Harold E. Buttram, MD
Catherine J. Frompovich
The foremost principle of law in the United States legal system is innocent until proven guilty. That is paramount in criminal law, but there seems to be a misapplication of that principle in one aspect of medicine involving brain hemorrhages, retinal hemorrhages, multiple fractures, and/or extensive bruising of infants and children, commonly being attributed to parental or caretaker abuse without first performing appropriate medical laboratory tests and investigations to rule out plausible medical causes of the findings. There are a number of acronyms involved: SBS (Shaken Baby Syndrome), NAT (Non-Accidental Trauma), plus others.
As a practicing physician, Harold E. Buttram had his first experience with SBS cases in 1999 when he, among many others, was contacted by Alan Yurko, who received a life sentence without parole in 1998 for supposedly murdering his infant son, and was prosecuted under the medical diagnosis of Shaken Baby Syndrome. On investigation, Dr. Buttram learned that the baby had been born prematurely, suffered from respiratory distress syndrome and remained underweight throughout the ten weeks of his life. The baby died within hours of receiving vaccines with many times the safe dose of Thimserosal, containing 50 percent mercury. (According to the Environmental Protection Agency (EPA), the upper safety limit of mercury is 0.1 microgram per kilogram body weight.) In addition, the vaccines included a lot of the DTaP vaccine (Diptheria-Pertusses-Tetanus) that turned out to be one of the “hottest lots” of the 1990s in terms of adverse reactions. However, in 2004 the father was granted an evidentiary hearing based on new evidence of the grossly flawed autopsy report of the baby, on which the father’s conviction had been originally based.
Since that time Dr. Buttram has reviewed medical records and written medical reports on well over one hundred cases and testified in court for the defense on approximately one third of the cases, involving all areas of the continental USA except the Southwest. At least one-third of these cases were done pro bono (at no charge), realizing that many families were being devastated financially as well as socially.
Occasionally in court prosecutors asked Dr. Buttram if he had ever testified in these cases for the prosecution. He always answered “no” for two reasons: First, he had never been asked by a prosecutor to testify for the prosecution, and second, he had never reviewed a case in which he felt that the traditional legal principle, “Considered Innocent until Proven Guilty,” was thoroughly and professionally implemented by hospital physicians. In other words, he had never seen a case in which hospital physicians thoroughly tested for and ruled out plausible medical causes of the findings before assuming accusatory-type diagnoses such as Non-Accidental Trauma, Shaken Baby Syndrome, or most direct of all, Homicide. Very commonly the accusatory diagnoses are assumed in the hospital emergency rooms with findings of brain and retinal hemorrhages (these two are usually found together) and/or multiple fractures without any serious attempt to test for plausible medical causes of the findings, which are almost always present in these cases. Based on these observations it would appear that the governing practice today is a perversion and/or reversal of the traditional “Considered Innocent until Proven Guilty.”
Epidemiologic and Medical Research Studies Implicating Vaccines in a Variety of Medical Complications Including Subdural Brain Hemorrhages, and Sudden Infant Death Syndrome:
I. Vaccines and Subdural (Brain) Hemorrhages.
The best evidence to date on this issue comes from the observations of ophthalmologist Horace Gardner who, based on an article from a Japanese neurosurgeon reporting that clusters of nontraumatic brain hemorrhages tended to occur around ages 7 to 10 months in Japan , Gardner astutely noted that there was a distinct age difference between nontraumatic brain hemorrhages in Japan and in the United States of America, where most nontraumatic brain hemorrhages tend to occur during the first six months of life.
The explanation, according to Dr. Gardner, was that Japanese do not begin their childhood vaccine programs until seven months, whereas in the United States they are administered during the first six months, starting within 24 hours of birth with the Hepatitis B vaccine . In essence these observations can potentially be transformed into a gargantuan epidemiologic study involving the childhood populations of Japan and the United States that, by present indications, could prove with certainty that vaccines are the primary cause of subdural hemorrhages now being misdiagnosed as SBS, NAI, etc.
