Persistent pulmonary hypertension of the newborn (PPHN)
The prosecution’s claim: Acute desaturation episodes were treated as part of the corroborative clinical picture supporting the prosecution's narrative of deliberate harm.
Prosecution claim
Acute desaturation episodes were treated as part of the corroborative clinical picture supporting the prosecution's narrative of deliberate harm.
Counter-evidence
Persistent pulmonary hypertension of the newborn (PPHN) is a recognised cause of acute, severe, refractory hypoxaemia in neonates and is independently associated with prematurity, perinatal asphyxia, sepsis, meconium aspiration and congenital diaphragmatic hernia. PPHN can present as sudden severe desaturation that does not respond to escalating ventilation or oxygen therapy, mimicking the trajectory attributed to deliberate harm in several of the indicted cases. Echocardiographic confirmation is required for definitive diagnosis but is operator-dependent and not always performed in real time on a busy unit.
Key point: PPHN is the textbook differential for sudden severe desaturation in a newborn that does not respond to standard escalation. Without echocardiographic confirmation at the moment of collapse, it is routinely under-diagnosed.
What the jury heard
Desaturation episodes were treated as part of the prosecution's clinical-deterioration framework. PPHN as a specific differential was not foregrounded.
What the Panel says
PPHN is not one of the Panel's conclusions in any indicted case; the Panel's findings are case-specific and lie elsewhere. PPHN belongs to the same methodological point: a differential that was never tested for cannot be treated as excluded, and a natural cause that was never excluded cannot support a finding of deliberate harm.
What independent experts add
- PPHN diagnosis is operator-dependent and frequently retrospective in busy NICU settings.
- Echocardiographic confirmation at the moment of collapse is rarely available after the fact, which is why this differential is easy to leave untested — and impossible to exclude retrospectively.
- PPHN is not a Panel finding in any indicted case; it is one of the untested differentials, not a diagnosis the Panel reached.