Nanny Trial: Exact causes of death still unclear

No one disputes that eight-month-old Matthew Eappen died on 9 February this year from a brain haemorrhage. But, as the trial of Louise Woodward progressed, it seemed that was all we could be sure of. Glenda Cooper, Social Affairs Correspondent examines the medical evidence.

British experts supported the prosecution's case, saying Matthew Eappen's injuries could not have been inflicted accidentally and gone unnoticed for three weeks. A neurosurgeon at Great Ormond Street Hospital said that to diagnose shaken-baby syndrome a number of things must be looked for: other injuries, fractures, other evidence of abuse and bleeding at the back of the eye.

The prosecution made the case that the injury that killed Matthew had been sustained on 4 February, when he was alone with Woodward and could not have been an accident, such was the force required - equivalent to falling 15 feet. Evidence from brain scans and of retinal bleeding proved this, they said.

Robert Barnes, a neuroradiologist, said the injuries were caused "within minutes or hours" of brain scans he did shortly after Matthew's admission to hospital. Lois Smith, an ophthalmologist said she had seen signs of recent retinal bleeding which showed extreme force had been used on him - equalling nine on a scale of severity from one to 10. The type of bleeding found in nine-month-old Matthew's eyes, she added, was "very, very rarely" seen in accident cases.

Brain scans can help date injuries, said the Ormond Street neurosurgeon, because the blood found between the brain and brain lining - the dura - changes colour with the length of the injury. Recent injuries would show up red, whereas older ones would change colour to grey and clear.

During the trial, Joseph Madsen, a paediatric neurosurgeon at Boston Children's Hospital, said that when he started to operate first a clearish, yellowish liquid, followed by blood, spurted from Matthew's skull. He agreed it had the appearance of serum - which the defence claimed is indicative of an old injury.

Jan Leestma, a neuro-pathology specialist, also said his examination showed evidence that a blood clot existed between the brain and the dura - before 4 February and there was evidence of re-bleeding in the area. The defence also called America's leading expert on shaken-baby syndrome, Lawrence Thibault, who raised the fact that there appeared to be no other injuries. Any violent shaking, he said, would have produced "injury to the neck, the structure surrounding the spinal cord and the cord itself". None of these was found.

But experts in Britain said the injuries were so severe they could not have been caused accidentally. Brian Neville, a paediatric neurologist at the Institute of Child Health/Great Ormond Street said: "The impact would have to be pretty immediate. There could well have been a previous injury that was partially resolved but the idea of building up pressure over three weeks - they wouldn't really do this. It would just make the baby ill. Something occurred of some severity."

A Home Office pathologist, Paula Lannas, agreed: "From my assessment of the evidence this is a tragedy for this little girl but in my opinion I believe her to be guilty. This sort of case arises all the time but she was unlucky because she got captured by the system. I couldn't accept that the injuries were three weeks old, as the parents were both doctors, and a child sustaining that extent of injury could not have appeared to be normal for three weeks leading up to his death. It would be apparent that something was wrong."

FootballGerman sparks three goals in four minutes at favourite No 10 role
Rumer was diagnosed with bipolarity, attention deficit hyperactivity disorder and post-traumatic stress disorder: 'I was convinced it was a misdiagnosis'
peopleHer debut album caused her post-traumatic stress - how will she cope as she releases her third record?
A long jumper competes in the 80-to-84-year-old age division at the 2007 World Masters Championships
Have you tried new the Independent Digital Edition apps?
ebooksAn unforgettable anthology of contemporary reportage
Radamel Falcao was forced to withdraw from the World Cup after undergoing surgery
premier leagueExclusive: Reds have agreement with Monaco
Arts and Entertainment
'New Tricks' star Dennis Waterman is departing from the show after he completes filming on two more episodes
tvHe is only remaining member of original cast
Lewis Hamilton will start the Singapore Grand Prix from pole, with Nico Rosberg second and Daniel Ricciardo third
F1... for floodlit Singapore Grand Prix
Life and Style
Walking tall: unlike some, Donatella Versace showed a strong and vibrant collection
fashionAlexander Fury on the staid Italian clothing industry
Arts and Entertainment
Gregory Porter learnt about his father’s voice at his funeral
Arts and Entertainment
tvHighs and lows of the cast's careers since 2004
Life and Style
Children at the Leytonstone branch of the Homeless Children's Aid and Adoption Society tuck into their harvest festival gifts, in October 1936
food + drinkThe harvest festival is back, but forget cans of tuna and packets of instant mash
New Articles
i100... she's just started school
New Articles
Life and Style
Couples have been having sex less in 2014, according to a new survey
Arts and Entertainment
musicBiographer Hunter Davies has collected nearly a hundred original manuscripts
New Articles
i100... despite rising prices
Holly's review of Peterborough's Pizza Express quickly went viral on social media
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
Independent Dating

