Friday, July 31, 2015

Shaken baby syndrome 2

Laura Elizabeth Cowley, Charlotte Bethan Morris, Sabine Ann Maguire, Daniel Mark Farewell, Alison Mary Kemp.    Validation of a Prediction Tool for Abusive Head Trauma.  Pediatrics.  Published online July 27, 2015.


BACKGROUND AND OBJECTIVES: Abusive head trauma (AHT) may be missed in the clinical setting. Clinical prediction tools are used to reduce variability in practice and inform decision-making. From a systematic review and individual patient data analysis we derived the Predicting Abusive Head Trauma (PredAHT) tool, using multilevel logistic regression to predict likelihood of AHT. This study aims to externally validate the PredAHT tool.

METHODS: Consecutive children aged <36 months admitted with an intracranial injury, confirmed as abusive or nonabusive, to 2 sites used in the original model were ascertained. Details of 6 influential features were recorded (retinal hemorrhage, rib and long -bone fractures, apnea, seizures, and head or neck bruising). We estimated the likelihood of an unrecorded feature being present with multiple imputation; analysis included sensitivity, specificity, and area under the curve, with 95% confidence intervals (CIs).

RESULTS: Data included 133 non-AHT cases and 65 AHT cases, 97% of children were <24 months old. Consistent with original predictions, when ≥3 features were present in a child <36 months old with intracranial injury, the estimated probability of AHT was >81.5% (95% CI, 63.3–91.8). The sensitivity of the tool was 72.3% (95% CI, 60.4–81.7), the specificity was 85.7% (95% CI, 78.8–90.7), area under the curve 0.88 (95% CI, 0.823–0.926).

CONCLUSIONS: When tested on novel data, the PredAHT tool performed well. This tool has the potential to contribute to decision-making in these challenging cases. An implementation study is needed to explore its performance and utility within the child protection process.

See:   Shaken baby syndrome 3/30/15



  1. The girl, who cannot be identified for legal reasons, suffered a fractured skull, broken leg, eye damage, bleeding and bruising during the attack almost two years ago at a flat in the Capital.

    Dunn tried desperately to lie his way out of trouble – but a jury was not convinced during what was described as “a stressful and difficult trial”.

    He insisted he had got up with the child to get her bottle and fell while holding her in his right arm as he tried to avoid a walker used by his victim’s older sister.

    He told the court: “From what I remember, at that point I tried to pull her in towards me. I knew I was going to hit the floor.

    “Immediately I thought she was OK. For the first few seconds I really thought she was OK, but very quickly after that I realised she probably was not, but I hoped.

    “I just hoped it would go away. I thought she would get better.”

    Dunn, from Wester Drylaw Place, told the child’s mother he had fallen while holding the girl, but insisted she was fine. He later sent her a message saying the baby was asleep but woke herself with hiccups.

    The baby girl was eventually taken to the Sick Kids Hospital, where it was noted that her heart rate was very high and there were signs her brain was not working properly.

    A consultant in paediatric and emergency medicine said she was taking occasional pauses in her breathing and he documented “a high-pitched scream”.

    A pattern of bruising was found above the child’s ankle which was suggestive of being caused by “gripped fingers”.

    The child’s mother told the High Court in Edinburgh: “She is a good little girl, but she has been left with very severe, lifelong disabilities.

    “She is not mobile. She is very floppy like a small baby. She will likely never stand, walk, even sit by herself.”

  2. Prosecutors allege that the child was in McCarthy’s exclusive care when the girl suffered massive brain injuries consisted with violent shaking, including extensive bleeding in her brain and the backs of her eyes.

    Specialists said she was subjected to violent force and that the injuries could not have been inflicted before that day.

    McCarthy’s lawyers have maintained her innocence, citing opinions from other specialists that the child sustained bone and compression fractures several weeks before her death, when she was traveling abroad with her family without McCarthy.

    They also say the child was sick much of her life and suffered from a bleeding disorder and gastrointestinal problems...

    The medical examiner’s decision to reconsider the case came amid doubts about the underlying science in abusive head trauma diagnoses, and followed a revised ruling last year in the death of a 6-month-old boy in Malden.

    In that case, the medical examiner’s office initially ruled that the infant died from shaking injuries to the head, but after receiving more information about the family’s medical history concluded that the manner of death could not be determined.

