Doctors believed Pippa Mae White was "getting better" less than 24 hours before she died from sepsis on June 13, 2022, an inquest was told on Wednesday.
Pippa was taken by her mother Annah to Cowra Hospital, in Central Western NSW, on June 12, several days after the generally healthy youngster began displaying symptoms including a high temperature, vomiting and diarrhoea.
A decision was made that evening to transfer Pippa to Orange Base Hospital, despite a belief by doctors she was getting better.
On-call pediatrician in Orange at the time, Adam Buckmaster said the decision to transfer Pippa was made out of caution, primarily based on the length of time she had been unwell.
Dr Buckmaster said he was informed over the phone by the doctor treating Pippa in Cowra, Suhail Mir, that she was sitting up in bed and eating an iceblock.
The experienced pediatrician said in his opinion, Pippa, "appeared to be getting better from whatever illness she had".
"My overall vision … was of somebody who has been unwell for a few days but appears to be on the road to recovery," Dr Buckmaster told the inquest.
However, Ms White claimed in her evidence that at the time her daughter was "lethargic" and vomiting back up any fluids given to her.
Pippa was "grunting" at least until their arrival at Orange hospital, her mother says. (HANDOUT/)
The inquest was shown several videos of Pippa prior to her being transferred to Orange which showed her breathing in a way that may have indicated respiratory distress.
Pippa's mother said the girl was "grunting" - a medical term for the body forcing air out of the lungs - which continued at least through to their arrival at Orange hospital.
Dr Buckmaster said if that was the case, and he was aware of the symptom, it would have painted a much "different picture" of Pippa's condition.
"It would make me much more concerned about her respiratory status," he said.
Dr Buckmaster did not assess Pippa in person until the morning after she arrived at Orange hospital, despite receiving a call several hours earlier, about 4.15am, to inform him her condition had deteriorated.
At that stage concerns of sepsis were raised and a treatment plan was formed including administering antibiotics.
Despite efforts to save Pippa she continued to deteriorate and was declared dead shortly after 1pm on June 13, having suffered two cardiac arrests.
Dr Buckmaster said in hindsight he regrets not attending the hospital in person after receiving the 4.15am phone call, but does not believe it would have affected the outcome.
"I can rightly see people would be critical I didn't jump out of bed at that time," he said.
"In retrospect I wish I had."
Many members of Pippa White's family in court received an apology from a pediatrician. (HANDOUT/)
Dr Buckmaster said he believed Pippa's condition did not start to significantly deteriorate until around midnight after she was admitted to Orange hospital, by which time it likely would have been too late for antibiotics to have saved her.
He told the inquiry had she been given antibiotics 12 or 18 hours earlier it may have made a difference to the outcome.
"She died from cardiovascular collapse, overwhelming sepsis," he said.
"It's really hard for people to hear this - some of that we can't control."
Dr Buckmaster apologised to the large number of Pippa's family and supporters who attended the inquiry, many of whom wore items in her favourite colour yellow.
"I wish with all my heart that we had a different outcome," an emotional Dr Buckmaster said.
"I hope that this process can bring some answers for you and possibly some changes for the better."
The inquest will continue, with evidence from Dr Mir and statements by Pippa's family members on Thursday.
