[Morizero]

> A toxicological screening of the “white curdled material” had detected codeine but not morphine. But Koren had claimed that the gastric contents “exhibited high morphine” levels—with no mention of codeine—“ruling out administration of Tylenol-3 to the baby.”

> “I don’t know what happened in that house, on that night, but I do know that someone gave this baby crushed Tylenol-3,” likely mixed in breast milk or formula. “That’s the only way these numbers make sense.”

Does no one care that this is potentially a murder case?

[alterom]

> Does no one care that this is potentially a murder case?

I'd say, a very low chance of murder, and a near-certainty of at least manslaughter (unintentional killing), with a zero chance of prosecution due to lack of evidence.

Plus, I hardly see any value of jailing any of the caregivers for this. Whether an investigation should be made, I don't disagree.

[hiyer]

Not just that, but potentially 17 other guilty caregivers have been cleared of suspicion based on the findings in that paper.

[teraflop]

I'd guess that everybody involved (including the coroner's office) tacitly understands that even if the baby was deliberately or negligently killed, there's very little chance after 20 years of finding evidence of who did it, in order to demonstrate guilt beyond a reasonable doubt. And if there's no chance of a conviction, there's no benefit to anybody from reopening the investigation.

The scientific case about infant opioid poisoning in general is a separate issue, of course. But assigning blame in this particular case doesn't have any bearing on that.

[thaumasiotes]

> And if there's no chance of a conviction, there's no benefit to anybody from reopening the investigation.

The benefit would be to formally reject the fake science that was used to close the investigation the first time. A conviction is beside the point.

[pickleRick243]

> And if there's no chance of a conviction, there's no benefit to anybody from reopening the investigation.

It's probably true that without a chance of conviction, standard protocol dictates that public resources should not be expended on reopening the investigation. But I was also heavily distracted while reading the article, scanning optimistically for the happy (under the circumstances) ending where justice is served. I certainly don't think there is "no benefit to anybody".

[Thorrez]

Why do you think someone intended to kill the baby?

>But the forensic-toxicology laboratory’s measurements showed that his acetaminophen concentration was in the range of what you’d expect to find in a baby’s bloodstream soon after he’d been administered a standard dose.

>“I am familiar with patients whose babies have died after a caregiver gave the opiate directly.”

Maybe the person thought the tylenol-3 would help the baby.

[radiator_1451]

Maybe the person thought that, but that would still be an absurd belief for them to hold. First of all, it doesn't seem like he had any problems he needed "help" with, the article only says he was "developing normally". Second of all, why would you give a random pill meant for adults to a baby not even two weeks old, without asking a nurse or at least reading the package insert?

[steelbrain]

> Does no one care that this is potentially a murder case?

Did we read the same article? Why are you so quick to jump the gun here?

> Koren obtained a sample of Rani’s breast milk, which she had kept in her freezer. His lab measured its morphine concentration at eighty-seven nanograms per millilitre.

If this is in the breastmilk, it will end up in the stomach, and it may end up in gastric contents. I don't understand this urge to demonize the parents, who on top of having lost a child, have to stand these witchtrials.

[pickleRick243]

Are you Koren? Did we read the same article? The one that calls into question anything Koren says or claims?

From the article I read:

"A twelve-day-old infant cannot crawl. It cannot grab, and it cannot put something into its own mouth. “It also cannot swallow a Tylenol-3 pill,” Juurlink told me. “I don’t know what happened in that house, on that night, but I do know that someone gave this baby crushed Tylenol-3,” likely mixed in breast milk or formula. “That’s the only way these numbers make sense.”"

[maxbond]

> If this is in the breastmilk, ...

Note that you and GP are talking about different values of "this." GP is talking about codeine, you're talking about morphine. The difference between the two is at the crux of this article.

[mlyle]

The original death finding falls just from simple back-of-napkin math.

87 ng/mL.

Baby eats 30mL per hour. That's 2.6 micrograms of morphine.

Elimination half life in neonates of ~8 hours means 30 micrograms in system at equilibrium if constantly fed this and the baby absorbs all of it (takes 4-5 half lives to get to that) and pharmacokinetics are linear. In reality a neonate likely absorbs well under 1/3rd, so you'd expect under 10 micrograms in equilibrium.

25-50 micrograms/kilogram is normal dosing of morphine in a neonate when it is necessary, every 6 hours (resulting in a peak systemic concentration of ~60-120 ug/kg after repeated dosing).

Compare -- 60-120 ug/kg therapeutic dosing to 10 micrograms in the neonate's body (3-4 kilos, so 3 ug/kg??)

And then, you end up with acetaminophen and codeine in the neonate's stomach, with no morphine... Even though these do not end up in breast milk in significant quantities.

[Twisol]

> I don't understand this urge to demonize the parents, who on top of having lost a child, have to stand these witchtrials.

Neither the article nor the commenter you replied to has demonized the parents. Yes, both the evidence discussed in the article and the opinions of those interviewed indicate direct administration of a pharmaceutical; it is appropriate to discuss this. Nobody has pointed the finger at anyone; it would indeed be quite inappropriate for such a discussion to be held in this forum.

[likpok]

The article goes into detail about how this level of morphine in the breastmilk could not have given the baby a lethal (or even clinically effective) dose.

Furthermore, Koren lied about what the tests showed the stomach contents to be: he omitted codeine entirely. Codeine (per the article) would not be expected to be transferred by breastmilk -- it's metabolized into morphine to be effective.