 Aoki N, Massuzawa H. Infantie acute subdural hemotoma. Clinical analysis of 26 cases. J of Neurosurg. 1984:61:273-280.
 Gardner, H.B. Retinal and subdural hemorrhages – Aoki revisited. Brit J Opththal.
II. Vaccines and Sudden Infant Death Syndrome
Study Shows Link between Numbers of Vaccines Administered and Infant Mortality Rates (IMRs).
The study entitled Infant mortality rates regressed against number of vaccine doses routinely given. Is there a biochemical or synergistic toxicity? was conducted by Neil Z. Miller and Gary S. Goldman and published in the peer reviewed Human and Experimental Toxicology Journal, which is indexed by the Nat’l Library of Medicine.
[Miller NZ and Goldman GS, Infant mortality rates regressed against the number of vaccine doses routinely given: Is there a biochemical or synergistic toxicity? Human and Experimental Toxicology, May 4, 2011, http://www.prisonplanet.com/new-study-finds-direct-link-between-vaccines-and-infant-mortality.]
This shocking new study published in a prestigious medical journal found a direct statistical link between higher vaccine doses and infant mortality rates in the developed world, suggesting that the increasing number of inoculations being forced upon children by medical authorities, particularly in the United States which administers the highest number of vaccines and also has the highest number of infant deaths is, in fact, having a detrimental impact on health.
III. Pourcyrous Study Indicates a Direct Link between Vaccines, Brain inflammation, and Brain Swelling.
The Pourcyrous Study: a Major Landmark in Medical History, Journal of Pediatrics, 2009; 151: 167-172.
A study on primary immunization of 239 premature infants with gestational ages of less than 35 weeks was conducted to determine the incidence of cardio-respiratory events and abnormal C-Reaction Protein (CRP) elevations associated with administration of a single vaccine or multiple vaccines simultaneously at or about two months of age. (CRP is a standard blood test indicator for body inflammation, which in the present study would represent brain inflammation.) CRP levels and cardio-respiratory manifestations were monitored for three days following immunizations in a neonatal intensive care unit sponsored by the University of Tennessee. Elevations of CRP levels occurred in 70 percent of the infants administered single vaccines and in 85 percent of those administered multiple vaccines, 43 percent of which reached abnormal levels. Overall, 16 percent of infants had potentially lethal vaccine-associated cardio-respiratory events with episodes of apnea (cessation of breathing) and/or bradycardia (abnormal slowing of the pulse). Intraventricular (brain) hemorrhages occurred in 17 percent of those receiving single vaccines and in 24 percent of those receiving multiple vaccines. Multiple vaccines were significantly associated with gastroesophageal reflux.
Although preliminary in nature, the Pourcyrous study is the first of its kind in that it provides evidence for a unified theory of vaccine reactions:
Brain inflammation, as indicated by elevations of C reactive proteins.
Brain edema, which can be assumed as one of the cardinal manifestations of inflammation.
Potentially lethal cardiorespiratory events.
Intraventricular brain hemorrhages.
Sir William Osler and the Differential Diagnosis
Sir William Osler (1849-1919), whose work was associated with McGill University, Johns Hopkins School of Medicine, Johns Hopkins Hospital, University of Pennsylvania, and University of Oxford, is generally considered to be the father of internal medicine, and the art of medical diagnosis. The medical art of disease diagnosis evolved from Osler’s groundbreaking work and has become the mainstay of medical practice.
As the principles of medical diagnosis have evolved over the years, they have become very similar to police work in which, first, there is a gathering of a list of suspects and, next, performance of appropriate tests and examinations to exonerate the innocent and identify the guilty party or parties. In civilized societies, at least in principle if not in practice, it is just as important to exonerate the innocent, as it is to identify and convict the guilty.
