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| cereral palsy depositions
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1 ________, M.D.
2 A Yes, I am.
3 Q The other end of it or the more,
4 what is the other parameter to a reasonable
5 medical probability, that this HIE occurred
6 no more than X before birth?
7 A I would say no more than 84 to 96
8 hours, somewhere in there.
9 Q Doctor, what's the basis of your
10 opinion, first of all, not the timing, but,
11 first of all, that what caused the child's
12 injuries was HIE?
13 A The basis for that are the CT-scan
14 findings, some evidence of liver dysfunction
15 at the time of birth, as well as elevated
16 levels of nucleated red blood cells. Those
17 are pretty much it.
18 And then the child's subsequent MRI
19 findings and how the child has ended up
20 developmentally.
21 Q Let's talk timing. With a
22 reasonable medical probability, what's the
23 basis of your opinion that the HIE occurred
24 somewhere between 48 hours and 84 to 96 hours
25 before birth?
ALLIANCE REPORTING SERVICE, INC. * (516) 741-7585
8
1 ________, M.D.
2 A I put the timing to that amount of
3 time right in there based on several things.
4 Number one, the child initially had
5 in the complete blood count an elevated level
6 of nucleated red cells, those are nucleated
7 red blood cells, and those are at about two
8 hours of life; and the proportion was 47
9 percent.
10 Nucleated red cells typically take
11 at least 12 to 24 hours to respond to hypoxic
12 or ischemic injury. Some people say they may
13 take upwards of 48 hours.
14 The reason I placed the timing of
15 the injury even at 48 hours and beyond is
16 because the nucleated red cells persisted in
17 the child's bloodstream for at least four to
18 five days.
19 Typically whenever you find
20 nucleated red cells in a child's blood, they
21 disappear by the second day of life or so.
22 And if you find it persisting
23 beyond that time in a child like this, it
24 points to the injury having occurred even
25 further before delivery.
ALLIANCE REPORTING SERVICE, INC. * (516) 741-7585
9
1 ________, M.D.
2 The other thing that was striking
3 to me on that first day as a blood study were
4 the liver function test, the levels of LDH
5 and CPK. These two were extraordinarily
6 elevated, and they had declined by two days
7 after that.
8 Typically what you see as a
9 response to organ injuries such as to the
10 liver is an increase in these enzymes that is
11 maximummed at approximately 72 hours of age,
12 and then the levels start to go down.
13 These were maximum again
14 extraordinarily high with the first studies
15 that were obtained on the first day of life.
16 The other thing that is consistent
17 with the injury in that time frame that I've
18 brought up is the child's finding on CT
19 scans.
20 And first CT scan, which was done
21 at approximately 13 hours of life, showed
22 substantial cerebral edema. And cerebral
23 edema is usually maximum and having those
24 kinds of changes that were described
25 somewhere between 48 and 72 hours after an
ALLIANCE REPORTING SERVICE, INC. * (516) 741-7585
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