In birth injury cases, frequently the hospital's lawyers will claim that the baby suffered an unknown, unknowable, unforeseeable event in the uterus before labor ever started that damaged the baby's brain - rather than the provable negligence of the healthcare team. As ridiculous as this sounds, they actually get experts to agree with this theory. So, it falls on the baby's lawyer to mount a credible and persuasive response to this claim.

Recently a study was published in the journal Neonatology 2009;96:211-218 that shows that liver enzyme derangement cannot be reliably used to predict when a baby's brain was injured. The published abstract is as follows:

Abstract Background: The term newborn pig is an established model for studying both brain and organ pathology after hypoxia- ischemia (HI). Serial liver enzyme activity is often used to predict liver injury but little is known about the relation between consecutive values of different liver enzymes and histologically verified liver injury. Objective: To determine whether plasma values of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) differed between newborn pigs with liver injures and pigs with normal livers after a severe global HI insult. Methods: Nineteen ^ 36-hour-old pigs underwent a 45-min global HI insult followed by 72-hour survival. Four histological sections from standardized areas within each liver were examined. Areas under the curve (AUC) for the enzymes were calculated and compared between pigs with pathological changes in the liver (n = 12) and pigs with normal liver histology (n = 7). Results: No differences in AUC for the enzyme values were seen between the groups. However, in pigs with liver injuries a transient significant increase in LDH at the end

of the HI insult (928 U/l (567-1,031)) was seen compared to the baseline value (679 U/l (548-866), p = 0.010). Significantly more liver injury was seen in animals with the umbilical vein catheter (UVC) tip inserted into the liver (p = 0.040) compared to animals with the UVC tip located outside the liver. Conclusions: In newborn pigs subjected to global HI, only LDH increases alongside pathological changes in the liver. Normal values of ALT and AST do not exclude hepatic injury.