    A number of outside medical specialists concluded that the infant had died of natural causes.

    After the change, Middlesex prosecutors dropped murder charges against the child’s father. Under the law, the medical examiner must identify the cause of death as a homicide for a murder prosecution to occur.

  3. A babysitter severely beat a 10-week-old infant, inflicting extensive bleeding on the child’s brain and eyes. The infant, a twin girl, born on May 22, was rushed to Cleveland MetroHealth Medical Center after her mother returned home from work.

    Samaje Humphries, 21, was arrested on second-degree felony charges of felonious assault and child endangering, according to Sandusky Police, in Ohio. Humphries admitted he got frustrated with the child and roughed her up.

    When the mother returned home from work, she found the baby breathing sporadically and at times, not at all, according to Sandusky Police Detective, Jon Huffman.

    Detective Huffman briefly explained the mother’s shocking discovery.

    “The mom knew something was wrong as soon as she saw the child. She got off work, came home, and immediately realized something was not right with her baby.”

    The medical staff later informed Sandusky police that the babysitter caused hemorrhaging on the infant’s brain and behind the eyes.

    Doctors said, “The baby will most likely be blind and/or have brain damage, or could pass away from her injuries,” according to a police report.

    Initially, Humphries denied injuring the girl when he first spoke to police. Eventually, “he admitted to losing his temper and that he could have hurt the victim, but didn’t mean it,” the police report stated.

    Two older siblings said they witnessed Humphries getting rough with the baby while she was making a fuss.

    Detective Huffman commented about the dreadful incident.

    “He admitted being rough with the baby and being frustrated. Then he said he blacked out. One of the (siblings) said at one point, (Humphries) did throw the baby on the couch. This was not an ‘oops, I dropped the child’ situation — It was not accidental.”


  4. A Syracuse man accused of killing his 3-month-old boy admitted to police he shook the baby after losing control.

    Felipe Lebron, 26, tried to revive his unconscious child before calling 911, he said in a statement. Lebron was charged with manslaughter in Anthony Lebron's death in January.

    "l lost control and I know I (screwed) up," Lebron wrote in his statement. "I need to work on my patience and my control."

    Lebron said he was uncomfortable and irritated when he picked the baby up and "whipped" his head hard. The baby suffered whiplash, he said.

  5. Gasca entered an Alford plea, which allows him to maintain his innocence while acknowledging that prosecutors had enough evidence to convict him...

    Prosecutors say Gasca violently shook his daughter while alone with her in a Toppenish hotel Oct. 29, 2013. Gasca and April’s mother took the girl to Toppenish Community Hospital the same day and said she had been injured in a fall, according to a police affidavit.

    Gasca initially told hospital staffers that he had dropped her while getting ice, then he said she fell down stairs, the affidavit said.

    April was taken to Harborview Medical Center in Seattle, where doctors told police she had suffered a severe brain injury consistent with being shaken violently. She died two days later.

    The girl’s mother told police that the day of the incident, she and Gasca had fought, prompting her to leave the room so that the child was alone with him.

    She returned to find that her daughter was blue, and Gasca told her the infant had fallen off the bed, the affidavit said.

    According to the affidavit, police found blood on the bedsheets and pillowcases, and they discovered a bloody baby outfit stuffed in a pillowcase.

    Another outfit stuffed in the pillowcase appeared to have been recently washed, the affidavit said.

  6. A cornerstone of SBS prosecutions is that baby-shaking produces a unique constellation of symptoms, and that the presence of those symptoms proves that a shaking must have occurred. A wide range of pediatricians, police and child-abuse investigators have embraced this concept, the way a preacher embraces his holy book. Confronted with such certitude, it’s not unusual for suspected perpetrators to admit to a shaking of some kind, though they are often at a loss to explain how whatever they did caused such damage.

    But that doesn’t matter. Once you “confess” to shaking a child, you’re doomed. The conviction rate of caregivers accused of shaking children has been estimated at 95 percent, and a confession, no matter how improbable, seals the deal...

    The sergeant wasn’t at all satisfied with Ramirez’s story about the boy falling from his shoulders. As he would later note in an affidavit, a child-abuse expert at Children’s had informed him that Kyran’s head trauma was “more likely the result of violent shaking, an injury more commonly termed ‘Shaken Baby Syndrome.’”

