Patent ductus arteriosus (PDA) — hemodynamic collapse in preterms
The prosecution’s claim: Acute desaturation and circulatory-instability episodes in indicted infants were framed as anomalous and as requiring a deliberate-act explanation.
Prosecution claim
Acute desaturation and circulatory-instability episodes in indicted infants were framed as anomalous and as requiring a deliberate-act explanation.
Counter-evidence
Patent ductus arteriosus (PDA) — a fetal cardiovascular structure that should close shortly after birth — remains open in a substantial proportion of preterm neonates and produces hemodynamic instability ranging from mild oxygen-dependence to abrupt cardiovascular collapse. The likelihood of haemodynamically significant PDA increases with prematurity: ~40-60% of infants born under 28 weeks and ~20% of late-preterm infants. PDA-mediated collapse can present suddenly, mimicking the trajectory the prosecution attributed to deliberate harm, and is documented in echocardiographic and clinical-management records that were variably available across the indicted cases.
Key point: A haemodynamically significant patent ductus arteriosus in an extremely preterm infant produces sudden cardiovascular collapse. It is the textbook differential for the trajectory the prosecution treated as anomalous.
What the jury heard
PDA was acknowledged as part of the general clinical context for some infants. Its independent association with sudden circulatory collapse was not given equal weight as a competing explanation.
What the Panel says
PDA is not among the Panel's conclusions in any indicted case — its findings lie elsewhere and are case-specific (thrombosis, sepsis, haemorrhage, pneumothorax, hypoglycaemia, untreated infection, birth injury). PDA belongs to the Panel's methodological point rather than to its diagnostic one: well-characterised natural causes of sudden collapse in preterm infants were never systematically excluded before a deliberate-harm explanation was adopted.
What independent experts add
- PDA prevalence by gestational age is documented in the BAPM management guidance and Cochrane review series.
- PDA is not a Panel finding in any of the indicted cases; it is one of the differentials the original expert approach did not systematically exclude.
- Echocardiographic findings in the indicted cases — where available — are part of the disclosure-completeness review under the CCRC submission.