91av

IT MAY not take much force to kill babies, says the largest and most detailed
study yet on the brains of infants whose deaths were suspicious. The findings
challenge the widely held view that only extreme violence causes shaken baby
syndrome.

The research, revealed exclusively to 91av, calls into question the
scientific evidence behind many convictions for killing infants and could open
the way for a wave of appeals. “Unless it is certain that injuries were caused
by gross negligence or worse, the judge will direct the jury to acquit,” says
John Binns, a criminal defence solicitor with Victor Lissack & Roscoe of
London. “On the basis of these findings, it is impossible to imagine a
prosecution succeeding in anything but the clearest cases.”

Jennian Geddes, a neuropathologist at the Royal London Hospital, and her
colleagues found that shaking can damage nerve fibres in the neck area that
control breathing. The subsequent lack of oxygen, makes the brain swell
dramatically. This causes brain damage of the kind previously blamed on direct
trauma to the brain caused by violent shaking, they will report in the July
issue of the neurology journal Brain.

“This is a type of damage that’s not been reported before,” says Geddes. “It
shows that you don’t have to use a lot of force to injure a baby,” adds Geoff
Vowles, a colleague at the Royal London Hospital.

Geddes says such injuries couldn’t happen just by bouncing a child on your
knee, or in normal everyday interactions between mother and child. “They would
have to involve vigorous unsupported movement of the head.” She believes most
people would realise this kind of force would be dangerous. “But you could
imagine scenarios that might produce the damage without it being deliberately
inflicted,” Geddes says.

“Hopefully, this will stop American attorneys being so dramatic in the way
they present evidence,” Vowles says, referring to the way the prosecutor in the
Louise Woodward case demonstrated how he thought Woodward had shaken the baby
with all her might for up to a minute.

Geddes’s team, including Helen Whitwell of Sheffield University, studied the
brains of 53 children suspected of dying from deliberate injuries. The coroners
at their inquests had ordered that the brains be removed and stored. Of the 53
children, 37 were less than a year old and 16 over a year.

In the past, brain damage in such circumstances has been blamed on the brain
banging against the skull as a baby is violently shaken or struck. This direct
assault causes a characteristic kind of damage to the axons of nerves known as
diffuse axonal injury, or DAI. But the researchers found evidence of DAI in only
two of the 37 infants less than a year old.

Instead, they found that three-quarters of the 37 babies had died because
they stopped breathing. “We found an as yet unseen pathology focused on the
craniocervical junction, the point where the brain meets the spinal cord,”
Geddes says. A rocking motion at this point can damage the vital part of the
spinal cord that controls breathing.

The joint is uniquely vulnerable in very young babies because their neck
muscles are so weak and their heads relatively large and heavy. Evidence of this
kind of stretching was found in eight babies, and three others showed damage to
neck nerves. Others may have had similar damage too, but the pathologists who
did the original autopsies didn’t look for it.

Pressure in the skull rises massively as the body tries to compensate for the
lack of oxygen, and the brain swells up. This causes a kind of damage virtually
identical to DAI—but the two can now be distinguished, thanks to new
tissue staining techniques that are far more sensitive and reliable. “Blood
vessels in the brain get squashed by the swelling and cause a specialised form
of damage to axons,” says Geddes.

The investigators also question the origin of other lesions that are assumed
to be evidence of extreme violence and markers for DAI. These include subdural
haemorrhages, or bleeding under the skull, and retinal haemorrhages.

Geddes found subdurals in 72 per cent of the 53 cases, but most were too
superficial to have caused death. She also found retinal haemorrhages in 71 per
cent of the 38 cases in which eyes had been examined. But she believes that both
types of lesions can also occur when the brain is starved of oxygen.

The researchers expect to receive a lot of flak over their findings, but they
believe the size and thoroughness of the study stands them in good stead. “The
evidence is there, and what spin others choose to put on it is up to them,” says
Whitwell. The message is to treat babies with extreme care, she stresses. “Don’t
shake them in the first place.”