Monday, 18 October 2010

SBS: Nicholas McKee charged: Pediatrician says baby suffered abusive head trauma; Neurosurgeon says she might have suffered cardiac arrest

Nicholas Ray McKee, 23, of Warfordsburg, Pa., also is charged with first-degree child abuse resulting in death, first-degree assault, manslaughter, second-degree child abuse, second-degree assault and reckless endangerment in the Jan. 9, 2010, death of Bella Appel-McKee, who suffered brain damage Jan. 3 while in his care at the Hancock home he shared with the baby’s mother, Jordan Appel.
McKee waived his right to a jury trial. The case is being heard by Circuit Judge Daniel P. Dwyer.
“I concluded Bella had suffered abusive head trauma,” Dr. Tanya Hinds, a pediatrician at Children’s National Medical Center in Washington, D.C., testified during the second day of McKee’s trial. Hinds testified that the girl sustained brain hemorrhaging and swelling, and injuries to the muscles and spinal cord in her neck.
Dr. Ronald H. Uscinski, a neurosurgeon, testified for the defense that the girl might have suffered cardiac arrest that deprived her brain of oxygen and that the bleeding on her brain could have been caused by spikes in intracranial pressure brought on by attempts to resuscitate her. The cardiac arrest could have been triggered by the baby vomiting and cutting off her airway, he testified.
Appel left her daughter in the care of McKee on the night of Jan. 3 to have dinner nearby at her grandmother’s home, she testified Wednesday. She left the girl behind because the child appeared to have a cold and it was cold outside, she testified.
About 30 minutes later, a relative called to tell her that there were firetrucks near her house, Appel testified. The girl was taken to War Memorial Hospital in Berkeley Springs, W.Va., then to Children’s National Medical Center, where she died six days later, according to trial testimony.
Hinds and Uscinski had opposing interpretations of MRIs, CT scans, photos and other medical records, from prenatal exams and pediatric exams before the injuries to examinations of the injuries and the autopsy report.
Hinds testified that the bleeding in the girl’s brain could have occurred within two days to two weeks of an MRI taken Jan. 5 and that the injuries were indicative of “acute, recent, high-energy events” similar to the trauma that might be sustained in a vehicle crash.
“They are also caused by vigorous repetitive shaking,” Hinds testified. “It would not be a birth injury.”
The injuries also could have been caused by grasping and twisting an infant’s head, or by holding the baby by the head, she testified. The girl had no outside bruising that would indicate an impact injury, but Hinds testified she could not rule that out.
The retinal hemorrhages in the girl’s eyes were “too numerous to count” and injuries of that extent could not be caused by efforts to revive her, Hinds testified.
“I don’t believe in the Shaken Baby Syndrome,” testified Uscinski, who said he had treated suspected cases and found there usually was another explanation for the injuries other than shaking.
Uscinski testified that the girl’s brain images showed evidence of both fresh and old blood, and that a high percentage of infants have some bleeding on the brain resulting from the trauma of birth. The subdural bleeding the girl suffered could have been “rebleeding” from that birth trauma, he testified.
Uscinski testified he could detect no evidence of neck injuries in the images that might be caused by shaking. The retinal hemorrhaging could be attributed CPR and other efforts to resuscitate the girl, Uscinski testified.
As for several fractures to the occipital bone of the girl’s skull, Uscinski testified those could have occurred at birth or after the girl’s death. The head of an infant deforms as it passes through the birth canal, which can result in injury, he testified.

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