By Michael D. Innis FRCPA;FRCPath
Retired Haematologist
Princess Alexandra Hospital Brisbane
Key words: Shaken Baby Syndrome, Liver disease. Haemostasis, Carboxylation, Osteogenesis
“As is your pathology, so is your Medicine,” said Sir William Osler.
Haemostasis (blood clotting) and Osteogenesis (bone formation) require the Carboxylation of certain proteins, Factors II.VII, IX and X in Haemostasis and Osteocalcin and matrix Gla Protein in Osteogenesis, to function effectively. Carboxylation takes place in the Liver and is disrupted by Liver dysfunction. The “Triad”, retinal and subdural haemorrhages with encephalopathy and fractures in children, hitherto regarded as a form of child abuse caused by vigorous shaking , is in fact the result of Liver disease as demonstrated in the following cases.
Case 1.
Date of Birth 12th February 2012
Birth Record
The child was born after a gestation period of 31 weeks via vaginal delivery due to pre-term labour. She was placed in the Neonatal Intensive Care Unit and required Continuous Positive Airway Pressure. Her birth weight was 1300 grams.
Progress
Immunizations were “up to date” on 18th May 2012. She had some twitching of legs for a couple of seconds for the last 2 or 3 weeks and had a bruise on her left arm, a diaper rash and scratches on her legs.
Her progress was satisfactory until at the age of 3 months, when on 5th June 2012, her mother noticed her mouth was bleeding and on looking into the infant’s mouth saw a lesion under the tongue which she thought was due to Thrush. The mother gave the child a dose of Tylenol but she continued to be “fussy ”, had difficulty in breathing, and was taken to the hospital Emergency Room. On examination she had an Oxygen saturation of 100% on room air, mild retractions, shallow breathing and tachypnoea. A 6mm tear distal to the frenulum without active bleeding was found and petechiae were seen on the left arm and right thigh.
Investigations
1. A pediagram showed multiple rib fractures, left tibial and left femur fractures.
2. Blood Chemistry
a. Creatinine 0.1 mg/dL Normal Range o.4 – 1.2
b. Glucose 113 mg/dL 70 – 99
c. Total Protein 5.7 g/dL 6.4 – 8.4
d. Albumin 3.4 g/dL 3.8 – 5.4?
e. ALT 140 unit/L 0 – 65
f. AST 46 unit/L 0 – 37
Comment.
The increased level of Glucose in the Blood is an indication that the level of Insulin in the Blood is reduced and a reduction of Insulin means Vitamin C is not entering the cells in the Liver[1] causing cellular dysfunction as shown by the increase in the AST and ALT and reduction of Albumin.
The cause of the increase in Blood Glucose is and autoimmune destruction of the βcells of the Pancreas [2]
As a result of disruption of Liver Function (about 17 days following the administration of vaccines} there was a failure of Carboxylation of some clotting factors, Factors II,VII,IX,X, and also of Osteocalcin and matrix Gla protein. The result is haemorrhages and fractures in the child.
There is clear evidence that this child had an Autoimmune reaction as a result of an Adverse Vaccine Reaction which affected the Liver and resulted in the failure of Haemostasis and Osteogenesis.
Case 2.
Date of Birth 3/03/2013
Pregnancy History.
The pregnancy was normal but it should be noted that there was a pet cat in the house during this time. Cats are known to carry the parasite Toxoplasma Gondii which can infect a mother and subsequently the unborn foetus causing Liver damage in the child.
Birth History.
Delivery was an uncomplicated vaginal delivery and the infant weighed 2960 gm and was breast fed initially but later was Formula fed.
Progress
Progress was satisfactory and she was given the routine mandated vaccines on 13/04/2013. Five days later the parents noted her leg was swollen and they took her to the local Hospital.
HOSPITAL Record dated 18/04/2013.
Swollen right lower leg, ankle and foot observed by the parents on 17/04/2013
No history of trauma.
Bruise on right jaw angle.
Two bruises on the fold of the neck (left side)
Moderately extensive subcutaneous soft tissue swelling is present in the lower leg and ankle region. There is slightly displaced right tibial metaphyseal bucket-handle fracture. No other fracture is identified in the right leg. Further evaluation.
Blood Tests.
1. APTT 30 sec Normal Range 25 – 37
2. Fibrinogen 4.4 g/L 1.5 – 4.0
3. PR 0.9 0.8 – 1.2
4. CRP 13 mg/L 0.0 – 10
5. Bilirubin 95 umol/L 0.0 – 24
Comment
The elevated Fibrinogen is an Acute Phase Reactant which means it is a response to an Acute Inflammation. The elevated level of Bilirubin indicates Liver dysfunction is the site of the inflammatory reaction.
Other evidence of an Inflammatory Response is the elevated CRP level.
Conclusion
The child shows all the signs and symptoms of an Infection of the liver and this is a known cause of fractures and bruising as indicated above. One cause of a liver infection is Toxoplasmosis and this should be investigated with appropriate tests.
Case 3.
Date of Birth 28.12.12
The child was born by emergency caesarean section at term and because of maternal infection and foetal stress was placed in the special care baby unit till 11th January 2013. He was given regular small doses of antibiotics as he had a problem with one of his kidneys.
On June 1st 2013 he was admitted to the Royal Hospital for Sick Children because his head growth had suddenly accelerated which on investigation was shown to be the result of a cerebral haemorrhage.
A hospital report states “In the absence of a medical explanation the most likely explanation of the bleeding is trauma. Given that there is no explanation of accidental trauma which would account for the bleeding the most likely explanation is that of non-accidental trauma”.
Significant Laboratory Investigations 22nd February 2013 showed abnormal Liver function
1. ALT 70 U/L Normal Range 50 – 60 U/L
2. AST 105 U/L 15 – 45 U/L
Comment.
These two investigations are proof that the Liver is severely dysfunctional and the clotting factors II, VII, IX and X, along with osteocalcin and matrix Gla protein are not being carboxylated and bleeding and fractures are inevitable.
It cannot be stressed too strongly that the Liver is the site of chemical processes which ensure blood coagulation is normal and where the bone mineralization is maintained.
Conclusion
Doctors making accusations of Non-accidental Injuries ignore the fact that Liver dysfunction, as shown by the abnormal Liver Function Tests, means that bone formation and haemostasis are impaired and fractures and haemorrhages are bound to occur.
The Shaken Baby Syndrome is a fabrication with no scientific basis.
References
1. Cunningham JJ. “The Glucose/Insulin System and Vitamin C: Implications in Insulin-dependent Diabetes Mellitus.” J Am CollNutr; 1998:vol 17 p105-108
2. Innis MD Autoimmune Tissue Scurvy Misdiagnosed as Child Abuse. Clinical Medicine Research. Vol. 2, No. 6, 2013,pp.154-157.
On Shaken Baby 