Pretoria - A two-year-old girl known as Baby L had such severe brain swelling that part of her brain died, the High Court in Pretoria heard on Thursday.
Baby L's 20-year-old mother and her 36-year-old boyfriend are on trial for allegedly trying to kill her, neglecting her, and failing to get medical treatment for her.
They have pleaded not guilty, claiming the toddler fell down a flight of stairs and off a washing machine.
Dr Sizwe Mbili, the neurosurgeon who treated Baby L after she was admitted to the Steve Biko Academic Hospital in Pretoria on December 30 last year, testified she was now in a vegetative state with minimal response to stimuli.
Her prognosis was poor, especially as she had sustained brain damage at such a young age before she could learn certain functions. She was unlikely to ever learn these and required constant care for basic functions such as turning and feeding.
Mbili testified that Baby L had been treated by a multi-disciplinary team because of the severity of her head and other internal injuries.
The court earlier heard that the toddler had bruises at various stages of healing all over her body, a fractured hip, swollen kidney and a severe injury to her pancreas, for which she needed emergency surgery.
Mbili said Baby L had been comatose and on a ventilator when she was admitted to the hospital's intensive care unit. She had a very low level of consciousness, low blood pressure, a low pulse and very little response to pain.
The reaction of her pupils to light was a sign of severe brain damage. A scan showed her whole brain was swollen and there was evidence of a small bleed and reduced blood flow to the brain.
She had to be sedated and put in a coma to suppress any activity in the brain to reduce the swelling. Parts of her brain started to die as a result of the pressure of the swelling.
He said the damage shown on a scan taken on January 1 did not fit with an injury sustained on December 27, when she was admitted to Steve Biko for the first time, but under a different surname.
Mbili described the injury to Baby L's brain as a high velocity injury which damaged the whole brain and was likely to have been caused a day or two before she was admitted to the hospital for the second time on November 30.
She was discharged the first time and her caregivers told to watch out for symptoms.
Mbili believed it was unlikely that the small brain bleeds shown on a scan during Baby L's first admission could have escalated over time to cause such drastic swelling.
He said a near drowning could have contributed to the swelling of the brain, but would not have caused the bleeding.
He could not pinpoint exactly what had caused the brain to swell, although the toddler had bruises on her head.
Pieter Coetzee, for the mother, put it to the surgeon that Baby L had been “fine and smiling” when she left for work on the morning of December 30 last year.
He also put it to Mbili that Baby L should have received an urgent operation to stop the brain bleeding.
Mbili disagreed. He said the brain bleeding had been in an inaccessible area of the brain and there were other means available to control the bleeding and inter-cranial pressure.
The trial continues on Monday.
Sapa