Report on Ma’Laya Wimmer
Date of birth July 1st 2002
First Hospital admission
Ma’Laya (Malaya) was the surviving twin of a Twin to Twin Transfusion Syndrome
Pregnancy of 30 weeks gestation. Labour was induced and the infant weighed
2 lb 14 oz (1.323 kg). Following delivery the child was admitted to the Neonatal
Intensive Care Unit because of 1. Prematurity, 2.Possible Sepsis and 3 Respiratory
Distresses.
Intubated in DR for Apnea and extubated later that day.
An ECG suggested mild pulmonic valve stenosis and a small Ventricular Septal
Defect. Therapy consisted of Ampicillin and GENTAMICIN (6 mg IV q 48 h for
3 days).
Hyperbilirubinemia was recorded on 7/04/02 and resolved following phototherapy.
The Hematocrit level was 22% on 7/8/02. Blood transfusions given on 7/13/02
and 7/29/02 and Hematocrit increased to 24%
On 7/13/02 Necrotizing Enterocolitis was suspected and Vancomycin administered
for 6 days, Cefitaxime for 10 days and Midazolam was also administered.
Immunizations at 8 weeks.
1, Hepatitus B on 8/28/2002
2. HiB on 8/30/02
3. DTaP on 8/30/02
4. IPV on 8/31/02
Respiratory support
1. With ventilator from 07/01/02 to 07/02/02
2. Nasal cannula from 07/02/02 to 07/04/02 and from 07/29/02
to 08/07/02
Discharged 09/03/02 at the age of 8 weeks.
An Apnea monitor was needed because of Apnea events witnessed by grandparents
who observed a change in colour around the mouth...
Second Hospital Admission
On 9/20/02 seen at Pediatric Consult for
1. Choking episodes and vomiting following feeds
2. Lips turning blue or black on a few occasions
3. Diminished oral intake
Admitted to CRCH/Peds for GERD. One episode of Apnea noted with brief “desat”
and spontaneous recovery. Patient discharged 9/20/02
11/01/02 Well Visit – 4 months
No abnormality was noted with the infant’s ability to roll over, push
up on elbows/hands, reach for objects, squeal/laugh, track with eyes, hear
and see. No abnormality was noted on physical examination
Immunizations at 12 weeks on 11/01/02
1. DTaP
2. HiB
3. IPV
4. Prevnar.
The infant was more irritable and off it’s food that day following the immunizations
and on the night of the 11/01/02 the mother heard the child cry and there
were frequent monitor alarms.
At 05:09 and 15 seconds on November 2, 2002 the alarm sounded and indicated
an event lasting 27minutes and 24 seconds. During this continuous situation
the heart rate went as low as 45 beats per minute and there were several
episodes of apnea, or cessation of breathing. The first apnea lasted for
48 seconds and the second lasted 21 seconds.
A characteristic pattern of breathing was identified on the E-gram seen when
the baby is grunting on exhalation and is associated with low levels of Oxygen.
The irritability continued throughout Saturday when the child was less active
and did not take as much formula. The mother noticed some twitching/jerks
and brought her for examination on Sunday morning. 11/03/02 but the doctor
did not feel any clear acute process was present.
Later that same day the mother presented to the emergency room with the child
in sustained seizure activity which was difficult to control.
Investigations
1. CT Scan demonstrated some prominence of the frontal
CSF spaces but no acute hemorrhage.
2. Lumbar puncture showed 150 red cells
3. Diffuse Retinal Hemorrhages were seen in the right eye.
Over the next 24 to 48 hours the seizures continued, the mental status of
the child altered she developed a high pitched cry and poor muscle tone.
At this point the diagnosis of shaken baby syndrome was made. Child protection
services were consulted and investigations carried out.
COMMENT.
Vitamin K Deficiency Bleeding and Hypoxic Brain Damage
following an Apparent Life Threatening Event explains all the signs
and symptoms observed in this child. The evidence for Shaken Baby Syndrome
is flawed. The accusers have ignored or misinterpreted the signs and
symptoms they observed and those reported by the mother.
1. The liver is the chief source of manufacture of the
blood clotting factors. It is a well known fact that premature birth predisposes
to immaturity of the liver and hence inadequacy of some blood clotting factors.
[1]. This would leave the child vulnerable to bleeding from any site in the
body - the brain and retina being no exception.
2. The American Academy of Pediatrics [2] recommends that
all new born children receive Vitamin K within hours of birth. The record
does not specifically mention Vitamin K was administered to this child. Vitamin
K at birth prevents the condition known as Vitamin K Deficiency Bleeding
(VKDB) [3]. VDBK is a major cause of bleeding in the first six months of
life
3. The administration of antibiotics destroys the normal
intestinal bacteria which is one source of Vitamin K for the infant in this
case the antibiotics caused Entero-colitis and undoubtedly destroyed this
source of the Vitamin and thereby aiding the final outcome.
4. Having been deprived of these protective measures is
one reason why this child had an intracranial bleed and bled into the retina.
