A chemical flaw in the physical makeup of a mother's three babies was "top of the list" of probable causes for their deaths, a court has been told.
Mrs Patel's denies murdering her three children
Pharmacist Trupti Patel, 35, of Maidenhead, Berkshire, denies murdering her three babies, Amar, Jamie and Mia, between 1997 and 2001.
Professor Peter Fleming, a paediatrician at Bristol Royal Children's Hospital and an expert of infant health, said all the evidence pointed to them having died from a metabolic disorder.
He told Reading Crown Court that an inborn error of metabolism was "by quite a long way
top of the list" of probable causes.
Earlier Prof Fleming, who has been awarded the CBE for his research into sudden infant death, told the court that the level of ammonia found in Jamie's blood was "exceptionally high, extremely high".
Prof Fleming said he had "never seen it go this high" as a result of death from asphyxiation and said he believed a metabolic disorder was
"I cannot explain this level of ammonia on the basis of a cardiac arrest, circulation cessation or a shortage of oxygen.
"It is completely outside of my experience to see such an elevated level as a consequence of such
"I am looking for the presence of an additional factor - a metabolic condition - which has pushed it up to that level," he said.
The trial continues.