Report on Amanda Sadowsky
DOB 16th February 2007 - Deceased 30th June 2007
This report is compiled from information in the following documents:
a. Information supplied by Amanda’s Mother – Tonya Marrhouri (sic)
b. Well Check 2-4 weeks 2nd March 2007
c. WSPC Progress Note 21st March 2007
e. Rainbow Babies and Children’s Hospital Admission Hisory – 29th June 2007
f. Discharge Summary – Dr Paul G Smith
g. NR CT C-SPINE W O C - Dr Jeffrey Sunshine
h. Chest /Abdomen AP - Dr Carlos Sivit
i. In Patient Abstract Summary University Hospitals – Dr Paul G Smith
j. Registration History – In patient
k. University Hospitals – Pediatric Emergency Department – 5 pages
l. Result Cerebral CT – Dr Craig Irish
m. State of
n. Toxicology Laboratory Report
o. BON SECOURS
q. Report of Autopsy Dr Joseph A Felo
r. Autopsy Protocol Elizabeth K Balraj MD
History of Pregnancy
While pregnant Tonya Marrhouri (sic) suffered from excessive vomiting and lost 10 lbs in weight in the first 3 months of her pregnancy. [my addition: see forum under ribs on this site: RIBS FORUM)
A loss of weight signifies malnutrition which is bound to affect the unborn child. Particularly concerning is the loss of essential Vitamins such as C and K which are essential for the control of bleeding and prevention of fractures [1,2]. [my addition: see forum under ribs on this site: Vitamin K Deficiency]
Oral Vitamins C and K supplementation has been suggested to counteract the possible deleterious effects of morning sickness. (Merkel RL. The use of menadione bisulfite and ascorbic acid in the treatment of nausea and vomiting of pregnancy. A preliminary report Am J Obstet Gynecol. 1952;64:416–418.)
The deleterious effects of a deficiency of Vitamins C and K on the infant are an increased tendency to bleed from any site including the brain. In addition there are changes in the bones with fractures and subperiosteal haematomas which may lead to a suspicion of child abuse, especially if there are accompanying bruises and ecchymoses. [1,2]
Amanda’s birth was by natural vaginal delivery and she had Apgar scores of 9 at 1 and 5 minutes but the mother noticed the infant’s hands and feet were blue. She weighed 7lb 10oz and became jaundiced within 24 hrs and the level of Bilirubin was abnormally high at 13.95 mg/dl. Hepatitis B Vaccine was administered and she was given an oral dose of Vitamin K.
Jaundice and an elevated level of Bilirubin suggest the possibility of Neonatal Hepatitis resulting in Vitamin K deficiency or abnormality. As stated above Vitamin K deficiency is a well recognized cause of Haemorrhagic Disease of the Newborn in which bruising, subdural and retinal haemorrhages occur which may be mistaken for Shaken Baby Syndrome (3). This possibility must be seriously considered and although Amanda was given a dose of oral Vitamin K at birth it is known that there is a failure rate of approximately 0.25 per 100,000(4).
This should be kept in mind when assessing bruises and bleeding in infants.
At the age of 4 weeks Amanda was taken to her General Practitioner because she was vomiting and was prescribed Pepsid.
When 2 months old she was given 5 vaccines which included DTaP, Comvax, IPV, PCV7 and Rotateq.
Redness of her eyes developed which were diagnosed as conjunctival haemorrhages and she had screaming spells which lasted for “hours at a time.”
All the above vaccines were given again on June 19th 12 days before she died with multiple fractures, bruises, abrasions and haemorrhages including intracranial haemorrhages.
Vaccines, apparent life-threatening events, Barlow’s disease and questions about “Shaken Baby Syndrome” was the subject of a publication in Journal of the American Physicians and Surgeons and is particularly relevant in this case, as this is almost exactly what happened to Amanda.
The literature on Adverse Reactions following the administration of vaccines is extensive and much of it is summarized in http://www.shirleys-wellness-cafe.com/vaccine_sids.htm
The conjunctiva hemorrhages and screaming are what might be expected in Barlow’s disease due to Vitamin C deficiency which, in this case followed the administration of a number of vaccines.
A week before death
The mother recalls Amanda “started having staring spells.” On one such occasion mother noticed “her lips are turned down on the left side.” [my addition: see page on website: Subconjunct Hem (SCH)]
Staring attacks may be epileptic or non-epileptic. In Amanda’s case the changes in her lips which accompanied the attacks suggests a right sided parietal brain lesion such as a blood clot.
