Autopsy Clears Medical Blanket in Baby's Death

A premature infant who developed a burnlike skin condition at Cook County Hospital last month died of natural causes unrelated to a luminous blanket used to treat jaundice, the Cook County medical examiner's office announced Monday.

The autopsy report for Michael Travis McKinney, who was born on April 10 and lived four days, said Michael had skin lesions over 40 to 50 percent of his body. The report said the injuries were the result of an extremely rare, probably hereditary condition called protoporphyria, which is aggravated by direct exposure to light.

But the report concluded that Michael died from bleeding in his brain - a common and untreatable complication in children born after only 24 weeks of gestation, as Michael was.

The results appeared to relieve the hospital and maker of the device, called a bilirubin blanket, of responsibility for Michael's death. Robert Clifford , a personal injury lawyer for Michael's parents, said although the report "raises as many questions as it answers," his clients have no immediate plans to sue the hospital or Ohmeda, the manufacturer.

"The parents want to be responsible," he said, pledging that he would not file a frivolous suit.

Since Michael's case first came to light, medical experts were perplexed at how the infant might have been injured by a device that gives off no heat and is routinely and safely used to reduce levels of toxic bilirubin. The boy?s family insisted the blanket was to blame.

The medical examiner's finding that the boy had protoporphyria suggests both the experts and the family were right.

Very little is known about the condition, which is so rare that even specialists don't know for sure how many infants have suffered from it.

"We're talking about less than a dozen recognized cases in the world," said Dr. Amy Paller, head of dermatology at Children's Memorial Hospital and one of the few international experts on protoporphyria.

An enzyme imbalance from the condition causes red blood cells to leak into surrounding tissue when the skin is directly exposed to light, such as that from a bilirubin blanket. Although no one knows for sure what causes protoporphyria in infants, it probably arises from a combination of genetic factors and blood transfusions given within the first days of life, Paller said.

Although the medical examiner's report did not indicate that the injuries from protoporphyria contributed to Michael's death, Clifford said he will consult experts to see if stresses from the injury might have been a factor.

Clifford questioned Donoghue's conclusion that there was no evidence of thermal injuries, given that "half a dozen other doctors" at two medical centers cited what they called "burns" in the child's medical chart.

Yet Paller said Clifford's concern comes from a common misunderstanding about injuries associated with protoporphyria.

"This has nothing to do with heat or thermal energy," Paller said. "This is a rare toxic reaction to the lights. But they look like burns, and when they're severe there can be swelling and blistering."

In the September 1997 issue of the journal Pediatrics, Paller and her colleagues described six cases of the skin condition from the last 10 years, including the only five known cases from the Chicago area. Describing the condition as "benign" and "transient," Paller noted that in several cases, doctors had initially classified the injury as a burn.

The Food and Drug Administration has been conducting its own investigation into the bilirubin blanket and Michael's death. An administration spokesman said Monday that FDA investigators will release their final report "in the near future," after they have inspected the medical examiners findings.

Clifford said he will consult with experts to see whether injuries from the bilirubin blanket, though not the direct cause of Michael's death, were "part of a chain reaction that led to his demise." He said the blanket should not have been used on Michael because the child was not jaundiced and the FDA had warned against using the devise as a preventive measure in very premature infants.

Yet Dr. Jeremy Marks, a neonatologist at the University of Chicago Hospitals, said the minute risk of protoporphyria is outweighed by the benefits of light therapy, which can prevent the brain damage and death often brought about by jaundice.

"Treatment with a bilirubin blanket has become a norm and probably has to do with the good outcomes we get in many premature children," said Dr. Jeremy Marks. "The rare baby who has something like this should not cause us to rethink a very effective mode of therapy."