Differential Diagnosis of Multiple Fractures in Infants and Children
As reported by the C. Jenny Committee on Child Abuse and Neglect in “Evaluating infants and young children with multiple fractures,” (Pediatrics, 2006; Sept; 118(2): 1299-1333), a differential diagnosis of multiple fractures in children should include the following list with appropriate evaluation of each, according to currently medical standards. Anything less should be considered substandard medical practice:
Preterm births (osteopenia of prematurity)
Rickets from vitamin D deficiency
Copper deficiency (rare)
Disuse demineralization from paralysis
Other rare conditions (e.g. Menkes Syndrome)
Pittsburgh Study of Vitamin D Deficiency Prevalence Bodnar, Lisa M. et al, High Prevalence of Vitamin D Insufficiency in Black and White Pregnant Women Residing in the Northern United States and their Neonates, Journal of Nutrition, 2007; 137: 447-452.
Serum 25-hydroxy vitamin D (25(OH)D) was measured at 4-21 weeks gestation and pre-delivery in 200 white and 200 black pregnant women and in cord blood of their neonates. Over 90 percent of women used prenatal vitamins. Women and Neonates were classified as vitamin D deficient (25(OH)D)<37.5 nmol/LI, insufficient (25(OH)D) 37.5 -80 nmol/LI, or sufficient (25(OH)D > 80 nmol/L). At delivery vitamin D deficiency and insufficiency occurred in 29.2 percent and 54.1 percent of black women and 45.6 percent and 46.8 percent black neonates respectively. Five percent and 42.1 percent of white women and 9.7 percent and 56.4 percent of white neonates were vitamin D deficient and insufficient respectively. Results were similar at <22-week gestation… These results suggest that black and white pregnant women and neonates residing in the northern US were at high risk for vitamin D insufficiency, even when mothers are compliant with prenatal vitamins.
Recommended Blood Tests and Supplements for Rickets:
Alkaline phosphatase (tends to become abnormal in liver and bone disease)
Parathormone (Produced in the parathyroid glands; it promotes calcium absorption from the intestinal tract and regulates calcium blood levels.)
25 hydroxy (OH) vitamin D.
Plasma ascorbate (vitamin (C).
Note: The mother should also have these blood tests for medical reasons to ascertain and/or indicate cause and effect.
It is likely that many cases of fractures from metabolic disease are being missed in hospitals for the following reason: In the early phases of metabolic bone disease x-ray studies are of limited value since there must be at least a 30-40 percent loss of bone
density (calcification) before there is any detectable reduction of whiteness on the films, which is also a level of bone loss at which there is increased risk of fractures taking place from ordinary handling.
[Lachman E. Osteoporosis: The potentialities and limitations of its
roentgenological diagnosis, Amer J Roentg,1955; 74:712-715.]
[Greer FR, Determination of radial bone mineral content in low birth weight infants by photon absorptiometry, Journal of Pediatrics, 1988; 113: 213-219.]
[Mazess RB et al, Does bone measurement of the radius indicate skeletal status? Journal of Nuclear Medicine, 1984; 25:281.]
Differentiating metabolic fractures from Traumatic Fractures
One of the defining differences between traumatic fractures and those of metabolic origin is a prevalence of shearing, severance, and/or major dislocations in fractures of traumatic origin as compared with their absence or rarity in those of metabolic origin. This is based on a report by Garcia et al (Rib fractures in children, a marker for severe trauma,
(Journal of Trauma, 1990; 30(6):695-700) which reported on a series of 33 children brought into a trauma center with rib fractures, all brought about by blunt trauma, 70 percent from auto accidents, 21.2 percent from child abuse, and 9.1 percent from falls. Mortality was 42 percent. 72 percent of children with three rib fractures had internal chest injuries. With four or more rib fractures, internal chest injuries were 100 percent.
A second defining difference is the absence of pain and discomfort in metabolic fractures. Traumatic fractures in contrast are almost always extremely painful. This is because there are no pain fibers in bone, while the surrounding connective tissues are
abundantly supplied with pain fibers. In metabolic fractures, which can take place spontaneously or with ordinary infant handling, surrounding connective tissue is seldom involved. In traumatic fractures, surrounding connective tissues are almost always torn
to a greater or lesser extent, which can be very painful. In my own experience in reviewing cases, even with 15 or 20 fractures from metabolic causes, there had been little if any indication of discomfort so that fractures were not discovered until x-rays were taken for other purposes.
