, before offering her condolences to the family for all the pain they had endured.

Also giving evidence was Dr Matthew James, who was consultant on the paediatric ward during Nuel-Junior's visit, although he did not examine him personally.

Dr James said that the period preceding Nuel-Junior's death had been “really fraught”, as all the beds were full, and he was also covering another department.

“I don’t feel I was able to support Dr Phillip as much as I would have wanted to,” he said.

Expert witness Dr Louis Grandjean said that having heard the evidence, it did not appear that the significance of Nue-Junior’s immunosuppression had been noted during his appointment at Stowhealth or by Ipswich Hospital.

When asked by coroner Catherine Wood if Nuel-Junior’s death could have been avoided had his mother had been advised to take him to A&E on the Monday, he said that “on the balance of probabilities, it could have been.”

He said that, had appropriate treatment been given at Ipswich Hospital, such as intravenous aciclovir, the risk of death would have been lessened, but he could not confidently say it would have been avoided.

He also said that the guidance provided to UK clinicians regarding the risk chickenpox poses to immunocompromised patients is lacking, and told the court that he had written to NICE (the National Institute for Health and Care Excellence) to register that concern.

Kate Stockton, matron for children at Ipswich Hospital, told the court that the hospital was introducing additional guidance to staff and screening to catch cases of infections at risk of developing into sepsis.

Nuel-Junior was taken to West Suffolk Hospital by ambulance on Wednesday, February 22. He died later that day, a week after his 10th birthday. 

Summing up the evidence, Mrs Wood that there were “a number of failures” in Nuel-Junior’s case.

She noted that neither the nurse from Stowhealth who initially examined Nuel or the team caring for him at Ipswich Hospital had been aware of the significance of his immunosuppression, and she said that she, too, would be writing to NICE and to the Royal College of Paediatricians to express concerns in the lack of guidance available to clinicians.

She recorded a narrative conclusion, finding that Nuel-Junior had died from varicella (chickenpox) which he had contracted whilst immunosuppressed, resulting from the steroids he had been prescribed for neurodegeneration.

She ended the proceedings by offering her own condolences to Nuel-Junior’s parents, and noted the dignity with which they had conducted themselves during the inquest.