Wednesday January 18th 2023 - Live Updates Chester Standard
Day 40 of Prosecution Evidence
Baby H
Electronic Evidence
12:19pm
Intelligence analyst Kate Tyndall has been recalled to court to talk the court through the sequence of events for Child H, presented as an electronic bundle of evidence.
As before, the sequence of events features medical charts, nursing/doctors' notes, significant events, plus timestamped evidence of messages recovered from Lucy Letby's phone.
The events show Child H was admitted to the neonatal unit at 6.40pm on September 22, 2015, shortly after being born.
12:27pm
Letby sends a message to a nursing colleague on September 23 informing her she's rearranging her shifts, and will be working with her.
She also informs her mother she's working that night as an extra shift.
She also messages another colleague to say how busy the unit is likely to be that night.
The following day, Letby messages a colleague to say the "It's completely unsafe", followed by a frowning emoji.
She messages a friend that work is "extra mad" so she wouldn't be able to do hula hoop [exercise].
She messages a colleague on the number of babies in the unit, in reference to how busy it was on that shift, and how she had not had chance to 'catch up on Corrie' [Coronation Street].
12:35pm
Letby is then recorded as being the designated nurse for Child H for the night of September 24-25.
Dr Alison Ventress records clinical notes of a lung issue for Child H that night.
X-rays at 1.40am and 2.29am on September 25 were taken. Child H was diagnosed with a punctured left lung.
Dr Ravi Jayaram records a desaturation for Child H and a test was carried out for a collapsed lung.
12:36pm
Letby sent a text to a colleague at 3.07am on September 25: "Can I go now??"
The colleague responds a few minutes later: "Yes. Let's run off together and rescue [colleague] too."
12:43pm
Letby's medical note for the morning of September 25 recorded the "profound desaturation" at 5am, with the fingers on the right hand noted to be white, along with a white patch on the abdomen.
12:50pm
The intelligence analyst continues to talk through the sequence of events, with descriptions of the care being given to Child H throughout the day on September 25, 2015, which includes another desaturation in the afternoon.
The cardiac arrest team is beeped at 4.23pm to attend the neonatal unit.
12:58pm
The sequence goes to the night shift of September 25-26, in which Lucy Letby is listed as a designated nurse in nursery room 1 for Child H. No other babies are in nursery room 1, with four babies (including Child G) in room 2, four in room 3 and four in room 4.
2:08pm
The sequence of events continues, with clinical/routine records relayed to the court on September 25. A blood transfusion for Child H is begun at 11.05pm.
A desaturation for Child H is recorded at 11.30pm, with Letby writing the note up retrospectively at 4.14am the following day.
Observations are being taken more regularly due to the blood transfusion, the court hears.
2:19pm
A morphine bolus is administered to Child H at 1.30am on September 26, and the blood transfusion is recorded by Letby as being completed at 2am.
However, a separate, handwritten paper record shows the blood transfusion having been completed at 3.05am. This separate record is not signed by anyone.
Letby records 'poor blood gas and 100% oxygen requirement' and a third chest drain was inserted around this time, the court hears.
Dr John Gibbs records this as being about 2.15am, as the chest x-ray showed a re-accumulation of Child H's left-sided pneumothorax (ie a collapsed lung). A further, third chest drain was inserted to relieve the pressure.
2:24pm
At 3.22am, Child H suffered a 'profound desaturation and colour loss to 30%'.
Letby records: 'Good chest movement and air entry, colour change on CO2 detector. Neopuff commenced in 100% oxygen and help requested.'
An intensive care chart for Child H on September 26 records 'blood complete 0324 - RESUS'. The record is initialled by Lucy Letby.
Dr Alison Ventress confirms in a clinical record she was crash called at 3.24am as Child H "had desat requiring bagging...Sats 60s then heart rate down to less than 100 so nurses crash called, wasn't being handled at all, no trigger identified.'
Upon her arrival, Child H was 'being bagged via ETT, good chest movement, capnograph positive, sats 60%, heart rate 70 down to 50'.
A test for a collapsed lung was carried out and air was removed.
2:31pm
Dr John Gibbs, consultant paediatrician, records he was called from home at 3.30am and arrived at the neonatal unit at 3.36am. He saw 'CPR in progress', and Child H had no pulse when chest compressions stopped.
The sequence of events details the series of medications administered to Child H.
Lucy Letby's note records, for 3.46am, 'x3 doses adrenaline and x1 dose atropine given...chest compressions stopped at 0346, heart rate 180, saturations >90, placed back on to a ventilator, 30% oxygen'.
2:34pm
Letby recorded, for the Child H event at 3.22am, 'profound desaturation and colour loss to 30%, good chest movement and air entry, colour change on CO2 detector, neopuff commenced in 100% oxygen and help requested. Serous fluid +++ from all 3 drains, became bradycardic. Drs crash called and resus commenced as documented'.