    Alejo brought Ramirez in for a second interview two days later — and all but invited him to accuse Voss of harming her son. “I think that possibly there’s more to the story,” he said, “as far as you trying to cover for her. Or the injuries happened in a different way and you’re afraid to tell me.”

    Ramirez insisted he was telling the truth. Kyran fell. But he also admitted to drinking beer and smoking marijuana that morning...

    Increasingly accusatory and confrontational, he insisted that Voss must have done something to produce the injuries the doctors had observed. “You shook him, didn’t you?” he asked.

    Sleepless for four days at that point, the tearful mother eventually wrote a statement admitting that she’d had a hard time in bed with a gassy, restless Kyran the night before Ramirez arrived: “I grabbed him out of bed and shook him 2-3 times, and probably more violently than I meant to…then sang him his song and rubbed his tummy, he went back to sleep to awake later. I told Damien (woke him up) and said I needed help with the baby, that I didn’t want to hurt him.” ...

    Voss was arrested and charged with child abuse; after Kyran died in foster care seven weeks later, of causes attributed to the head injury, the charge became first-degree murder...

    She insisted that Ramirez was lying and that her “confession” was coerced nonsense, that she’d done nothing more than “jostle” her son the night before he was hurt.

    At trial, though, the relentless machinery of the SBS diagnosis held sway. A medical expert asserted that the fatal injuries were consistent with a violent shaking. Voss had admitted to shaking her child, however she tried to minimize it. The jury took only six hours to deliver its verdict: guilty of knowing and reckless child abuse resulting in death.

  7. Susan Goldsmith knew the attacks were coming. A veteran journalist who has covered child-abuse issues for The Oregonian and Los Angeles New Times (a now-defunct weekly owned by the former parent company of Westword), Goldsmith knew how deeply invested some prominent members of the American Academy of Pediatrics were in promoting Shaken Baby Syndrome. So when she and her cousin, director Meryl Goldsmith, decided to make a documentary about SBS, she braced herself for blowback.

    She didn’t have to wait long. Just before the first public screening of The Syndrome last fall at the Kansas International Film Festival, organizers received a letter from the National Center on Shaken Baby Syndrome, denouncing the documentary as a deadly contagion that required immediate quarantine.

    “We are concerned that the film contains inaccurate and misleading information…that may result in serious public health risks,” the letter states. “Should viewers leave with the impression that shaking an infant does not cause serious harm that could result in death, numerous infants could be put in significant danger.”

    Similar letters went out to two other film festivals, hinting at legal action. At all three festivals, organizers declined to cancel the showing of The Syndrome. At a screening in North Dakota, caretakers showed up with battered children in wheelchairs, carrying signs that declared, “I Am Not a Myth” — and engaged in a confrontational question-and-answer session with the filmmakers.

    “It’s a very emotional issue,” Goldsmith notes. “The festival organizers have been told that by showing our film, they are promoting child abuse.”

    Actually, nothing in The Syndrome suggests that shaking a baby is a good idea, or that child abuse isn’t a serious public-health and -safety issue. The film’s primary subject, though, is another kind of abuse: the abuse of science. It traces how SBS evolved from a hypothesis to a diagnosis to an engine for dubious prosecutions, all with an alarming lack of empirical research, skepticism or critical review from the legal and medical communities. As one debunking pathologist puts it in the film, “People are being convicted of crimes that did not occur. It has resulted in thousands of families that have been destroyed.”...

  8. Other doctors have had second thoughts. One of the debunkers featured in The Syndrome is Patrick Barnes, a pediatric neuroradiologist who practices and teaches at Stanford University Medical Center. Barnes was an expert witness for the prosecution in the Louise Woodward case, but the evidence put on by the defense in that trial prompted him to question the assumptions behind SBS. He’s now regarded as a traitor to the cause because he has testified for the defense in alleged SBS cases. Raising doubts about the triad, he says, “actually threatens the entire Shaken Baby Syndrome working group and industrial complex.”

    Barnes is also one of the child-abuse experts who filed an affidavit in support of Krystal Voss’s appeal of her conviction. In that affidavit, Barnes disagrees with Dr. Wells’s assertion that the injuries Kyran suffered could only have come from a shaking and slamming. Based on the medical evidence, he concludes, it’s just as likely that the boy was hurt exactly as Ramirez first claimed, before he changed his story.

