Critical blood tests were never performed on young Aibha Conroy six months before she died, a leading doctor claimed at an inquest.
Additionally, on the night of her death, six-year-old Aibha did not receive the standard dose of dextrose that is usually given to hypoglycaemia patients, paediatric endocrinologist Dr Susan O'Connell told the Coroner's Court in Dublin.
Aibha, from Gowla, Connemara, died at Temple Street Children's Hospital in Dublin on December 14, 2011. Four days previously, she had been admitted to Galway University Hospital suffering from hypoglycaemia, or low blood sugar, weakness and vomiting.
Dr O'Connell, who is based in Cork University Hospital,emphasised the significance that Aibha suffered a prolonged episode of hypoglycaemia on the night of 10-11 December.
There is a "high probability" that Aibha's hypoglycaemia was related to the cerebral oedema, or brain damage, that she suffered on 11 December, although she emphasised that the relationship is not totally understood.
Dr O'Connell emphasised that prolonged hypoglycaemia "is not good for the brain".
Dr O'Connell also pointed out that no successful critical samples were ever carried out to determine whether Aibha had an underlying metabolic or endocrine issue.
These are a series of blood tests to be carried out while a patient is suffering from hypoglycaemia. They are critical in the investigation of hypoglycaemia, said Dr O'Connell.
Meanwhile, Aibha's primary school teacher said the girl's mother had fully expected to receive an earlier referral to Crumlin Children's Hospital in Dublin for blood tests, although this referral was not received.
Caroline Ni Chonghaile said at the start of the school year in September 2011, Kathleen Conroy mentioned that she was expecting referrals for Aibha to Crumlin hospital very shortly.
Kathleen and John Conroy were again present for the entire proceedings yesterday. Their solicitor, Damien Tansey, said the family is "expecting answers" from this inquest.
At one point a photo of Aibha was shown to Dr O'Connell, the coroner and the legal teams, in order to shower skin colour.
"She looks like a sweet, happy child," Dr. O'Connell said as Mrs Conroy fought back tears.
The inquest continues today.