Child F

Pathology

At trial the Crown relied on a laboratory result for Baby F of insulin 4,657 pmol/L with a C-peptide of 169 pmol/L, presented as diagnostic of exogenous insulin. No fatal outcome. Panel conclusion: Baby 6 had prolonged hypoglycaemia because of sepsis, prematurity, borderline intrauterine growth restriction, lack of intravenous glucose when the long line infiltrated for several hours, and poor medical management of the hypoglycaemia; and his insulin level and insulin/C-peptide ratio do not prove that exogenous insulin was used, being within the norm for preterm infants. The Panel directly contradicts two prosecution premises: the blood sugar did not rise from 1.3 to 2.4 when the dextrose infusion stopped between 1000 and 1200 (it was 1.4 at 1146; the 2.4 was measured after 1200, once the drip was restarted), and the sugar rose after 1900 not because the infusion bag was changed but because the dextrose was increased to 15%. Because bags were prepared in pharmacy and stored on the unit, multiple bags would have had to be contaminated. The Panel also notes the C-peptide was not low for a preterm infant (20th–45th percentile), potassium was normal (insulin lowers potassium), and insulin autoantibodies — common in preterm infants — bind insulin and raise measured levels. On the C-peptide specifically, the Panel notes it was not low for a preterm infant (20th–45th percentile) — adult reference ranges do not apply.