Events on 29th June 2007
Amanda's mother, who was at work, received a call from Amanda's father at about 3pm who said he "dropped Amanda, her head is swelling and she is having trouble breathing."
A call was made to 911 and Amanda was admitted to the Fairview Hospital. The Nursing Progress Notes state Amanda was intubated and bruising was noted on the right side of her chest. She had a left parietal deformity and diffuse swelling on the right scalp. The pupils were not reacting.
Dr. Richard Treat records the child was found limp with agonal respirations and pink, but became ashen and cold during transport to the hospital and later became limp.
Dr. Treat's description is typical of an Apparent Life Threatening Event (ALTE), which was defined by the 1986 National Institutes of Health Consensus Development Conference on Infantile Apnoea and Home Monitoring as follows:
An episode that is frightening to the observer and is characterized by some combination of apnoea (central or occasionaly obstructive), color change (usually cyanotic or pallid but occasionally erythematous or plethoric), marked changed in muscle tone (usually marked limpness), choking and gagging. In some cases, the observer fears that the infant has died. ALTE is not so much a specific diagnosis as a description of an event.
The causes of an ALTE are numerous and include Gastroesophageal relux (GER), Seizure, Infection (e.g., sepsis, meningitis, and infant botulism), inborn errors of metabolism and congential adrenal hyperplasia. In this case a seizure was the most likely cause as indicated by the history of staring and left-sided lip spasm.
The significance of an ALTE is that the cessation of breathing which occurs causes cerebral hypoxia (lack of Oxygen to the brain). Geddes et. al. have shown that in the immature brain, hypoxia alone is sufficient to activate the pathophysiological cascade which culminates in dural heamorrhage. This could be another explanation for Amanda's subdural heamorrhages.
The swelling of the head is a cephalhematoma (blood collected between the periosteum and bone on the scalp) and is a known feature of a bleeding disorder such as Vitamin C or K deficiency which would also account for the bruising seen on the child.
Further Investigations in Hospital
Multiple haematomas were present on the scalp and in addition to the bruise on the thorax, a bruise was noted on the left thigh.
A CT scan showed numerous skull fractures, intracranial heamorrhages adjacent to the falx and a subtle area in the left parietal lobe of decrease attenuation which was thought to most likely indicate a remote injury of focal encephalomalacia.
Ophthalmoscopic examination showed bilateral retinal haemorrhages. A CT of the Cervical Spine showed transverse lucencies suggestive of minimally displaced acute fractures of C6.
It is commonly held that when bruises and fractures are observed in an infant that cannot be explained by the caregiver, a diagnosis of Non-Accidental Injury is justified.
However, it has been pointed out that such a diagnosis is unjustified before a Nutritional Deficiency has been excluded. The following response was posted to a British Medical Journal Blog by Dr. Harvey Marcovitch:
"1. Dr. Harvey Marcovitch rightly encloses the term 'expert' in inverted commas. Some 'experts' say a child with fractures of the skull, femur and ribs, intracranial and retinal bleeding, and bruising which the parents are unable to explain has suffered from 'The Shaken Baby Syndrome' or Non-accidental injuries.[1,2]
"Other 'experts' say the cause of these lesions can be exlained by the result of the Prothrombin Time, which is significantly elevated in some cases  and by the elevated blood level of Histamine others .
"Non-accidental Injury or Nutritional Disorder - that is the question that divides the 'experts'.
"An elevated Prothrombin Time means, in this context, Vitamin K is either deficient of (sic) abnormal and Vitamin K deficiency is a well recognized cause of possible false allegations of child abuse when bleeding is the principle mode of presentation .
"To understand how fractures, whether of the skull, ribs or long bones, may occur when there is a deficiency or abnomrality of Vitamin K, one must first grasp the role of Vitamin K in bone formation.
"A simple explanation for the layman is this: Vitamin K is necessary for the removal of Calcium from the blodo and for its deposition into bone so as to provide strength to that bone. When Vitamin K is reduced this process is impeded and the bone remains weak and may fracture spontaneously. This is one explanation of fractures.
