Trial of childminder charged with injuring baby hears from consultant paediatrician
A consultant paediatrician has told the trial of a childminder accused of assaulting a baby that it wasn't reasonable to suggest brain injuries suffered by the baby happened before she was dropped off at her childminder.
Registered childminder Sandra Higgins (34) is alleged to have caused the injuries to the 10-month-old baby she was minding at her home by shaking the child.
Ms Higgins (34) of The Beeches, Drumgola Wood, Cavan town, County Cavan has pleaded not guilty at Dublin Circuit Criminal Court to intentionally or recklessly causing serious harm to the baby on March 28, 2012.
On the third day of the trial, consultant paediatrician Dr Alan Finan said her brain injuries could not reasonably have occurred before 9am on that day, prior to her being left by her mother with her childminder.
The court has heard the child was fine that morning and during the day. Around 5pm Ms Higgins brought her to Cavan General Hospital where she presented with active seizures, brain injuries and fractured ribs.
Dr Finan said: “In my professional view it would not be a reasonable suggestion that she could have been normal for seven hours with those injuries already being incurred. It would not be a reasonable proposal.”
He told Sean Gillane SC, prosecuting, that he would find a proposal that the injuries could have been caused accidentally to be unacceptable.
“That the combination of injuries could be caused accidentally would not be credible,” he said.
He said the injuries clearly indicated the baby had suffered non-accidental injury and that shaking injury was a likely explanation.
The court heard these conclusions were contained in a report provided by Dr Finan to investigating gardaí on April 11, 2012.
Under cross examination Dr Finan agreed that in an earlier report, dated April 2, he stated that “precise dating of [the infant's] injuries is not possible at this time”. In the report he said this dating could be made upon further evaluation and medical imaging.
He denied a suggestion from Remy Farrell SC, defending that he had changed his mind between the first and second report.
“I didn’t change my mind. I felt I wasn’t in a position to complete a final report, I termed it an preliminary report. On April 11 I felt I had reached a point where I was able to draw conclusions,” he said.
Mr Farrell put it to him that nothing had changed between the two reports and suggested that the doctor had “just needed to think about it”.
Dr Finan replied: “It was a very serious issue. I needed to be careful about the conclusions drawn. I took the time I needed.”
He agreed with a defence suggestion that “lots of babies”, under five per cent of new born babies, have chronic subdural haemorrhaging. He said a chronic condition is ongoing while an acute condition is a very recent event.
He said a chronic subdural haemorrhage may not have significant symptoms.
The trial at Dublin Circuit Criminal Court continues before Judge Patricia Ryan and a jury of eight men and four women. There is a court order prohibiting publication of the child's name.
Professor Michael O’Keeffe, a Consultant Ophthalmologist, said he examined the infant at Temple Street Children's Hospital two days after the alleged assault.
He said he found extensive bleeding at the back of both eyes. He said these were very extensive haemorrhages.
He said: “Haemorrhages of this nature in this baby were very suspicious of a shaken baby.”
He added: “It's obviously a very controversial and big diagnosis. It has significant implications for many people. One has to exclude other causes.”
The professor said that he has seen the infant a number of times since and that her haemorrhages have eventually cleared.
Dr Finan told Mr Gillane that a CT brain imaging scan showed the child had subdural haemorrhaging or bleeding over both halves of the front of the brain. There was also bleeding between the brain lining and the brain.
He said there was evidence the baby was not seeing anything. The baby continued to have seizures for five days.
He said the persistence of seizure indicated significant manifestation of brain abnormalities. He said there was reduced movement to her right limbs which persisted for a long period after her discharge from hospital in April.
A skeletal survey found two rib fractures which were not recent. He said the infant also had finger tip bruising on her back which was also consistent with shaken baby syndrome.
Dr Finan told the court: “The whole picture very clearly indicated to us that she had suffered significant non-accidental injury. I mean an injury that is inflicted.
“The combination suggested to be me a shaking injury was a likely explanation.”
He said retinal detachment, retinal haemorrhaging and the subdural haemorrhaging were significant indicators of a shaking injury.
Dr Finan told Mr Farrell that a lucid interval was an interval of time where a patient remains lucid following an acute head injury. He said it is usually associated with a head injury in an adult.
He agreed that a report from this baby's public health nurse made in September 2011 noted an increase in the head circumference of the infant of around ten per cent.
Asked was this significant he said it would be a reason to review and follow up. He said he wasn't aware of this growth when making his conclusions about the infant's brain injuries.
He said a chronic subdural haemorrhage would not lead to an increase in head circumference. He told Mr Gillane that this head circumference was still within the normal size and was neurologically normal.