2:37pm
Letby records a Child H family communication at 4.28am: 'Parents visiting at start of shift. Updated on condition and advised to try and rest overnight. Midwife contacted during resus to [help take mum to the unit].'
A follow-up note said parents were concerned about the possibility of brain damage, and Child H remained poorly and could relapse. Dr John Gibbs offered a blessing to be administered and the parents accepted the offer.
Child H was then blessed with parents and family members present.
2:39pm
Letby recorded 'good blood gas at 0700 - ventilation reduced to 22/4, and rate reduced...in 26% oxygen. [Child H] appears settled.'
2:54pm
A series of messages recovered from Letby's phone, of messages sent to and from her phone at around 9am on September 26, are shown to the court. They include Letby's colleague Yvonne Griffiths commending Letby for "all your hard work these last few nights". She says Letby "composed" herself "very well during a stressful situation" and it was "nice to see" her "confidence grow" as she advanced throughout her career.
Letby shows this message to a colleague and asks her how she should reply. Her colleague expresses surprise. A series of messages are exchanged between Letby and the colleague acknowledging there had previously been "bitchiness" among staff and there had been "comments" about Letby regarding her role which Letby had found "upsetting".
2:56pm
Medical notes record Child H's parents were present as treatment continued for the baby girl, with further medication administered during the day of September 26.
3:11pm
The trial is now resuming following a short break.
Intelligence analyst Kate Tyndall is continuing to talk through the sequence of events, which had reached the night shift of September 26-27, 2015.
3:14pm
At this point, Child H was the only baby in room one of the neonatal unit, and for this night shift (September 26-27), Letby was the designated nurse for two babies in room two.
3:19pm
There is a further, profound desaturation for Child H, with a crash call made at 8.49pm.
Dr Matthew Neame recorded attending to the neonatal unit.
Letby, on shift, messages a colleague at 9.31pm to give an update on Child H's progress throughout the day.
She messages colleague Alison Ventress a couple of moments later to say Child H 'had a stable day', and took out the original drain at 8pm, adding 'just blocked tube, lots of secretions!'.
3:22pm
Letby messages her colleague, for Child H, 'I've been helping Shelley [Tomlins, designated nurse for Child H that night] so least still involved but haven't got the responsibility'.
Colleague Alison Ventress messaged Letby: "Never known a baby block tubes so often!! Glad she's had a stable day..."
3:26pm
Letby messages a colleague just before 11pm, lamenting that she had forgotten to record Strictly that night, and BBC iPlayer doesn't work on her iPad.
Letby then is recorded as being on Facebook at 12.45am and 12.46am, liking a post and photo.
Child H then has a 'profound desaturation' timed at 12.55am. Nurse Shelley Tomlins recorded: 'profound desaturation to 40% despite equal bilateral entry and positive capnography'.
3:31pm
Staff were crash called to the neonatal unit room 1. Dr Matthew Neame reintubated Child H and chest compressions were started at 1.07am. Child H's heart rate dropped to 40bpm.
Adrenaline was administered.
Chest compressions were discontinued at 1.13am.
A request was made to transfer Child H to Arrowe Park Hospital.
"No explanation" could be found for why Child H had had such a profound desaturation, the court hears.
3:37pm
Child H had a further desaturation at 3.30am, and medication was administered.
The transport team arrived at 4.10am and Child H was handed to the transport incubator at 4.45am and the handover was completed at 5.20am.
Child H was cared for at Arrowe Park Hospital between 6.10am on September 27 to 11.30am on September 30.
3:49pm
Child H returned to the Countess at 12.15pm on September 30, and was discharged on 5.05pm on October 9, 2015.
3:51pm
Further messages found on Letby's phone from that morning are relayed to the court. Letby informed two colleagues what had happened to Child H that night.
Colleague Alison Ventress replied: "Think of all the babies you have saved and have gone home happily."
3:53pm
On October 5, 2015, Letby searched on Facebook for the mother of Child H, as well as two other parents involved in the case, in the space of three minutes at 1.15am.
3:57pm
A corrected slide from the sequence of events is now shown to the court, showing that for the September 26-27 night shift, Shelley Tomlins was the designated nurse for Child H in room 1 - the only baby in that room that night.
Lucy Letby was a designated nurse for two babies in room 2, with another nurse, Christopher Booth, looking after Child G in room 2. Four babies, including Child I, were being looked after in room 3, and four babies were being looked after in room 4.
4:02pm
Intelligence analyst Claire Hocknall has been recalled to talk the court through the neonatal review schedule for Child H.
5:17pm
Here is a story from today in court:
Lucy Letby trial: Baby ‘improved dramatically’ after hospital transfer
5:17pm
The case will continue tomorrow with further evidence heard in the case of Child H.
Recap: Lucy Letby trial, Wednesday, January 18