Differential Diagnosis of Brain and Retinal Hemorrhages
and of Spontaneous Bruising in Infants:
Hemophilia and other rare hereditary conditions.
Late-form hemorrhagic disease of the newborn due to vitamin K deficiency is probably very common in children but seldom specifically tested with the PIVKA test (Proteins in Vitamin K Absence). Risk factors include prematurity, being small for gestational age, traumatic delivery, and antibiotic therapy during neonatal period. Antiobiotics kill out beneficial intestinal flora necessary for endogenous production of vitamin K.
[Rutty GN et al, Late-form Hemorrhagic Disease of the Newborn, American Journ Forensic Med and Path, 1999; 20(1):48-51.]
[Innis, Michael D, Vitamin K Deficiency Disease, White Dove Court, Wurtulla, Queensland, Australia, 4575; firstname.lastname@example.org.]
Classical scurvy from vitamin C deficiency.
Classical Scurvy (Vitamin C Deficiency)
Vitamin C deficiency is probably a fairly common contributory factor in bruises and other medical complications (with the exception of brain hemorrhages, which were not described in classical scurvy, but in my years of involvement in SBS cases I have found only one case in which vitamin C blood level was tested.
[Clemetson, CAB, Vitamin C, Volumes I, II, and III, CRC Press,
Boca Raton, 1989.]
Short Distance Falls vs Shaken Baby Syndrome
Biomechanics is a scientific specialty that evolved as a research wing of the U.S. Highway Department to research whiplash-type injuries from auto accidents and to advise on protective safety devices to prevent such injuries. In recent years they have also become involved in shaken baby syndrome research, since the biodynamics are identical. As the one and only experts in the field of biodynamics, it is well established by biomechanical researchers that
Short distance falls can be lethal.
That humans can generate only a small fraction of force required to cause head injury by shaking alone.
That if the supposed violent shaking were actually taking place, it would be nearly 100 percent fatal from structural neck injury, which has a much lower threshold of injury than the head. Yet, structural neck injury is rarely found in cases attributed to shaken baby syndrome.
Note: This issue is reviewed in the book, Shaken Baby Syndrome or Vaccine-Induced Encephalitis? by Harold E Buttram, MD, available on Amazon.
Cardiopulmonary resuscitation (CPR) injuries have been well described in the medical literature and have the potential of being mistaken for signs of inflicted child abuse.
[Kaplan, JA and Fossum, RM, Patterns of Resuscitation Injury in Infancy. American Journ Forensic Med and Path, 1994; 15(3):187-191.]
[Plunkett, John, Resuscitation Injuries Complicating the Interpretation of Premortem Trauma and Natural Disease in Children, Journal of Forensic Science, 2006; 51(1): available online at: www.blackwell-synergy.com.]
Recommended Initial Evaluation and Laboratory Tests for Brain and Retinal Hemorrhages and Spontaneous Bruising in Children
Complete blood count with platelets
Blood chemistries and liver function tests
Prothrombin and Partial thromboplastin times (Routine screening tests for hemorrhagic disorders.)
PIVKA blood test (Proteins in Vitamin K Absence, a specific test for late-form hemorrhagic disease of the newborn.)
Plasma ascorbate (vitamin C)
If any of the above-tests are abnormal, a hematology consult should be requested.
The general pattern of precipitous diagnoses of shaken baby syndrome/shaken impact/non-accidental trauma in hospital emergency rooms in children with findings of brain hemorrhages, retinal hemorrhages, bruises, and/or multiple fractures, without first performing adequate tests to rule out plausible medical causes, must be considered substandard and unacceptable medical practice. The courts can no longer overlook these deficiencies. Furthermore, there is a forensic need for objective investigation by qualified medical professionals together with attorneys-at-law who are zealous and protective of medical ethics and criminal law as applied to misdiagnosed shaken baby syndrome and non-accidental trauma cases.