"The Scientific explanation is Vitamin K is a co-factor in the enzymatic conversion of Glutamic acid (Gla) to γ-carboxyglutamic acid (Gla) by γ-glutamyl-crboxylase a process necessary for the biological activity of the blood clotting factors II, VII, IX, X protein C and S as well as bone Gla protein and matrix Gla protein which control osteogenesis [Furie B et al; Vitamin K –Dependent Biosynthesis of γ-Carboxyglutamic Acid. Blood Vol 93;1999:pp 1798-1808].
"In Vitamin K deficiency there is under-carboxylation of Osteocalcin and failure of adequate mineralization of bone with resulting tendency to spontaneous fractures.
"Skull fractures, rib fractures or the long bone fractures are all explained by the same process of undercarboxylation of Osteocalcin because of lack of Vitamin K. For more details see Vitamin K Deficiency Disease.
"The role of Vitamin C is explained in the article Caffey Revisited. A Commentary on the Origin of 'Shaken Baby Syndrome'.
"Neither group of 'experts' accuse the other of deliberately misrepresenting the facts but merely of being misinformed.
"For the sake of the parents one sincerely hopes the matter will soon be settled.
1.Harding B, Risdon RA, Krous HF. Editorial Shaken Baby Syndrome BMJ 2004: 328: 720-721
2. Reece RM and 105 other doctors. The evidence base for Shaken Baby Syndrome. BMJ 2004; 329:1316-1317
3. Innis MD. Vitamin K Deficiency Disease Jour Orthomol Med 2008;23: 15-20
4. Clemetson CAB. Caffey Revisited: A Commentary on the Origin of “Shaken Baby Syndrome”Jour Amer Phy& Surg 2006;11:20-21
5. Rutty GN, Smith CM, Malia RG. Late-form hemorrhagic disease of the newborn. Amer J Forensic med Pathol,1999,20(1):48-51"
I have made it clear to the Medical Establishment that they cannot accuse a care giver of injuring a child without first excluding a Nutritional Cause – particularly Vitamin C and/or Vitamin K Deficiency.
Before Amanda’s lesions are attributed to homicide a full Biochemical and Coagulation profile should have been done to make sure Justice was not being perverted.
Some Laboratory tests have been sent to me but the Coagulation Studies, which are always done if a child is bruised or is bleeding, have been withheld. They must be disclosed if Justice is to prevail.
Laboratory Findings which have been disclosed are at the bottom of a page sent to me and include:
1. AST 361
2 ALT 267
Both these values are very much above normal and could indicate Liver dysfunction as seen in Neonatal Hepatitis.
Neonatal hepatitis is a cause of Vitamin K Deficiency and would explain all the signs and symptoms observed in Amanda.
Attempts to obtain the results of the:
1. Prothrombin Time
2. Partial thromboplastin Time
...have been unsuccessful. [emphasis added]
As these tests will almost certainly be abnormal and will prove that Amanda suffered from a deficiency/abnormality of Vitamin K as a result of a dysfunction of the liver it is essential they be produced to avoid a perversion of the course of Justice.
There is clear evidence of dysfunction of the Liver. The Liver is the site of storage of Vitamin K and the formation of the factors that control haemostasis (blood clotting). As I have explained in my response to the Blog in the British Medical Journal without adequate Vitamin K stores the child suffers from all the signs and symptoms which have hitherto been called Shaken Baby Syndrome or Shaken/Impact Syndrome and Non-accidental Injury.
I conclude that Amanda suffered from undiagnosed Neonatal Hepatitis as shown by the abnormal Liver function Tests and as a consequence developed Vitamin K Deficiency Disease which caused her death. An Adverse Vaccine Reaction resulting in a fall in the level of Vitamin C cannot be excluded.
Michael D Innis MBBS; DTM&H; FRCPA; FRCPath.
[to be continued...]
He outlines 3 cases with an ALTE and which were automatically suspected as SBS cases as a result of the injuries that were present. He even highlights a Dublin case where the coroner refused to conclude shaken baby syndrome because "there is no evidence of cerebral trauma or 'Shaken Baby Syndrome' despite the radiological and clinical findings..." That took courage to go against the opinions of the specialists involved.
Dr. Innis presents a compelling evidenciary article to suggest that there are other reasons for these injuries, not necessarily a caretaker or parent shaking the baby and without differential testing for nutritional deficiencies being excluded, this is an unsafe diagnosis.