The High Court has approved a further payment of €4.3m for a nine-year-old girl who suffered brain damage at birth.

The payment brings to more than €8m the total paid to Skye Worthington under a settlement against the HSE over the circumstances of her birth at Kerry General Hospital in 2011.

The court heard she has cerebral palsy, cannot speak and can only communicate through special eye gaze technology.

At a previous hearing in 2015 when the case was settled, the HSE and Kerry General Hospital, Tralee, apologised unreservedly to Skye, from Rochestown, Co Cork, who had sued over the injuries sustained during her delivery in April 2011.

At a remote hearing today, High Court President Ms Justice Mary Irvine approved the latest interim payment and said she was thrilled Skye is doing so well and taking part in activities including horse-riding and swimming.

The girl's mother Colleen Worthington said she was a lucky girl and the judge replied Skye was very lucky to have such loving parents in Colleen and Kevin.

The judge said the application for approval was terribly important and it was to ensure that the funds were sufficient to give the girl the best life she can have.

When the case settled in 2015 the hospital also said lessons had been learned from the management of Skye's birth and a formal review had taken place.

On that occasion an interim payment of €2.5m had been paid out which was followed by a further payout of €1.35m three years later.

The court was told that liability had been admitted in the case.

In her actions for damages, it was alleged there was mismanagement of labour and the labour accelerant drug syntocinon should have been stopped when a deceleration in the baby's heartbeat was noted.

Had she been delivered 15 minutes earlier, she would have been spared acute hypoxia, the court was told.

The baby was delivered by emergency cesarean on 22 April 2011 but was flat and was transferred to Cork University Hospital where she received excellent care, it was stated.

The case will come back before the High Court in 2029 when Skye's future care needs will be assessed.