Abstracts of Medical-Legal Case Reports
Shaken Baby Syndrome and/or Non-Accidental Trauma
People v. Joseph McElheny, Indictment # 10-1057 Regarding Death of Ina McElheny from Multiple Fractures and Intestinal Intussusception,
the Latter being Complicated by Small Bowel Perforation.
(Attorney permission granted)
Following the death of Ina McElheny soon after hospitalization with findings of multiple fractures and an intestinal perforation, the pathologist diagnosed “homicide” based in large part on the multiple fractures without examining the birth records, which involved an extremely traumatic birth. Also, based on Dr. Buttram’s phone call to the mother, Dr. Buttram learned that her diet was grossly deficient in dairy products (the primary dietary sources of vitamin D) during the last trimester of her pregnancy, and that Ina’s birth was traumatic due to the baby’s large size (10 lbs and 8 oz birth weight) and in a facial presentation, one of the most difficult positions for delivery, which did require use of forceps for delivery. With a traumatic delivery and the plausible presence of intrauterine rickets, it is highly probable that the original rib fractures occurred from birth trauma. Based on hospital records, neither the pathologist nor hospital physicians had considered these possibilities, checked on the mother’s diet during pregnancy, or ordered appropriate blood tests for rickets, which could have been but were not done, following the baby’s terminal hospital admission. The intestinal perforation in turn occurred within days of the baby’s receiving the Rotavirus vaccine, which are well known to be a major complication of the Rotavirus vaccine. The symptomatic progression in the patient was compatible with an acute intestinal obstruction from intussusception, which, in turn, was complicated by an intestinal perforation, following which the patient rapidly deteriorated and died. In view of these negligences of hospital physicians, there can be no reasonable grounds for the charge of “homicide” registered against the father.
After prolonged deliberation in the court case, the jury dismissed all charges against the father except a minor misdemeanor.
Regarding the Case of Isanna Candelario, DOB 3/23/11
State of New Jersey
Department of Children and Families:
NOTICE OF EMERGENCY REMOVAL PURSUANT TO
N.J.S.A. 9.6-8.29 and 9:8:30
WITHOUT COURT ORDER
TO: Isaac and Jennifer Candelario.
This is official notice that DYFS HAS REMOVED
Isanna Candelario and Jenissa Candelerio (Names of Children).
Current Status on October 10, 2011:
Children remain in custodial care.
(Parental Permission granted –attorney not yet assigned)
Very similar to the patterns of Case I, Dr. Buttram learned from a phone call with Isanna’s mother that her intake of dietary sources of vitamin D were negligible due to her intense and prolonged morning sickness during her pregnancy with Isanna. Prenatal vitamins were discontinued on advice of her obstetrician, as they seemed to worsen nausea and vomiting; nor was there any significant exposure to sunlight as an alternate source of vitamin D. The baby was born on 11/23/10 by a planned C-section. Birth weight was 7 lbs and 6 oz. The baby was primarily breast-fed and supplemented with Similac formula. On 2/1/11 at 3 ¾ months age, Isanna’s older sister, Jenissa, stumbled and fell on Isanna while walking along the edge of a couch where Isanna was also lying, resulting in a head-to-head impact resulting in a bluish-colored bruise on the bridge of Isanna’s nose, and a purple-red discoloration of her eyelids. Isanna appeared dazed, but she remained awake and otherwise appeared to be normal. Isanna was taken to her pediatrician following the accident, who did not have any concerns of abuse or neglect. The DTaP and Hib vaccines were administered during the same 2/1/11 visit. On 3/10/11, 38 days after her sister’s accidental fall, Isanna was again taken to her pediatrician with a bulging anterior fontanelle. Isanna’s head circumference had increased 6 centimeters in the previous 6 weeks. A head CT scan on 3/14/11 and brain MRI on 3/31/11 reported findings of chronic subdural hematomas, after which the patient was admitted to the ICU of Hackensack University Medical Center, where a skeletal survey revealed three lateral rib fractures, a posterior rib fracture, and bilateral mid-clavicular fractures. An ophthalmologic eye examination revealed bilateral retinal hemorrhages, all of which were attributed to “Non-Accidental Trauma.” Blood tests included Hgb of 9.9, elevated platelets, mildly abnormal liver ALT function test of 132 (6-50). Alkaline phosphatase was normal at 235, calcium high normal at 9.5 (8.7-9.8). The prothrombin and partial thromboplastin times were normal, as were other bleeding studies. The 25 hydroxy vitamin D blood test was deficient at 25.9 (32–100.8). The parathormone blood test, which tends to be elevated in rickets, was not done.