    “If Kyran fell from his babysitter’s shoulders and hit his head on the ground,” Barnes says, “this type of accident could have caused the brain injury Kyran suffered here.” ...

    Voss’s motion for a new trial essentially argues that SBS became so firmly entrenched in the legal system that many people involved in her case — prosecutors, investigators, her own lawyers — failed to do their job. In pursuit of elaborate coverups, they failed to embrace the problem-solving approach known as Occam’s razor, which maintains that the simplest explanation is usually the correct one. “I’ve always believed that Ramirez’s very first statement was really the truth,” she says. “Listening to the sound of his voice on the [interview] tapes, I really believe it happened just like he said it did: There was a big fall.”

  9. Sebastian Dufresne's back stiffened and arched and his body went limp twice last year when he was 5 months old, prompting his dad to call 911.

    But whether abuse or a medical condition caused it wasn't clear.

    The doctors couldn't even agree...

    After the second 911 call, Cory Dufresne told his in-laws he might have put Sebastian down too hard. In March, police arrested him on suspicion of felony child abuse, but prosecutors haven't charged him...

    At the juvenile court trial, Drs. Suzanne Haney, Donny Suh and Bradley Bowdino gave opinions that the subdural hematomas and retinal hemorrhages were the result of nonaccidental trauma.

    Drs. Joseph Scheller and Matthew Wood pointed to possible causes connected to a condition the boy has, called benign extra-axial spaces of infancy, as the more likely cause and said the bleeding could have occurred spontaneously or from mild head trauma...

    But Porter did find that the state proved Sebastian's symptoms were consistent with abusive head trauma.

    If it was caused by his medical condition, Porter said, one would expect the episodes to have occurred while he was in the care of others or to continue to happen regardless of who was taking care of him.

    "The far more logical conclusion based upon the evidence presented is that Sebastian was injured at the hands of his father ...," the judge wrote.

    And Porter found by a preponderance of the evidence -- a lesser burden than in criminal cases -- that Cory Dufresne had caused his son's injuries.

    But she stopped short of terminating his parental rights, which requires a higher standard of proof.

    Porter said he had demonstrated ongoing love, care and affection for his children.

    And she said she was not convinced she should deny Cory Dufresne an opportunity to participate in a rehabilitative plan, or that his actions were so aggravated she should find him unfit to parent his son and daughter.

  10. Cheyenne Rae is an adorable, spunky 3-year-old who suffered brain damage when her father shook her to try to stop her crying when she was eight months old.

    Cheyenne’s mother, Amy Owensby, posted Monday on the Prayers for Cheyenne Rae Facebook page: “Happy Survivor Day, my beautiful baby! Three years since Cheyenne was shaken by her dad. Three years since I was told she wouldn't live through the night. Three years since her heart stopped. Three years since she had half her brain removed. Three years since our lives changed forever. So very blessed that she's still here with me, proving miracles do happen.”

    Pictures show Cheyenne laughing, mugging for the camera, splashing in a pool, jumping on a trampoline and enjoying summertime.

    Other than weakness in her right leg, it is difficult to tell the long battle she has fought in her short life.

    After lying to try to cover up what he had done, Cheyenne’s father, James Davis Jr., of Wellford, eventually admitted that he shook 8-month-old Cheyenne while he was caring for her on Aug. 17, 2012.

    Owensby was separated from her husband, who took care of Cheyenne on the weekends.

    Davis had no prior criminal record, and there was no indication that he would harm the baby.

    When Davis, then 28, pleaded guilty, he said Cheyenne would not stop crying, and he “just snapped.” …

    “It only takes a few seconds to change things forever,” she said. “A few seconds of frustration and anger to cause the unthinkable. I had heard about shaken baby syndrome and always thought 'that will never happen to me.' But clearly, it did. It happens way more often than I ever imagined and that needs to be known.”

    “Cheyenne was a happy, healthy, thriving baby girl, (and) now she struggles to do stuff she mastered months ago. She's doing amazing, but it is still heartbreaking to see her frustration when she can't do something no matter how hard she tries that used to take no effort. Cheyenne is a tough little girl and she makes this whole process look easy but in reality, most babies don't even get the chance to try to get better.

  11. Kohler, the Summit County coroner, said she saw bleeding in and around the base of the skull and bleeding in her eyes, the optic nerve, the back of her retina and her brain.

