Rare but ‘catastrophic’ bacterial infection behind NSW children’s deaths

A rare but highly aggressive infection that surged after the lifting of COVID restrictions probably contributed to the death of two-year-old Pippa White, as well as resulting in the deaths of at least four more children in NSW, an inquest has heard.

Associate Professor Kathryn Browning Carmo, acting director of the NSW Newborn & paediatric Emergency Transport Service (NETS), told an inquest into Pippa’s death on Tuesday that hers was one of the first “in a series of cases” of Group A streptococcus (iGAS) the emergency service dealt with over a two-year period.

Pippa’s parents, Brock and Annah White, at their home near Newcastle ahead of this week’s inquest.Credit: Dean Sewell

Carmo said NSW was largely “immune naive” to what appeared to be a more aggressive form of the bacteria Streptococcus pyogenes when doctors at Orange Base Hospital called for NETS assistance around 6am on June 13, 2022, hours before Pippa’s death.

The infection was rare but could lead to “devastating, crashing and catastrophic” cases of sepsis in children, Carmo said, noting that some children could go from having very little water in the lungs to “complete whiteout” on scans “within hours”.

“It was that aggressive … it was an absolutely devastating illness,” she said.

An academic paper co-authored by Carmo and read in court showed the NETS team were referred to 77 cases of children with iGAS between November 2022 and February 2024. Four died from the infection.

In the previous five years, they had responded to just nine cases.

Although Pippa’s blood tests did not confirm she had the infection, Carmo said she had many of its symptoms and experts accepted that it contributed to her illness.

Throughout 2023, NSW Health issued repeated warnings to parents and clinicians about a surge in the rare but deadly infection, which also led to the deaths of at least two children in Victoria.

Pippa White.

Carmo, an experienced neonatologist at the University of Sydney, said Pippa’s condition may have been identified and treated more quickly today as a result.

Western NSW Local Health District executive director of quality, clinical safety and nursing Adrian Fahy earlier told the inquest clinicians treating Pippa had become “anchored” on her condition being caused by a viral infection.

Fahy said that it was “quite remarkable” that doctors did not raise sepsis as a possibility until her bloods were taken at 4am, hours before her death.

He said the health district had since increased efforts to remind staff of the red flags for sepsis, which occurs when the body’s immune response to an infection causes damage to its own organs and tissues.

“Sometimes you need to stop, take a deep breath and think ‘am I on the right track here?’ ” Fahy said.

Fahy also confirmed the on-call registrar treating Pippa was working a 25-hour shift, and the health district has since made changes to ensure doctors were not working back-to-back on-call and day shifts.

The inquest continues.

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