Thursday December 1st 2022 - Chester Standard live updates
Colour Code
Blue text - Lucy Letby's (Defendant's) texts and Facebook searches
Green text - Countess of Chester Hospital medical staff
Black text - Police/Intelligence Analysts evidence
Orange text - Medical expert witnesses
Purple text - Agreed Facts and Parents evidence
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Day 33 of Prosecution Evidence
Baby G
Kate Tyndall Police Intelligence Analyst - Electronic evidence - sequence, hospital records & LL's texts
Birth May 2015, transfer to CoCH Aug 2015, and focus on 6th to 8th Sept 2015
9:06am
The jury have been told that today, the evidence will begin in the case of Child G.
A reminder that none of the children can be identified in this case, due to reporting restrictions.
9:13am
Previously in the trial, during the prosecution opening, prosecutor Nicholas Johnson KC told the jury there are three attempted murder charges in the case of Child G.
The prosecution say all three murder attempts happened in the neonatal unit in September 2015.
10:33am
The trial has now resumed, and the jury will be hearing the case of Child G, a baby girl.
Nicholas Johnson KC, for the prosecution, says intelligence analyst Kate Tyndall will first talk through the sequence of events, before a statement from the parents of Child G will be read out to the court.
10:38am
The court is first shown Lucy Letby's shift patterns for June 2015.
Mr Johnson says, for the indictment, the charges of murder and attempted murder for Childs A-F, Letby was on night shifts.
Letby was also on a night shift for September 6-7, the night Child G suffered a collapse. The prosecution say this was one of three murder attempts by Letby on Child G; the defence deny this.
10:41am
Child G was born on May 31, 2015, at Liverpool's Arrowe Park Hospital, at a gestational age of 23 weeks and six days. She weighed 535g - 1lb 2oz.
Previously, the court heard this baby was the most premature birth of all the babies in the trial.
She was in a poor condition at birth, requiring ventilation.
10:45am
She was cared for at Arrowe Park, a tertiary centre, until being transferred to the Countess of Chester Hospital on the night of August 13. At this stage she would have been a gestational age of 34 weeks plus 3 days.
Nursing notes for Child G on Friday, August 14, recorded by Caroline Bennion, note: 'Currently [Child G] is on CPAP Peep of 4 in 29-40% of oxygen...has been since 17/7/15 and has occasional desaturations. [Child G] is trialling off CPAP in ambient oxygen and manages 1 hour in 2 episodes daily. May be eligible to trial Optiflow.
'Fluids are all enteral feed.'
A further note: 'Mum intends to breast feed and is expressing well...first immunisations have been given on August 1.
'[Child G] has had metabolic bone disease but is not currently treated. Mum and dad have been shown around the unit and have been given contact numbers'.
10:48am
The court hears, from August 14 to September 6, Child G was treated at the Countess of Chester Hospital neonatal unit.
The next evidence presented to the jury will be from September 6 onwards.
At 2am on that day - when Child G was 99 days old - a feeding chart shows she was being fed with expressed breast milk, Gaviscon and a fortifier.
10:53am
The court is also shown a range of medications which were administered by Lucy Letby and another nurse, during that night, to Child G, before the handover at 7.30am.
For the day shift, the designated nurse for Child G was Vicky Blamire, who recorded hourly observations and was a co-signer for some of Child G's medication.
Consultant Dr Stephen Brearey records observations in an 11am clinical note.
It was noted that Child G's weight had increased, by this point, to 1.985kg (4lb 6oz).
10:56am
Vicky Blamire's note at 3.37pm records 'all safety equipment present and correct', and Child G continued to receive regular feeds.
Further prescribed medication is administered to Child G throughout the day.
Her note at 6.44pm records, for Child G, 'Another bottle completed this evening. Bowels now open'.
11:00am
The handover takes place for the night shift team at 7.30pm.
A different nurse to Lucy Letby - who cannot be named due to reporting restrictions - was the designated nurse for Child G this night.
Letby was the designated nurse for one baby in room 1.
The other nurse was the designated nurse for Child G in room 2, and another baby in a room whose location is unconfirmed on the chart.
There were a total of seven babies in the neonatal unit that night, being looked after by a total of five nurses.
11:03am
Lucy Letby was the co-signer for medication administrations for Child G, along with the designated nurse.
An observation chart for August 6 shows Child G's observations are made every three hours, with a heart rate in the 'normal' range at that stage.
11:07am
Letby had messaged colleague Kate Bissell at about 8.30pm enquiring about expressed breast milk for the baby she was the designated nurse for that night. The matter is clarified in the text conversation.
11:10am
Further medication is administered to Child G at 1.46am, signed by the designated nurse and Alisa Simpson.
At 2am, the designated nurse records observations for Child G and a neonatal feeding chart records this is Child G's 100th day since birth.
She received 45mls of milk via the nasogastric tube, with 'ph4' aspirates recorded. Child G was noted to be 'asleep' at this stage.
The milk was expressed breast milk, plus fortifier and Gaviscon.
11:13am
Lucy Letby writes a note, written in retrospect at 8.57am, where care of Child G was transferred to her following an 'event'.
The note says "written in retrospect for care given from 2am to present. [Child G] had large projectile milky vomit at 2.15am. Continued to vomit++. 45mls of milk obtained from NG tube with air++. Abdomen noted to be distended and discoloured. Colour improved few minutes after aspirating tube, remained distended but soft. Reg[istrar] Ventress asked to review. To go nil by mouth with IV fluids. Dr called to theatre."