In summary, this case again illustrates a dark proneness of hospital physicians to precipitously bring charges of inflicted child abuse when the history of the mother’s negligible dietary sources of vitamin D during Isanna’s pregnancy, along with her prolonged morning sickness, would predictably lead to clinical vitamin D deficiency and other nutritional deficiencies resulting in Isanna’s increased vulnerability to fractures. Although Isanna would have received some vitamin D from her Similac formula, her 25-hydroxy vitamin D level was still below normal at time of her hospitalization. The history, physical findings, radiology and laboratory reports, are entirely compatible with intrauterine vitamin D deficiency leaving the baby’s ribs vulnerable to rib fractures from birth trauma and/or the accidental fall of Isanna’s sister as well as the brain hemorrhages from their head-to-head impact.
(This case concerned the death of Rouqaya M. Alrubea from brain hemorrhages, attributed by hospital physicians to “probable nonaccidental trauma,” even though screening blood tests were diagnostic of a hemorrhagic disorder, which was never adequately evaluated or treated by hospital physicians.
(Parental and attorney permission granted)
As recorded in the discharge summary, the discharge diagnoses were:
Head trauma with intracranial bleed.
Probable non-accidental trauma.
On physical examination the patient was described as being intubated. The pupils were equal and sluggish. Neck was in a C-collar. There were no injuries to the head or neck. Bilateral rhonchi were present in the lungs. The abdomen was soft and non-tender. Genitalia and rectal exam were negative. Extremities were normal. There were no bruises, abrasions or other signs of trauma other than those incidental to emergency medical care.
Prothrombin times were performed two times on following hospital admission and once a day later with consistently elevated levels of 16.2, 14.6 and 14.4 (Normal ranges 9.1-11.9) with elevated INRs of 1.40, 1.55, and 1.38 (normal ranges 0.87-1.13).
(COMMENT: In Dr. Buttram’s ten-plus years of reviewing alleged inflicted head trauma cases, which now number well over 100, when elevations of prothrombin and/or partial thrombopastin times were found, in most instances there was further hospital investigations and testing for hemorrhagic diseases, which were not pursued in the present case. It is true that the patient was known to be terminal at the time, and from this standpoint further diagnostic pursuit would have been useless.
However, from a standpoint of criminal investigation, this negligence could be tragic in terms of erroneous diagnosis of inflicted trauma when the true source or sources of brain hemorrhage arose from medical causes. From this standpoint a hematology consultation should have been requested, who would have pursued further diagnostic evaluation. Failure to do this, in my opinion, can justly be considered as medical negligence. One test that should have been performed is the PIVKA test (proteins in vitamin K absence), a specific diagnostic test for late-form hemorrhagic disease of the newborn (late-form HDN) from vitamin K deficiency. By way of explanation, vitamin K is essential for liver production of clotting factors VII, IX, and X, deficiencies of which may result in hemorrhagic disease with a special proneness for brain hemorrhages. Risk factor for late-onset HDN include repeated courses of antibiotics, which the patient had had, as antibiotics tend to kill off intestinal flora that are essential for intestinal production of Vitamin K, one of the body’s primary sources of vitamin K under normal circumstances.
