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

Dr. Brent O’Neill testified for the prosecution in District Court on Monday in the first-degree murder trial of 22-year-old 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 observed “extensive ischemia,” or an inadequate supply of blood, in the brain.

It showed up as black on the CT scan, and O’Neill said the left side of Caiden’s brain was completely black, meaning it 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, adding that “this was a very serious, non-survivable injury.”

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.

Demasellis said she was concerned that the subdural hematoma, a collection of blood outside the brain, might have been non-accidental and that “any time a child comes in with an injury that severe, it’s a possibility” that it wasn’t caused by accident.

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.

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

On Aug. 7, 2016, 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.

Caiden’s brain pressure on that day ranged from 36-102 millimeters, she added.

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 or abusive head trauma.

The last one, O’Neill said, is a common cause for the injury in younger patients.

Demasellis conducted the first brain death exam of Caiden the night of Aug. 9, 2016, and the boy showed no signs of brain function. The next day, Dr. Carleen Zebuhr conducted a second brain death exam and declared Caiden dead at 2:24 p.m.

O’Neill said that as a pediatric neurosurgeon, he has given a number of lectures on traumatic brain injuries in children and he has seen injuries from 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 said he was testifying based on his 14 years of personal experience as a pediatric neurosurgeon.

Mechanism of injury

O’Neill said he was told that Caiden fell off a coffee table and hit a dollhouse during the fall. Demasellis said a member of either the emergency room team or the trauma surgery team told her that Caiden had sustained his injuries from falling off a table.

O’Neill said he did not remember if he spoke with a detective, and Demasellis said Gillette Police Detective Jeremy Dowdy gave her more details on Caiden’s injuries and drew her a picture of how it allegedly happened. She did not know what happened to the drawing.

Both O’Neill and Demasellis said they were not shown any video or audio of Nielsen’s statements to law enforcement on how Caiden had received his injuries.

What Dowdy told Demasellis “heightened my concerns,” she said, because she didn’t think the boy’s injuries could possibly come from jumping from a 20-inch table.

During cross-examination, defense attorney Nick Carter asked her if she thought those injuries would be possible from a fall of 5 feet — Caiden was 39 inches tall, and added to the height of the table, this adds up to nearly 5 feet — and she said it depended on how much force was applied.

Child protection team

The Children’s Hospital Colorado child protection team, a group of doctors that is called in when there is suspected child abuse or neglect, said the injuries they observed in Caiden the day he arrived there were consistent with child abuse.

Dr. Denise Abdoo, a pediatric nurse practitioner and member of the child protection team, said she looked at the results of Caiden’s chest X-rays and CT scans and noticed several injuries, including brain swelling, a subdural hematoma, a jaw fracture and two rib fractures.

Those injuries, along with bruises on different parts of Caiden’s body, led her to diagnose that it was the result of child abuse.

The boy had bruises on his left scalp, left ear and left cheek, as well as on his chest, back and legs. The bruises on the torso and ear were concerning, Abdoo said, because children don’t normally bruise there like they would their knees or shins.

Abdoo said she spoke with Caiden’s mom, Crystal Hudson, to get a detailed medical history of the child. Hudson told Abdoo that the boy hurt himself after he jumped off a coffee table.

Abdoo said this didn’t make sense given the severity of the injuries and the fact that some of them were new while others were old. One of the rib fractures was healing, while the other was recent.

Abdoo also asked Hudson about any old injuries that Caiden might have suffered. Hudson told her that Caiden had fallen from monkey bars a month or two before Aug. 6, 2016, and that he fell off a church bench about a week before Aug. 6.

During previous testimony, Hudson told the jury that Caiden had fallen off a zip line at Sage Bluffs Park in mid-June, and later that same day he fell off some monkey bars at the same park.

Dowdy, the lead investigator in the case, said Hudson told him about the monkey bars but made no mention of a zip line. He also said that there are no monkey bars at Sage Bluffs Park and that Hudson said she did not actually see her son fall.

Hudson took Caiden to the emergency room June 13, 2016, the day after Caiden allegedly fell. Dr. Mark Kellam, the emergency room doctor at Campbell County Memorial Hospital who saw Caiden that day, said Hudson had told him that a toy had been thrown at Caiden, which might have caused him to fall.

During cross-examination, Carter asked Abdoo if she could date the bruises. She said she could not. He then asked if she could date the recent rib fracture, and she said she could not. She said it could be anywhere from one to 10 days old, but other than that, she had no idea how old it was.

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