Although 3-year-old Caiden Fedora was officially declared dead on Aug. 10, 2016, a pediatric neurosurgeon who saw him at Children’s Hospital Colorado four days earlier thought that the injuries the boy suffered were “not survivable” and that Caiden was essentially brain dead on that day.

Caiden had been flown from Gillette to Aurora, Colorado, for further treatment on the severe head injury he'd received the morning of Aug. 6, 2016.

Dr. Brent O’Neill testified for the prosecution in District Court on Monday morning in the trial of Joseph Nielsen, who is accused of killing Caiden. O'Neill said that after looking at the results of a CT scan of Caiden’s head, he saw that there was “extensive ischemia,” or an inadequate supply of blood, in the brain.

The ischemia showed up as black on the CT scan, and O’Neill said the left side of Caiden’s brain was completely black, meaning that this part of the brain was dead, and a large part of the right side was black as well.

During a physical examination, Caiden showed no neurological responses, and “at that time, the exam was consistent with brain death,” O’Neill said.

“This was a very serious, non-survivable injury,” he said.

Dr. Gina Demasellis, a pediatric critical care physician, said Caiden had a “significant amount of bruising” on his forehead, below his chin, on his cheeks, around his collarbone, on the sides of his chest and abdomen and on his legs.

An intracranial pressure monitor was put in the boy’s head to measure Caiden’s brain pressure, and the initial reading was at 53 millimeters of mercury. O’Neill said treatment begins at 20 millimeters. A normal reading is about 10 millimeters, Demasellis said.

That just confirmed the doctors’ beliefs that Caiden would not survive the injuries, O’Neill said.

On Aug. 7, Caiden was put on an EEG to monitor his brain activity because severe brain injuries often increase the risk of seizures, Demasellis said. The EEG showed that Caiden had no brain activity.

O’Neill said that a subdural hematoma as large as the one he saw in Caiden is often seen from victims of a high-speed car crash, a downhill skiing accident, a fall from a two-story building and abusive head trauma. The last one, O’Neill said, is a common cause for this injury in younger patients.

As a pediatric neurosurgeon, O’Neill said he has seen hundreds of low-height falls, dozens of high-speed accidents and about a dozen falls from two stories or greater, he said.

But he could not name any specific studies off the top of his head about traumatic brain injuries in children. Instead, he was saying this based on his 14 years of personal experience as a pediatric neurosurgeon.

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