Case No. FD25F00020 - [2025] EWHC 783 (Fam)

For the purposes of this application I have a very helpful witness statement from Professor CC. She has been a consultant physician for 22 years. She has established a specialist antenatal service for those living with HIV. She provides care routinely in this area. She is to my mind, a considerable expert in this narrow specialist field.

Paragraph 9 of her witness statement summarises the situation. She says this

“Both the clinical team and I involved in [PP]’s care are increasingly and considerably concerned that [PP] may have an undiagnosed infection, possibly HIV, Hepatitis B or syphilis, which will put her baby at risk of infection, which could be prevented with appropriate management. We are of the view that the baby needs to be tested urgently for these conditions upon delivery and that [PP] has a heightened risk profile as detailed below, meaning this baby is particularly at risk.”

She goes on to set out her involvement with the mother and sets out the chronology and the mother’s persistent declining of BBV screening. She notes the working diagnosis of Kikuchi lymphadenitis. She is plainly concerned about the risk of the mother having an undiagnosed BBV infection.

Sadly she has had experience of situations where mothers have declined testing and where their children have contracted HIV. She has had experience of one child who died where there had been no testing.

In terms of the jurisdiction I am exercising today, she is clear that the mother has capacity to make decisions regarding her own medical treatment and to exercise her parental responsibility. She sets out the risks to the unborn baby if it has an undiagnosed BBV. She makes it clear that the complications are potentially fatal, and makes the point that all BBV infections are preventable with appropriate testing and treatments.

She goes on to say that for any potential HIV infection, the chance to stop transmission in utero has been lost, so it is even more important to take steps to reduce the risk now. She tells me that testing the cord blood tests for maternal antibodies, and that treatment for HIV must be given ideally within 4 hours and not later than 72 hours after birth. Treatment for HBV must be given within 24 hours of birth. She is clear that timely testing and treatment is essential.

She states that the mother is opposed to BBV testing and has repeatedly declined it.
She states that the treatment options which include testing for BBVs via the cord blood, is non invasive and poses no risks to the child. She makes the point that one of the options is to do nothing, but this could mean an infection for the baby which may have fatal consequences. She sets out a table of the options with all the risks and benefits against them.

She repeats the urgency of the matter and the fact that the treatment for HIV must take place within 4 hours of birth. She states that rightly, the plan must involve the mother.

Professor CC gave oral evidence. Mr Fullwood’s essential line of questioning (which was undertaken with skill) was that the evidential basis to suspect that PP had a BBV was limited, as while there was a working diagnosis of Kikuchi lymphadenitis there was no confirmed diagnosis of Kikuchi lymphadenitis, no diagnosis of any BBV and no other non-clinical matters applied to PP (such as drug use or sex work). I remind myself that in her evidence Professor CC had said that PP did have raised infection markers (such as CR-P), which could be consistent with a BBV but also with a number of other conditions.

She also stated that there was some evidence that patients who repeatedly refused tests may be positive for BBV. She accepted there was no evidence of any safeguarding issues in respect of PP’s other 4 children. She was clear that the BBV screening tests posed no risk to the child. She stated that the local authority was aware of the matter but was not clear what the safeguarding issues are or what steps had been taken. She also told me that a mother breast feeding with HIV increases the risks of transmission to the baby. I am clear that the safe-guarding issues in this case need to be considered fully and soon.

I was referred to various academic journals, which for reasons of time, I cannot go into. The overall evidence and her assessment of the mother and what she gathers from academic articles, is that there is a real concern that the mother has an undiagnosed BBV, the baby is therefore at risk of infection and in order to reduce the risk the baby needs to be tested as soon as possible and given treatment within 4 hours of birth.

The mother was invited to give evidence but declined. I understand she is very anxious and concerned. These proceedings should have been brought earlier. I afforded her as much time as possible to get representation. Her case is that there is not enough evidence that she has a BBV for her baby to be tested.