Terminal blood tests also showed abnormal elevations of the liver function tests, almost certainly the result of the patient’s heavy vaccine program without any modification for her prematurity, based on the frequency in which vaccine-induced liver enzyme elevations following are reported to the Vaccine Adverse Event Reporting System (VAERS). The compromised liver function, in turn, along with plausible vitamin K deficiency, would have been a contributory cause of the hemorrhagic disorder.
Medical Report on Amanda Sadowski, Born February 16, 2007,
Died June 30, 2007.
State of Ohio v. Sadowsky, Cuy.Ciy. Case No. 499457
(Permission granted by parents)
The history of the present case can be briefly summarized in that the Japanese father of Amanda Sadowsky suffered from a poorly understood cerebral arterial occlusive disease referred to as Moyamoya Disease, involving large intracranial arteries, especially the distal internal carotid artery and the stem of the middle and anterior cerebral arteries, which are prone to develop occlusive complications. Sufferers of this condition tend to develop physical clumsiness. Vascular inflammation is absent. The disease occurs mainly in Asian children and young adults, in which physical clumsiness often takes place. Vera Scheibner, Ph.D. wrote about this and other similar diseases in Medical Veritas (Vol. 6, 2009; 1992-2011) attributing these complications to adverse childhood vaccine reactions, which is probably correct, since the disease was little, if any, known until vaccine programs were introduced.
Although a devoted father, the baby died after an accidental four-foot, headfirst fall from the father’s hands resulting in the baby’s death. The primary technical interest in the case comes from the work of a scientific (PhD) specialty known as bioengineers, which has evolved over a period of many decades as a valued research wing of the U.S. Highway Department to research the biodynamics of whiplash injuries from auto accidents. Since the biodynamics of the so-called shaken baby syndrome would be identical with those of automobile accident whiplash injuries, beginning with the Duhaime publication in 1987, bioengineers (sometimes in teams with M.D.s) have conducted a series of sophisticated studies demonstrating that humans cannot generate more than a small fraction of force necessary to cause head injury by shaking alone but that, if such shaking were actually taking place, it would almost universally result in death or paraplegia from structural neck injury, as the neck has a far lower threshold of injury than the head.(1-8)
The primary interest of this case rests in the fact that, with a plausible accidental explanation for the baby’s fatal head injury, never seriously considered either by hospital physicians or our legal system, this case is a classical representation of today’s perversions of the traditional legal doctrine: Considered Innocent until Proven Guilty in our court system.
This case involved hospital findings of infant subdural (brain) and retinal hemorrhages which were attributed to parental abuse in the form of “non-accidental trauma,” but which, in fact, were almost certainly secondary to a hemorrhagic disorder referred to as Late-Form Hemorrhagic Disease of the Newborn,” diagnosis of which was never considered nor properly evaluated by hospital physicians. (Since full approval could not be obtained, all identifications have been removed.)
Abstract: This baby was born at gestational age of 28 weeks. Her birth weight was 3.8 lbs. She subsequently required seven weeks of hospital care in the hospital NICU unit for multiple complications including respiratory distress, apnea, bradycardia, septicemia, anemia, jaundice, retinopathy of prematurity, and hearing loss. She was treated with antibiotics, antifungal medications, and theophylline drops for ongoing respiratory distress. Complications included diarrhea (almost certainly associated with intestinal fungal overgrowth secondary to antibiotic therapy), weight loss, and abnormal hearing and visual examinations.
Multiple vaccines were administered in the usual time schedules without making allowances for the baby’s extreme prematurity and compromised health. The patient remained fragile and intermittently ill for her two months of life, during which she received repeated courses of antibiotics, often complicated by diarrhea and weight loss.
