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See the 60-second demo →In an unreported 2025 Maryland Appellate Court decision involving Johns Hopkins Bayview, the court affirmed summary judgment for the defendants after excluding both of the plaintiffs' causation experts. The case involved a child born at 30 weeks who later developed cerebral palsy. The plaintiffs alleged that the defendants' negligence had caused the CP. The experts' reports built the causation chain on a constellation of biomarkers that, the court found, the medical literature did not establish as reliable indicators of the timing of neurological injury. And neither expert had addressed the elephant in the room: prematurity itself substantially elevates the cerebral-palsy baseline rate.
If you handle birth-injury cases as a plaintiff attorney — and especially if your case involves a premature delivery — the Bayview/Hopkins decision is the cleanest 2025 illustration of a structural reporting failure that defense bars across the country are now systematically attacking.
The plaintiffs were the parents of a child born at 30 weeks gestation. The child later developed cerebral palsy. The plaintiffs alleged that defendant negligence — at delivery and in the immediate post-delivery period — had caused the CP. They retained two causation experts, each opining that the CP was the result of the alleged negligence.
Both reports relied on a set of biomarkers that the experts treated as reliable indicators of the timing of the neurological injury. If the timing pointed to the period of alleged negligence, the causal inference followed.
The Maryland Appellate Court affirmed exclusion of both experts on three findings:
Summary judgment for the defendants. Affirmed.
The prematurity-as-alternative-cause analysis is the single most consistent failure mode in birth-injury Daubert practice in 2024–2026. The Maryland Bayview/Hopkins case is the cleanest example, but the pattern repeats:
Cerebral palsy in particular has a literature that the defense bar knows cold. The CP baseline rate in 30-week preemies is multiples of the term-baby rate. The medical literature is unambiguous on this. Any expert opining on CP causation in a premature child without addressing the prematurity-elevated baseline is, by 2026 standards, performing a methodologically incomplete analysis.
The deeper problem is that prematurity is a subtle alternative cause to address. It is not a binary like "the patient had a prior infection" or "the patient is obese." It operates probabilistically — increasing the baseline rate without specifying mechanism in any individual case. That makes it easy to overlook in the report. Defense counsel are not overlooking it.
Four concrete steps:
1. Build the prematurity-adjusted baseline-risk analysis into the report's structure. The report should contain a section that explicitly addresses: (a) the recognized baseline rate of CP at the gestational age in question, (b) the published evidence on how that baseline compares to the term rate, and (c) why the alleged negligence — rather than prematurity itself — is the more likely cause in this specific case. The analysis cannot be skipped. The defense will surface it if the report does not.
2. Audit biomarker reliability against the published literature. Many birth-injury causation reports rely on neuroimaging findings, cord blood gases, Apgar scores, base deficit, and similar biomarkers as timing indicators. Some of these are well-supported in the literature; some are not; and the support depends heavily on the specific clinical context. Before the report cites a biomarker as a reliability anchor, the literature should be checked. The Bayview/Hopkins court's central reliability finding was that the experts treated biomarkers as more reliable than the literature supports. Avoid the same defect by checking the support before relying on it.
3. Anchor the timing analysis in literature, not in the expert's clinical experience. "I have seen this pattern before" is not a Daubert-compliant timing analysis in 2026. The timing inference has to be supported by published evidence specific to the biomarker, the gestational age, and the clinical context. If the literature does not support the precise inference your expert is drawing, the expert needs to acknowledge that in the report rather than gloss over it.
4. Sequence the alternative-cause matrix correctly. In a premature-birth CP case, prematurity is the leading alternative cause and should be addressed first in the report's etiology section. Other alternative causes — intrauterine infection, placental abruption, genetic syndromes, metabolic disorders — follow. Sequencing matters because a report that addresses the second-most-likely alternative cause but skips the most likely one looks result-driven. The defense will say so.
A broader point: birth-injury cases in 2026 require a literature-anchored, alternative-cause-first reporting structure. The clinical-narrative reports that worked in 2018 do not work now. The fix is procedural — change the report's structure — but the structure has to be in place from the start of the engagement, not retrofitted after the defense Daubert motion arrives.
MedLegal AI's Daubert workup tool ships a birth-injury alternative-cause matrix that loads with the case at intake. For each gestational age, the tool surfaces the CP baseline rate from the published literature and flags any draft report that does not address the baseline-rate adjustment in its etiology section. The tool also runs a biomarker-reliability audit, cross-checking each biomarker the report cites against the literature on its reliability for the specific timing inference being drawn. For cases involving HIE, infection, abruption, or other clinical contexts, the tool maintains a literature-anchored alternative-cause checklist that mirrors the analytical structure the Maryland Appellate Court (and the Delaware Supreme Court in Scottoline) would have credited. The point is to prepare smarter for Daubert challenges — to give birth-injury experts a report structure that addresses prematurity and other alternative causes before the defense surfaces them. You can run a free Daubert workup on your expert here.
The Bayview/Hopkins decision is the cleanest 2025 cautionary tale for plaintiff birth-injury attorneys handling premature deliveries. The structural defect was not subtle: neither expert addressed prematurity itself as the leading alternative cause for CP in a 30-week preemie. That failure mode is now systematically attacked by the defense bar in CP and birth-injury cases nationwide. The fix is procedural and inexpensive — sequence the etiology section to address prematurity first, anchor biomarker reliability in published literature, and audit the alternative-cause matrix before the report is signed. The cases that survive Daubert in 2026 will be the ones whose birth-injury reports look fundamentally different from the Bayview/Hopkins reports.
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