Medical experts in the trial of a man accused of murdering a Tauranga toddler say her unsurvivable injuries were the result of significant blunt force trauma.
One of the experts says the force used not only caused massive bleeding in and around the brain but also severe multiple haemorrhages in both eyes "too numerous to count".
The trial of Adrian Colin Clancy entered its second week in the Rotorua High Court today.
Clancy has denied murdering 17-month-old Sadie-Leigh Gardner in Tauranga on March 27, 2019.
On that date, the Crown alleges Clancy violently assaulted Sadie-Leigh while she was in his sole care, before seeking help from a neighbour for the unconscious girl.
Sadie-Leigh died two days later in Starship hospital.
The defence says there is no Crown evidence linking Clancy to the alleged assault.
Professor Colin Smith, an expert neuropathologist and an honorary consultant in neuropathology at the University of Edinburgh gave evidence by audiovisual link today.
Smith said he conducted a physical examination and also a microscopic post-mortem examination of the brain and spinal cord of the deceased.
He said there was acute fresh haemorrhaging in the brain but no evidence of previous haemorrhaging (old blood) in and around the brain.
Smith said these types of fatal injuries typically happened in road accidents or falls from a significant height or a crushing-type head injury.
The suggestion the toddler had motor skills and was walking around prior being put to bed on March 27 "was not compatible" catastrophic head injury, he said.
Without reasonable evidence of any prior head trauma such as a fall or crash, it was his assessment she suffered an "inflicted head injury," he said.
"In my opinion this is a case of blunt force head impact."
"What we have here is what appears to be relatively healthy child being found in her cot with a traumatic head injury," Smith said.
Under cross-examination by defence lawyer Kerry Tustin, Smith agreed he could not definitively say when the head injury was likely to have happened.
Dr Yvonne Ng, a paediatric ophthalmologist consultant, said she examined Sadie-Leigh's eyes after she was admitted to Starship hospital's intensive care unit on March 28.
She said examination with microscopic instruments revealed severe multiple retinal haemorrhaging in both eyes, "too numerous to count".
This included splits in the retinal layers which had a "dome-shaped" appearance.
Ng said the severity of the damage was highly suggestive of the child having undergone a significant trauma. It was consistent with sudden acceleration and deceleration traction.
She said these types of severe injuries were mostly seen in inflicted head injuries, such as severe crushing, deliberate significant shaking or falls from several storeys.
Ng told the jury that the amount of force needed to cause this amount of damage to both eyes would have been "quite significant".
"We are not talking about a playful shake certainly, not even in rousing the child."
Under questioning from Crown prosecutor Richard Jensen, Ng said with this sort of injury she would expect the significant impacts would be apparent to others immediately.
"I would not expect the child to be behaving normally and running around,"she said.
Ng said in her opinion an inflicted impact left the child with severe haemorrhaging and resulted in the loss of peripheral sight and unsurvivable injuries.
Under questioning by Tustin, she agreed she could not say when the damage to the toddler's eyes occurred but said it would have happened at the same time as the head injury.
She said she discounted any delayed impact from an earlier trauma as there was no evidence or witness statement to support that proposition.
Dr Peter Heppner, the head of paediatric neurosurgery at Starship hospital
also gave evidence for the Crown yesterday by audiovisual link.
He said the cause of death was the result of significant blunt force trauma to the head which led to skull fracture and a significant lack of blood and oxygen to the brain.
Heppner said while he could not definitely say when the injury was inflicted, if the child regained consciousness it would only have been for about five to 15 minutes.
He said it was difficult to be absolutely categorical in terms of the timing of the injury.
However, Heppner said with this type of head trauma, the acute subdural bleeding in the brain tends to happen fairly quickly after the injury is inflicted.
Heppner said by far the most plausible explanation for the head injury was blunt force injury inflicted on Sadie-Leigh within 15 minutes of her going into a coma.
Under questioning by Clancy's lawyer, he agreed he could not definitively say whether the toddler's injuries were accidental or deliberate without looking at all the other factors.
The trial continues.