11:15am
The designated nurse from the start of the shift records a note: 'nurse L Letby taken over care [of Child G] following vomit/apnoeic episode after 2am feed'.
11:16am
Dr Alison Ventress writes clinical notes, timed at 2.35am and written retrospectively at 4.40am.
They record: 'Called to r/v [Child G] urgently at 2.35am.
'Had very large projectile vomit (reaching chair next to cot + canopy). Abdo appeared discoloured purple and distended. [Child G] distressed and uncomfortable. Red in face and purple all over. [Oxygen] to 1L via nasal cannula...'
11:17am
Letby's note at 3am for Child G - 'bowels opened large green watery stool at 0300'.
11:19am
At 3.15am, Letby's note adds: 'Approx 0315 [Child G] had profound desaturation to 20%, marked colour loss with apnoea. Brady to 50s. Neopuffed in 100% oxygen, observations improved but [Child G] remained apnoeic. Drs arrived. Intermittently breathing/apnoea.
'Decision made to intubate. Moved to nursery 1...'
11:25am
Dr Ventress also noted Child G was planned to cannulate, with plan to administer fluids, but this was delayed due to the need to deliver another baby in the delivery room.
Later, she noted: 'called out of theatre to say [Child G] had gone apnoeic and dusky. Dr called in...
'On arrival sats 50% in oxygen. Receiving IPPV from nurse. Heart rate ok.
'Pink and well perfused with mask CPAP....[Child G] then had another profound apnoea and heart rate down to 70, sats 40%.'
The doctor adds Child G was then intubated, and 'IV vitamin K given due to blood from trachea'.
Mr Johnson says this is another case where a baby is bleeding at the mouth.
Dr Stephen Brearey noted: 'Called in at 0330...large vomit and loose watery stool earlier followed by desat and brady. Intubated by Dr Ventress on my arrival. A small amount of blood visible on intubation. Blood samples taken and sent...'good gas post intubation'.
At 3.45am, Child G's parents were notified by the former designated nurse.
11:27am
The blood sample for Child G is taken at 3.59am.
Lucy Letby records observations, a fluid balance and an intensive care chart for Child G at 4am.
The observations have gone, the the court hears, from every three hours, to every one hour.
11:30am
A blood gas record is shown for Child G, from August 14 to September 7. Lucy Letby has signed for the last of those records.
An x-ray of Child G is taken at 4.49am. Consultant radiologist Dr Amer Rehman records, for the abdomen, 'generally slightly distended bowel loops, but gas noted in rectum, no transition point, mural or free gas detected on balance'.
11:34am
Lucy Letby and Alisa Simpson are co-signers for medications for Child G at 5.15am, and for a neonatal infusion prescription at 5.30am.
Dr Alison Ventress notes, for 5.30am, 'approx 0530 had another profound desat, hr down ton 60 and sats to 40%. Taken off vent and IPPV neopuff via ETT.
'Recovered slowly but desat when back on vent ? ventilator problem so flow sensor changed + then whole ventilator changed'.
Dr Brearey also records Dr Ventress changed the ETT with 'less leak'.
Child G had 'one further brady and poor perfusion.'
Child G was sedated and 'will need discussion with Arrowe Park Hospital/Liverpool Women's Hospital'.
The parents were kept informed, the note adds.
11:37am
Dr Ventress notes, from 6.05am - 'profound desat to 40% + HR down to 80. Decision to reintubate. IPPV given via ETT initially. Heart rate 120 but sats remained 50% [despite increase in oxygen]
'ETT removed at 6.10am. Thick secretions ++ in mouth. Blood clot at end of ETT. IPPV via facemask given
'NG aspirated as abdo appeared v large ~100mls aspirated.
'Reintubated 0615 ETT with intubation drugs. Blood-stained fluid in oropharynx.
'Capnograph positive.'
The plan was to continue a series of medication, plus morphine, and keep parents updated.
11:39am
Lucy Letby noted: 'Reintubated at 0615 with intubation drugs...clear air entry and bilateral chest movement. Blood gases as charted...10% glucose commenced. Morphine running...[Child G] agitated and fighting ventilator. [Medication given]. Now synchronising well.'
11:40am
Medication is administered, with Lucy Letby being a co-signer along with Alisa Simpson.
Dr Rehman has a further x-ray report at 6.36am, comparing observations with the previous x-ray. Among his observations, he notes: 'Lungs with slightly improved appearances, probably reflecting improved inspiration.'
11:46am
The former designated nurse are written retrospectively at 7.49am.
For the night '[Child G] was being nursed in a Kanbed with moniroting...
'Feeds 180ml/kg 3x8 ebm with fortifier and Gaviscon via alternate bottle/NGT. Abdomen full but soft with no discolouration. Aspirates minimal, partial digested milk. Passed urine and bowels open++. Short period of straining/uncomfortable at start of night when having cuddles with dad. Dr Ventress aware.'
The note adds care was transferred to Lucy Letby following Child G's large milky vomit just after 2am.
The nurse adds, for family communication 'dad present for early part of night shift, had cuddles with [Child G]. Parents called by me approx 3.45am...arrived shortly after'.
Recap: Lucy Letby trial, Thursday, December 1
