The ‘unified hypothesis’ of Geddeset al. is not supported by the data

Abstract

Inflicted head injury to the developing brain frequently results in serious disability. The pathogenesis of the neuraxial and ocular findings in infants believed to have suffered inflicted head injury remains the subject of considerable debate. Recent neuropathology studies of fatal cases of inflicted head injury and of a foetal/perinatal non-traumatic model have led to the proposal that there is a 'unified hypothesis', the essential feature of which is hypoxic brain swelling secondary to cervicomedullary injury. It has been suggested that less than violent forces may be involved and even that some cases may not be due to trauma at all. The purpose of this paper is to provide a critical review of the data upon which these suppositions are based on a background of what is already known. It is submitted that there are serious flaws in the methodology; the conclusions reached cannot logically be drawn from the data; and the 'unified hypothesis' is not supported by the evidence. On the basis of the data presented, it is also difficult to sustain the secondary hypothesis purporting to describe a minority cohort with 'infantile encephalopathy with subdural and retinal bleeding' of non-traumatic causation.

Subdural Hemorrhage and Hypoxia in Infants With Congenital Heart Disease

“…5 Thus, in some infants with unexplained SDH a presumptive diagnosis of AHT might be incorrect. Although controversial, 6 this "unified hypothesis" quickly appeared in court, culminating in a judicial review of criminal prosecutions for AHT in the United Kingdom, where deficiencies in the hypothesis were acknowledged. 7,8 Several subsequent postmortem studies have found no association between hypoxia and SDH in infancy, [9][10][11] but other authors continue to suggest a strong association between SDH and hypoxia in the presence of additional factors.…”

Shaken baby syndrome: the quest for evidence

“…44 The 2003 had macroscopic SDH. 30 My own experience is that if the dura is adequately sampled, dural and subdural membrane bleeding is frequent in association with macroscopic SDH. Again, careful prospective studies are needed.…”

Community paediatrics: Soft science or firm foundations?

“…Such was the seduction of precise mechanistic thinking that even Albert Einstein, when confronted with the ambiguities of the quantum world, declared in frustration that 'I shall never believe that God plays dice with the world'. 2 Controversies surrounding the diagnoses of autism 3,4 and nonaccidental head injury 5,6 are two of many examples that suggest an analogous degree of uncertainty applies to the world of community paediatrics. Traditionally, paediatrics has enjoyed the certainty of biologically defined constructs of health and health care as exemplified by the detail tested in the Fellow of the Royal Australasian College of Physicians (FRACP) written exam.…”