Isarangkura and Chuansumrit found a high level of intracranial bleeding resulting
from insufficiency of Vitamin K dependent factors [4]
5. On 9/20/02 the mother noticed the child suffered from
choking episodes and turned blue which alarmed her and she sought medical
advice. This event is significant and was diagnosed as GERD (Reflux disease
for short). GERD is a known cause of ‘Apparent Life Threatening Event’ [5]
[which in turn may result in Intracranial bleeding by producing hypoxia (defective
oxygenation of the brain)
6. At her 4 month Well Check the child appeared to be perfectly
healthy and was vaccinated with 4 vaccines. Within hours of these vaccinations
the mother noticed the child was listless, irritable and off its feeds. That
night the mother also heard the child cry which was unusual. Vaccination
with DTaP vaccine is known to have adverse reaction in some children [6]
and has been known to cause death [7].
7. On the morning of November 2nd the Apnea alarm indicated
two periods of cessation of breathing lasting 48 and 27 seconds
respectively. Any period of
Apnea lasting more than 20 seconds provokes an ‘Apparent
Life Threatening Event’. As I have mentioned above
Apnea of this duration causes hypoxic brain damage which
has been adequately demonstrated by Geddes et al who stated,
“In the immature brain hypoxia both alone and in combination with infection
is sufficient to activate the pathophysiological cascade which culminates
in altered vascular permeability and extravasation of blood within and under
the dura”. [8]
8. There are thus two good reasons for considering a NATURAL
CAUSE for the signs and symptoms found in this child.
a. Possible Vitamin K deficiency from failure to give the
child an injection of Vitamin K at birth and secondly from administering
antibiotics which destroyed the intestinal bacteria needed as a source of
Vitamin K.
b. Hypoxic brain damage following two significant periods
of Apnea recorded on the Apnea Monitor.
Response to Dr Craft and Dr Tomez
Both these doctors stated “something forceful was done
to the infant on 11-2-02 from about 5am to 5:30am.”
They are mis-interpreting the two periods of Apnea, registered on the monitor
at these times, which resulted in the HYPOXIC BRAIN DAMAGE.
They appear to regard the Apnea Monitor Alarm and consequent Cerebral Hypoxia
as some sort of physical abuse by a perpetrator. Such an interpretation
is manifestly false.
Response to Dr Patterson.
Regarding the vaccines given to the child some hours before
the mother noticed the child was irritable, off its feeds and “jumping” Dr
Patterson states, “vaccines are medications, and there is always a risk,
however slight, of a reaction to the vaccines.”
What Dr Patterson does not say is that VACCINES HAVE BEEN
KNOWN TO CAUSE DEATH IN SOME CHILDREN [7].
With regard to the retinal hemorrhages he quotes the Nelson Textbook of Pediatrics
as stating it is “commonly associated with acceleration-deceleration injury”.
The acceleration-deceleration hypothesis is just that – a hypothesis. Science
requires Hypotheses to be Demonstrated before they are accepted as Fact.
No such demonstration has been made in regard to the ‘acceleration-deceleration’
hypothesis and it therefore remains in the realm of the unsubstantiated and
cannot have any legitimacy as a scientific fact.
Conclusion
All the evidence points to this child having a deficiency of the clotting
mechanism and a superimposed Hypoxic episode which resulted in Intracerebral
pathological changes and Retinal hemorrhages.
Michael D. Innis MBBS; DTM&H; FRCPA; FRCPath
Honorary Consultant Haematologist
Princess Alexandra Hospital
Brisbane
Australia
References:
1. Williams WJ; Beurler E; Erslev AJ; Lichtman MA. HEMATOLOGY
Fourth Edition page 1285
2. American Academy of Pediatrics: American Academy of
Pediatrics Vitamin K Ad Hoc Task Force: Controversies
concerning vitamin K and the
newborn. Pediatrics 1993 May; 91(5): 1001-3[Medline].
3. Zipursky A. Vitamin K at birth BMJ (1966) 313:179-180
4. Isarangkura P, Chuansumrit A. Vitamin K Deficiency in
Infants. IX th Congress of the International Society of Haematology
Asian Pacific Division 1999 http:// haem.nus.edu.sg/ishpd/1999/43.pdf
5. Discovery Health – Apparent Life Threatening Event and
GERD (Google search)
6. Lewis K, Jordan SC, Cherry JD, Sakai RS, Le CT. Petechiae and urticaria
after DPT vaccination: detection of immune complexes containing vaccine
specific antigens. J Pediatr 1986:109; 1009-12
7 W. C. Torch, "Diphtheria-pertussis-tetanus (DPT) immunization: A potential
cause of the sudden infant death syndrome (SIDS)," (Amer. Academy of Neurology,
34th Annual Meeting, Apr 25 - May 1, 1982), Neurology 32(4), pt. 2.
8 Geddes JF, Tasker RC, Hackshaw CD, Nickols CD, Adams GGW, Whitwell
HL, Scheimberg I. Dural haemorrhage in non traumatic infant deaths does it
explain the bleeding in “shaken baby syndrome” Neuropathology and Applied
Neurobiology 2003 (29) 14-22
Multiple Studies Show Increased Hazard of Vaccines
in Premature Infants
Ma'Laya's page