The patient was hospitalized for pneumonia for two consecutive periods plus vomiting and dehydration. Further examinations during the latter hospitalization revealed subdural and retinal hemorrhages, which were attributed to “non-accidental trauma.” Coagulation studies during the latter hospitalization included significant prolongations of the prothrombin time and the partial thromboplastin time. However, these abnormal bleeding tests did not have the follow up testing that they should have had in the form of the PIVKA test (proteins in the absence of vitamin K), which is specifically diagnostic of vitamin K deficiency, the underlying cause of “Late-form hemorrhagic disease of the newborn,” (HDN) something that is probably very common but, in Dr. Buttram’s experience, rarely tested. The PIVKA test should be routine and mandatory following findings of abnormally elevated prothrombin and partial thromboplastin times, the standard screening tests for coagulation disorders.
If the PIVKA test had been done, or alternately, if a therapeutic trial of vitamin K injections had been instituted, the baby’s hemorrhagic disorder would have been rapidly corrected instead of the continuing brain hemorrhaging, which did take place during hospitalization.
Late-form HDN may be associated with up to 100 percent intracranial hemorrhages. Risk factors include prematurity, being small for gestational age, birth asphyxia, traumatic delivery, and antibiotic therapy, which eradicates beneficial intestinal microorganisms that are necessary for endogenous production of multiple nutrients including vitamin K.
From a standpoint of criminal investigation, this negligence could be tragic in terms of erroneous diagnosis of inflicted trauma when the true source or sources of brain hemorrhage arose from medical causes. From this standpoint a hematology consultation should have been requested, that would have pursued diagnostic evaluation further. Failure to do this, in Dr. Buttram’s opinion, justly can be considered as medical negligence. Among others, one test that should have been performed is the PIVKA test (proteins in vitamin K absence), a specific diagnostic test for late-form hemorrhagic disease of the newborn (late-form HDN) from vitamin K deficiency. By way of explanation, vitamin K is essential for liver production of clotting factors VII, IX, and X, deficiencies, which may result in hemorrhagic disease with a special proneness to brain hemorrhages. Risk factor for late-onset HDN include repeated courses antibiotics, which the infant had had, as antibiotics tend to kill off intestinal flora that are essential for intestinal production of Vitamin K, one of the body’s primary sources of vitamin K under normal circumstances.
Terminal blood tests also showed abnormal elevations of the liver function tests. In Dr. Buttram’s opinion these abnormal liver function tests were almost certainly the result of the patient’s heavy vaccine program without any modification for her prematurity, based on the frequency in which liver enzyme elevations following vaccines are reported to the Vaccine Adverse Event Reporting System (VAERS). The compromised liver function, in turn, would have contributed to the abnormally prolonged prothrombin times.
(1) Duhaime A-C, Gennarelli TA, Thibault LE, Bruce DA, Margulies SS, Wiser R. The shaken baby syndrome: a clinical, pathological and biomechanical study. J Neurosurgery. 1987; 66:409-15.
(2) Prange MT, Coats B, Raghupathi R, et al. Rotational loads during inflicted and accidental infant head injury. J Neurosurgery. 2001; Abst. D8; 18:1142.
(3) Ommaya AK, Goldsmith W, Thibault LE. Biomechanics and neuropathology of adult and paediatric head injury. British J Neurosurgery. 2002; 16:220-42.
(4) Prange MT, Coats B, Duhamie A-C, Margulies SS. Ahthropomorphic simulations of falls, shakes, and inflicted impacts in infants. J Neurosurgery. 2003; 99: 143-50.
(5) Goldsmith W, Plunkett J. A biomechanical analysis of the causes of traumatic brain injury in infants and children. American J Forensic Med & Path. 2004; 25:89-100.
(6) Bandak, FA. Shaken baby syndrome: a biomechanics analysis of injury mechanisms. Forensic Science Int. 2005; 151151:71-79.
(7) Prange MT, Newberry W, Moore T, Peterson D, Smyth B, Corrigan C. Inertial neck injuries in children involved in frontal collisions. SAE 2007 World Congress; Warrendale, PA; Society of Automotive Engineers; SAE paper #2007011170.
(8) Monson K, Sparrey C, Cheng L, Van Ee C, Manley G. Head exposure levels in pediatric falls. NNS 2007; abstract.