    She testified an MRI showed significant injury to a ligament in the child’s neck, suggesting whiplash. She said the back of the child’s neck showed swelling. There were no other external bruises.

    On direct examination, the coroner said one possible cause of death was violent shaking. She ruled the baby’s death a homicide, saying no accident could have caused the injuries she observed.

    However, Attorney Bernie Davis, who represents Pratt, made a crucial point in his cross examination, getting Kohler to admit that the injuries may have happened before Pratt took custody of the child Jan. 19.

    Davis asked Kohler, that assuming a violent shaking occurred, when a person would expect to see symptoms of a violent shaking. “I would expect the symptoms immediately after that incident,” Kohler testified.

    “What would you expect to see?” Davis asked.

    “They are not going to be as bright and interactive. They may be more irritable, they may be more sleepy and lethargic. They’re not going to engage you in the same way, ” she said.

    Davis asked Kohler if the injuries could have occurred before the child was returned to Pratt.

    Kohler said based on the fact that the child was asleep when she was returned to Pratt by the grandparents, “There is a likelihood the child may have been injured prior to her transfer.”

    Pratt was caring for Sophia and three other young children while Sophia’s parents were out of town.

    Murphy said Michael Rock Sr. and his wife, Charlene, took Sophia to their home the night of Jan. 18 to give Pratt a break, returning her to Pratt’s home about 2 p.m. Jan. 19. The child was asleep when she was returned.

    Davis questioned Kohler about a sleeping child.

    Kohler said a sleeping child could be just that, asleep, or it could mean the child is comatose or unconscious. She said a layperson could look at the child and see them as potentially asleep.

    About 1 a.m. Jan. 20, Murphy said Pratt called 911 to report the baby was in distress.

    The baby was taken by squad to MedCentral and then Akron Children’s Hospital, where a doctor concluded her injuries were caused by being violently shaken. Sophia Rock died Feb. 3.

    Pratt was acquitted. See:

  12. There are no witnesses to what happened to a 3-month-old baby that caused bleeding on his brain and both retinas; bruising on his armpits, one leg and the top of his spine; and an injury to his spleen. These injuries have left the boy with significant vision loss and developmental delays.

    Was it a hereditary medical condition — excess fluid on the brain — that triggered a brain bleed and then a seizure, as the defense suggests?

    Or, as prosecutors argue, was it a case of an angry Gloucester father, who had already complained about the baby’s crying, lashing out and either throwing or shaking the infant?

    That’s the decision Lawrence Superior Court Judge Mary Ames will have to make by Monday, when she is expected to deliver her verdict in the trial of the baby’s father, Daniel Green...

    Both the pediatrician and the technician thought the infant looked well and, initially, so did the staff at Beverly Hospital, medical records indicate. But by 2 a.m., the baby was being transferred to Children’s Hospital in Boston...

    The case highlights not only the continuing problem of what was once known as “shaken baby syndrome,” despite numerous educational campaigns to increase awareness of the damage it causes, but the plight of homeless families being housed for extended periods in hotel rooms.

    Hopwood pointed to all of the stresses in Green’s life at the time: he was unemployed and homeless, unable to support his family, $12,000 in arrears in child support payments to a former girlfriend, and he was unhappy in his marriage.

    “He couldn’t deal with it,” argued Hopwood. “He couldn’t handle it any more.”

    Collins argued that Green may have been under stress, unhappy and deeply in debt, but that doesn’t mean he was capable of harming a child he’d been consoling just a short time earlier, while the technician was present.

    Rose-Green, the child’s mother, was under just as much stress and, Collins suggested, sent text messages showing she was just as angry as her husband. Furthermore, Collins pointed to Green’s willingness to speak to investigators throughout the day after the baby was hospitalized.

    Collins challenged the timeline of the case, suggesting medical records show the infant was brought to Beverly Hospital around 6:37 p.m. that night and that a Walgreen’s surveillance video showing Green’s wife still at the pharmacy at that hour was not correct because Daylight Savings Time had ended just weeks earlier.

    The prosecution’s expert, Dr. Alice Newton of Children’s Hospital, had testified that the injuries to the child occurred somewhere between a half hour and four hours before he showed symptoms. Collins suggested that could only mean the child was already in the hospital when the damage occurred, and not alone with Green.

