Birth Injuries

Evaluation of a "Birth Injury" Case, Part II (continued)

Much to their surprise, they discovered that umbilical vasoconstriction did not occur at any concentration of meconium unless the meconium was introduced directly into an umbilical artery. On the other hand, it is generally known that sterile water introduced into an umbilical artery will also cause vasospasm.

Various components are present in the blood of newborns. In the medical literature, numerous authors attempt to answer the question of whether the examination of the quantity of a particular blood element or the timing at which a certain quantity of that blood element is present or the process by which the blood element increases or dissipates in its concentration, reveals the time when a brain injury has occurred. Such efforts have been made with reference to platelets, NRBC's and lymphocytes. Certain defense experts, claim that an infant having a platelet count of 185,000 when born has, by reason of this platelet count, been injured prior to the mother's labor admission. There is no scientific evidence in the medical literature ascribing such a significance to platelets. In fact, the general pediatric literature makes clear that such levels of platelets are normal.

Other defense experts rest their timing defenses on the appearance of nucleated red blood cells. Legitimate medical evidence supports the proposition that nucleated red blood cells can be found in increased numbers at some point following a hypoxic stimulus. Any defense expert who claims that he or she can predict the timing of a hypoxic stimulus based on the level of nucleated red blood cells present at some point in time, is basing the conclusion upon fantasy. Benirschke, in his text Pathology of the Human Placenta, Third Edition, analyzes the folly of such positions. Benirschke points to his own experience that has shown a significant elevation in nucleated red blood cells occurring shortly after hypoxic insult. The literature contains examples of cases where a longer interval between hypoxic insult and elevation was observed.

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