By clicking 'Search' you
are agreeing to our
Terms of Use.

iJobs Job Widget
iJobs General

Volunteer Trustee opportunities now available at The Society for Experimental Biology

Unpaid Voluntary Position : Reach Volunteering: Volunteer your expertise as Tr...

Early Years Educator

£68 - £73 per day + Competitive rates of pay based on experience: Randstad Edu...

Nursery Nurse

£69 - £73 per day + Competitive London rates of pay: Randstad Education Group:...

Primary KS1 NQTs required in Lambeth

£117 - £157 per day + Competitive London rates: Randstad Education Group: * Pr...

Day In a Page

Scottish referendum: The Yes vote was the love that dared speak its name, but it was not to be

Despite the result, this is the end of the status quo

Boyd Tonkin on the fall-out from the Scottish referendum
Manolo Blahnik: The high priest of heels talks flats, Englishness, and why he loves Mary Beard

Manolo Blahnik: Flats, Englishness, and Mary Beard

The shoe designer who has been dubbed 'the patron saint of the stiletto'
The Beatles biographer reveals exclusive original manuscripts of some of the best pop songs ever written

Scrambled eggs and LSD

Behind The Beatles' lyrics - thanks to Hunter Davis's original manuscript copies
'Normcore' fashion: Blending in is the new standing out in latest catwalk non-trend

'Normcore': Blending in is the new standing out

Just when fashion was in grave danger of running out of trends, it only went and invented the non-trend. Rebecca Gonsalves investigates
Dance’s new leading ladies fight back: How female vocalists are now writing their own hits

New leading ladies of dance fight back

How female vocalists are now writing their own hits
Mystery of the Ground Zero wedding photo

A shot in the dark

Mystery of the wedding photo from Ground Zero
His life, the universe and everything

His life, the universe and everything

New biography sheds light on comic genius of Douglas Adams
Save us from small screen superheroes

Save us from small screen superheroes

Shows like Agents of S.H.I.E.L.D are little more than marketing tools
Reach for the skies

Reach for the skies

From pools to football pitches, rooftop living is looking up
These are the 12 best hotel spas in the UK

12 best hotel spas in the UK

Some hotels go all out on facilities; others stand out for the sheer quality of treatments
These Iranian-controlled Shia militias used to specialise in killing American soldiers. Now they are fighting Isis, backed up by US airstrikes

Widespread fear of Isis is producing strange bedfellows

Iranian-controlled Shia militias that used to kill American soldiers are now fighting Isis, helped by US airstrikes
Topshop goes part Athena poster, part last spring Prada

Topshop goes part Athena poster, part last spring Prada

Shoppers don't come to Topshop for the unique
How to make a Lego masterpiece

How to make a Lego masterpiece

Toy breaks out of the nursery and heads for the gallery
Meet the ‘Endies’ – city dwellers who are too poor to have fun

Meet the ‘Endies’ – city dwellers who are too poor to have fun

Urbanites are cursed with an acronym pointing to Employed but No Disposable Income or Savings
Paisley’s decision to make peace with IRA enemies might remind the Arabs of Sadat

Ian Paisley’s decision to make peace with his IRA enemies

His Save Ulster from Sodomy campaign would surely have been supported by many a Sunni imam