    Hopwood argued, however, that the child was brought in much later that night, pointing to Beverly Hospital emergency room records showing he was first seen after 11 p.m. She told the judge the earlier time written on the records actually referred to the time the doctor’s notes were transcribed, on the following day, Nov. 28.

  13. Both principals and pupils requested additional programmes on topics such as sex education, bullying and peer pressure, said City Mayco member for social development and early childhood development, Suzette Little.

    “In this financial year, each of the directorate’s eight districts will receive four simulators, including a healthy baby simulator, substance abuse addiction simulator, foetal alcohol syndrome simulator and a shaken baby syndrome simulator,” she said.

  14. The case against Green was circumstantial, with prosecutor Karen Hopwood pointing to Green’s statement to investigators, which appeared to minimize the infant’s health issues and his own marital problems — problems that were revealed in text messages between Green and his wife, as well as with a former girlfriend with whom he also has a child.

    Green also tried to blame hospital workers for the child’s injuries.

    At the time of the crimes, Green, his wife, her daughter and their infant son were all living in a room at the Extended Stay America hotel, under a state-funded program that houses homeless families in motel rooms. The couple was originally from the Gloucester area.

    Green’s wife, Samatha Rose-Green, is due in Salem Superior Court Tuesday. She is currently facing charges of permitting injury to a child.

    The defense had called attention to discrepancies in the timeline offered by prosecutors, suggesting that Green was not alone with the infant long enough to have done what he was accused of doing.

    They also called a pediatric neurologist who testified that the brain bleed could have been caused by a hereditary condition that causes excess fluid to collect between the brain and the skull, creating pressure on blood vessels...

    Green is currently serving a two-year jail term for taking part in assaults on other inmates at the Middleton House of Correction, where he is reputed to be affiliated with a gang called the Crazy White Boys, and in trying to cover a security camera while other inmates went after a correctional officer inside Salem District Court.

  15. Mariah Ramirez and Derek Podanay left their 5-month old son with a trusted babysitter. When they returned home, he seemed sick, but his pediatrician pegged it to a stomach virus. By the next morning, however, they were rushing him to the hospital, where it was determined that he'd been shaken. And while it was the babysitter who allegedly shook the infant, not the parents, the baby still hasn't been retuned home...

    She and her husband had no idea what caused their son's injuries until a fellow mom—someone Ramirez said she doesn't even know well—phoned her with horrifying news: The mom told Mariah that the sitter said she had shaken the baby. “[We]’re very fortunate, because if she wouldn’t have come forward, we still wouldn’t have known,” said Mariah. A phone call from police was next, letting Mariah know that the babysitter confessed and was now in custody. And Fox 8 reported that the police say "the investigation is now complete and in the hands of the St. Charles County prosecutor."

    Still, baby Daniel remains in protective custody with his grandmother. Why? Apparently, it's standard precaution in shaken-baby cases, pending a criminal investigation. That makes sense, honestly, but it certainly doesn't make it any easier on the parents. “It’s just upsetting that right now there’s been a confession and we still don’t have him back,” Ramirez said.

  16. A murder charge has been dropped against an Irish nanny accused of killing a 1-year-old girl in her care after a state medical examiner reversed a finding that the child's death was a homicide caused by shaken baby syndrome, prosecutors announced Monday.

    Aisling Brady McCarthy, 37, was charged with killing Rehma Sabir in Cambridge in 2013. McCarthy insisted she was innocent and her lawyers vigorously challenged the medical examiner's findings that Rehma died of complications of blunt-force head injuries.

    In a written statement, Middlesex District Attorney Marian Ryan announced that the murder charge was dropped because the medical examiner issued an amended ruling changing the manner of death to "undetermined."

    Ryan said the medical examiner found Rehma had past medical issues and may have had some type of undiagnosed disorder.

    "Based on an assessment of the present state of the evidence, including the amended ruling from the Medical Examiner who performed the autopsy, the Commonwealth cannot meet its burden of proof," Ryan said...

    In the new ruling, the medical examiner said the decision to change the cause and manner of death came after additional materials were reviewed, including expert witness reports from both the defense and prosecution, additional transcripts of police interviews, transcripts of grand jury testimony, additional medical records and additional lab testing related to the girl's death.

