posted by admin on Feb 1
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1 Q With anything.
2 A These are in prematures and –
3 Q Well, how many weeks do you think this
4 child was, sir?
5 A I think it was between 28 and 31 weeks.
6 Q Okay. Any literature out there with
7 preemies of that same gestational age suffering a low
8 heart rate, any literature out there with subsequent
9 neurological outcome?
10 A Well, I think I’d go back and explore this
11 Volpe literature indicating that fluctuations in
12 cerebral blood flow are linked to intraventricular
13 hemorrhage. And I think that there’s, you know, a
14 series of articles that his groups worked on looking at
15 the relationships between fluctuations in blood flow
16 and hemorrhage. But that’s the — you know, I think
17 the accepted mechanism of hemorrhages, fluctuations in
18 cerebral flood flow. And bradycardia is a prominent
19 cause from that. And in a premature infant like this,
20 we can assume that the cerebral circulation is pressure
21 passive. So any bradycardia in the premature infants
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1 is going to be translated into reduced blood flow in
2 the infant.
3 Q Do you know of any of that Volpe literature
4 that talks about bradycardia for even a few seconds
5 causing brain damage in a subsequent infant?
6 A In a what?
7 Q Subsequently for that infant.
8 A Yeah, I think there’s — I think if you
9 follow the Volpe literature, there’s certainly
10 correlations between oscillations and cerebral flood
11 flow and bradycardia in the newborn nursery linked to
12 periventricular leukomalacia.
13 Q And in all of those articles by Volpe, and
14 even in his textbooks, isn’t it fair to say that
15 bradycardia has to last for a certain amount of time
16 before it will affect the fetus?
17 A I’m not sure of that. The main issue is
18 that the — it’s related to oscillations of blood flow,
19 ups and downs in blood flow. I don’t think there’s a
20 good connection between exactly how much time the
21 bradycardia occurs.
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1 Q Okay. In all of Volpe’s literature where
2 he talks about the oscillations, wouldn’t you agree
3 that those infants who are brain damaged have multiple
4 oscillations of bradycardias and normal heart rates?
5 A Well, at least they — I’m not sure if they
6 all have multiple. They have — I’m not sure there’s a
7 good connection between exactly how many and how long
8 they last, but there is a strong link between
9 bradycardia and — and oscillations in cerebral blood
10 flow.
11 Q Do you know of a single article, sir,
12 whether it’s by Volpe or anybody else, that says just
13 one or two oscillations of heart rate to a premature
14 fetus is enough to cause neurological brain damage to
15 the extent that this fetus has?
16 A I don’t — I can’t really think of
17 literature that’s addressed that one way or the other.
18 Q You mention in your report in the middle of
19 the paragraph, “My general opinion is based on research
20 indicating that injury to the developing brain occurs
21 when a critical threshold is reached as opposed to
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1 occurring incrementally in the cumulative dose-related
2 fashion.” Do you see that sentence?
3 A Yeah.
4 Q Are you referring to your own research,
5 sir?
6 A No. Well, I think my research, but other
7 research indicates that the — for example, the
8 Goddard-Finegold research, you withdraw blood, you
9 reinsert blood, and once you — once you’ve reached a
10 threshold of reduced blood flow, then that’s enough to
11 damage the brain.
12 Q Would your own research be included in
13 those articles you identified at the beginning of the
14 deposition from your CV?
15 A No. I just actually cited review articles
16 which are more clinical in nature. Mine is — related
17 to this topic is — is more related to — I guess I
18 don’t have anything definitely related to clinical work
19 on this topic, so I cited reviews that I wrote.
20 Q Then why did you tell me your opinion’s
21 based on your own research and others’ research,
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1 including the Finegold articles? Really it’s not based
2 on your own research.
3 A Yeah, my opinion is, but I just chose not
4 to — not to cite those articles because the other
5 articles I wrote, the review articles, incorporate my
6 own research plus others’ research.
7 Q So there are other articles on your CV now
8 that indicate you did personally your own research
9 which backs up your theory of this critical threshold,
10 correct?
11 A Well, I think they’re consistent with it.
12 I think that the ones that I cited are the — are
13 better ones because they’re broader. They cover a
14 wider range.
15 Q So the articles you cited on your CV at the
16 beginning of the deposition mention your personal
17 research about this critical threshold theory, correct?
18 A Right.
19 Q Okay. Do all the articles you cited at the
20 beginning mention that, or is there one or two
21 particular articles that mention your personal research
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