Doctors at Wollongong Hospital were unaware for several hours that baby Helani Sirianni's life was draining away from a brain bleed, an inquest heard yesterday.One doctor conceded that intervention which may have helped was not given until the baby girl's condition markedly deteriorated.Helani was transferred to the Royal Hospital for Women at Randwick but she died on February 10, 2008, 47 hours after she was delivered by vacuum extraction.Parents Michael and Marlissa Sirianni of Farmborough Heights, who had been agitating for the inquest since their first-born's death, sat grim-faced through the distressing evidence before Coroner Scott Mitchell in Glebe Coroner's Court.Mr Mitchell encouraged them to display their photos of Helani with pride, noting she was "a pretty baby and despite her short life was an important member of the community".Helani died from multiple organ failure caused by hypovolemic shock due to vacuum extraction, according to the post-mortem examination report submitted with the brief of evidence by chief investigating officer Detective Sergeant Stephen Davies.Dr Monique Cebola, the obstetrics registrar who delivered Helani about 3am, told the inquest she resorted to vacuum extraction because of the baby's failure to progress and foetal distress."Did any of this cause you to think intervention from a senior person was warranted?" Adrian Moroya, for the family, asked.Dr Cebola said she had managed this type of birth in the past and "felt confident to continue".She said the suction was meant to draw the baby down and move its head into position for birth.Dr Cebola said she used the suction three times, which was within protocol.She said she had concerns after the birth because the baby was not responding to resuscitation and that she offered to help arrange for a catheter as volume replacement may be required."(But) the baby did start to respond and I didn't feel it was necessary at this stage," she said.Paediatrician Dr Steve Hartman, who first saw Helani at 3.30am, said there were several unsuccessful attempts at inserting a catheter but when Helani began to stabilise he decided not to persist."I thought it was a rather invasive process and it might be best to let the child rest," he said. He said when he got a phone call at 7.30am from the hospital to say Helani was unwell he ordered the catheter be inserted "immediately".Mr Moroya: "With hindsight, do you agree a catheter should have been inserted at 4am?"Dr Hartman: "Given what happened to Helani, I would consider the catheter should have been inserted."When questioned why he didn't take this action immediately, he said it was the first brain bleed in a baby he had dealt with in 32 years so he did not expect this condition was likely.Dr Hartman said although the catheter may have helped Helani in the short term, "in my experience once a condition like this occurs there is no remedy".Since Helani's death, protocol for vacuum extraction had been tightened with enhanced training for nurses and registrars, Deborah Cameron from the South Eastern Sydney Illawarra Area Health Service told the inquest.The inquest is expected to conclude tomorrow.