    "These additional materials put forth several different and often conflicting opinions about the cause of Rehma's death," the report states, according to excerpts contained in Ryan's statement.

    "In particular the overall state of Rehma's health and her past medical issues raise the possibility that she had some type of disorder that was not able to be completely diagnosed prior to her death," the report states.

    The report said that Rehma had a history of bruising and that she might have been prone to easy bleeding with relatively minor trauma.

    "Given these uncertainties, I am no longer convinced that the subdural hemorrhage in this case could only have been caused by abusive/inflicted head trauma, and I can no longer rule the manner of death as a homicide," the medical examiner wrote in the report.

    "I believe that enough evidence has been presented to raise the possibility that the bleeding could have been related to an accidental injury in a child with a bleeding risk or possibly could have even been a result of an undefined natural disease. As such I am amending the cause and manner of death to reflect this uncertainty."

  17. There was a rush to judgment in this case from the get-go. Within hours of McCarthy’s arrest, reporters were doing their jobs and poring over court records that painted a highly unflattering, and highly prejudicial, portrait of her as a young woman with a volatile temper.

    She was accused of biting a roommate and harassing another nanny. A former boyfriend said she attacked him after they broke up and threw a beer bottle at a woman he was talking to in a pub. But even that former boyfriend said he didn’t believe McCarthy would harm a child. That was the widespread view in the Irish immigrant community, even among those who knew her but didn’t necessarily like her: whatever McCarthy’s problems with adults, she wouldn’t take it out on a child. She had been a nanny for more than 10 years. A crying child wouldn’t faze her.

    None of it added up.

  18. Browne says this is only the second time since 2006 that the state medical examiner has amended the manner of death on an autopsy. The other time was just last year and it also involved the death of a child — and it also caused murder charges to be dropped.

    The two cases also involved the same child abuse specialist: Dr. Alice Newton, who is now at Massachusetts General Hospital. She declined to comment for this story.

    Prosecutors say the new information that came forward in Brady McCarthy’s case includes the child’s pediatric records and the possibility that the 1-year-old may have had a rare bleeding disorder that could have caused her to bruise more easily.

    But many doctors say shaken baby syndrome — or abusive head trauma, as it’s often called — is a clear medical diagnosis that’s not easy to mistake.

    “Sadly this is a reality of current life in medicine, and one has to be skeptical in seeing a sudden turn in a case like this,” said Dr. Eli Newberger, a pediatrician.

    Newberger suggests there may be an ulterior motive for some doctors.

    “The first thing that occurred to me was, is this pathologist grooming himself or herself for the lucrative defense business across the country?” he said.

  19. A 10-month-old baby remains in the hospital after he was knocked unconscious by his father.

    Police responded to a child abuse call on the 800 block of Indiana at around 2 p.m. on Saturday and police confirmed the child was still in the hospital as of Sunday afternoon.

    An officer told KRIS 6 a concerned citizen filmed the father shaking the baby. The child was knocked unconscious and rushed to the hospital.

    The child's condition is not known at this time.

  20. On Aug. 7, Wallace's 23-year-old husband, Cory, was arrested in the Feb. 10 death of their 5-month-old son, Jensen.

    Cory Wallace allegedly told investigators he dropped the baby on a hardwood floor in the family's Meeker Avenue home. Rather than seek medical attention for the child's brain injuries, Wallace said he put his son in a playpen, and later determined the baby had died.

    The father said he then set fires in Jensen's bedroom in a bid to cover up the cause of the child's death.

    The night of their baby's death, the Wallaces told authorities they were in another room when the fire broke out in Jensen's bedroom.

    Sheryl Wallace was treated at IU Health Ball Memorial Hospital for smoke inhalation. Her husband claimed he suffered hand burns in a bid to rescue his son.

    According to a court document, Sheryl Wallace told police her son was "happy, smiling (and) not fussy" when she put him down for a nap about two hours before the fire was reported. A child abuse pediatrician, however, told investigators that the baby's "abusive head trauma" — previously called shaken baby syndrome — likely would have led to a "demeanor.. inconsistent" with his mother's account.

    An autopsy revealed the baby had died before the fires were set in his room and that he had had suffered earlier injuries, including broken ribs, that reflected abuse.

    Sheryl Wallace also gave an account of her husband discovering the fire that evening that was inconsistent with his later confession to police.