UK - Lucy Letby Trial - Media, Maps & Timeline *NO DISCUSSION*

[Tortoise]

Prosecution evidence, January 27th 2023, Day 47 - no live updates

Child I

Nurse Ashleigh Hudson - October 13th 2015 (night shift 12th/13th)

The infant had been 'very stable' 15 minutes earlier, when Miss Hudson stepped away from Nursery 2 to help a colleague in the high-dependency Nursery 1 [...].

She diverted for only 'seconds' to get some expressed breast milk she planned to give Baby I a short time later.

Unaware that the infant was unwell, Nurse Hudson returned to the nursery but did not immediately examine her. Instead she began preparing the milk with her back to Baby I's cot.

'Lucy was in the doorway. We were talking, I don't remember the content of the conversation. (Then) she said she thought (Baby) I looked pale'.

[...]

'The main light for the room was switched off but the light in the corridor was on. So you were able to do things in the room and have enough light to see where your patients were and where the equipment was.'

[...]

Nurse Hudson said that after Letby made her remark about Baby I looking pale she looked towards the infant.

'I couldn't see her. I could see that she was in the cot, but I couldn't see the top half because she was covered by the canopy. I switched the main light on'.

[...]

Mr Driver: 'Was there anything about the layout or lighting that would have afforded her a better view of the baby than the one you had?'

Nurse Hudson replied: 'No'.

She added: 'After switching the light on I immediately went to I, pushed back the canopy and realised she was in quite poor condition'.

[...]

She was later shown various images and selected the one she thought showed the lighting as it was that day – September [October] 13, 2015.



[...]

Either she or Letby put out a crash call, and while other medics rushed to the room they began trying to resuscitate the baby.

Daily Mail Lucy Letby 'was in tears as she said 'it's always me when it happens'

 

[Tortoise]

Prosecution evidence, January 27th 2023, Day 47 - no live updates

Child I

Nurse Ashleigh Hudson - October 13th 2015 (night shift 12th/13th)

The court heard the main light was switched off in the nursery and Child I was in a cot with a canopy, which obscured the light from the baby's face, and had blankets covering her bottom half.

[...]

It was put to her that it would have been impossible to recall the exact lighting on the day in question.
She said she "couldn't claim for it to be precise, but it has been an image that has been imprinted on my brain for quite some time".

BBC Lucy Letby: Murder-accused nurse cried over baby collapses, court told

 

[Tortoise]

Prosecution evidence, February 1st 2023, Day 48 - no live updates

Child I

Registrar Dr Matthew Neame - 13th/14th October 2015

“My impression was the increase in abdomen distension may have caused (Child I’s) lungs to be squashed… making it hard for her to breathe.” [...]

At 7.45am, her heart rate fell “dangerously low” to below 60 beats per minute, said Dr Neame, which prompted CPR to begin.

Thirteen minutes of resuscitation from medical staff followed before she recovered. [...]


Mr Myers went on: “And the underlying cause could be infection in some cases?

Dr Neame said: “Yes (but) when seen infection is usually accompanied by other signs.”

Mr Myers said: “Or low oxygen levels?

The witness said: “It can be.”


Letby's Text Messages 14th October 2015

In WhatsApp messages read to the court, Ms Letby asked a colleague on the afternoon of 14 October if Child I was staying on the unit.
She added: "I'd like to keep her please."
Her colleague, who cannot be identified for legal reasons, replied: "Yes. Staying for now. OK re keeping."
An hour later the colleague messaged: "I've had to re-allocate. Sorry."
Ms Letby said: "Has something happened?"
The colleague replied: "No. Was just asked to reallocate so no one has her for more than one night at a time. Or one shift. Not just night."
Ms Letby responded: "Yeah that's understandable."


Chester Standard Lucy Letby trial: Doctor saw ‘unusual’ mottling on baby

BBC: Baby had unusual skin mottling, Letby trial hears - BBC News

 

[Tortoise]

Prosecution evidence, February 2nd 2023, Day 49 - live updates

Child I

Nurse Shelley Tomlins - 29th September 2015
Agreed Facts

10:35am

An 'agreed facts' statement is read out from nurse Shelley Tomlins, who recalls Child I.
She said she was the first one who looked after her upon her arrival, and looked after her multiple times.
She recalls Child I "definitely" had feeding and gut problems, and problems with a distended abdomen.
She said "it was like" there were blockages in her bowel.
For September 29, 2015, she was the designated nurse on a long day shift. Child I was "mottled" in appearance, with blotchy skin. She said some babies looked like that "all the time", and for some it was a sign they were not well.
She says she cannot say for certain, but the mottled appearance was "probably" all over her body.

10:37am

She says Child I had a cardiac arrest "as we were looking at her".
Resuscitation attempts began and the family arrived, along with Dr Ravi Jayaram, consultant doctor.
The nurse describes the procedures done to stabilise Child I.

10:42am

The nurse recalls a point when the bowels went "massive" and caused another collapse, as it impacted the lungs.
The nurse says the shift was significant for her as it was her last ever shift at the hospital, leaving the hospital a few days later.

LIVE: Lucy Letby trial, Thursday, February 2

Tweets

Court is now being read a statement from nurse Shelley Tomlins about her recollection of Child I. Her statement recalls how on October 14 2015, she went onto the neonatal unit to takeover her care from Ms Letby. While the nurses were talking, Child I went into cardiac arrest

'She had a cardiac arrest right as we were looking at her', Ms Tomlins' statement said. Child I required full resuscitation and was eventually stabilised on a ventilator 'I thought we had lost her', Ms Tomlins said

The nurse said the shift was significant for her as it was her last at the hospital before leaving for another job

https://twitter.com/MrDanDonoghue

 

[Tortoise]

Prosecution evidence, February 2nd 2023, Day 49 - live updates

Child I


Nurse Joanne Williams
Agreed Facts

Nurse Joanne Williams, in a brief agreed facts statement, recalls being involved in chest compressions for Child I.


Nurse Laura Eagles - 13th/14th October 2015
Agreed Facts

Laura Eagles, in her agreed facts statement, was also asked about the October 13-14 event for Child I. She recalls from the notes the collapses happened at 7am and 7.45am. She said Lucy Letby was the designated nurse, from looking at the notes.

She recalls who else was on shift and the other babies on that night, and that it was "very busy".

She recalls CPR began at 7.45am, and the 7.45am collapse was more or less a continuation of the 7am collapse.

She said from her memory, Child I was ill for a long time, and it was difficult to separate one event from another in her recollection.

Registrar Dr David Harkness - 13th/14th October 2015
Agreed Facts

10:51am

Dr David Harkness, in his statement, said October 13-14 was "quite an eventful night" for Child I.
He said Child I deteriorated and required CPR in the early hours.
His next recorded entry was on a ward round later on October 14. He said it was suspected Child I had NEC. She had had two "quite prolonged" cardiac arrests and was on a ventilator. Blood gases were "acceptable but not fantastic, and on the poor side".
There "had been a suggestion of a collapse of the left lung", which would explain why there were problems ventilating her.
Child I's bowels were open, which was a "good sign". Blood culture tests were awaited, for signs of an infection.

10:53am

Further tests were sought to check for NEC and to monitor Child I's bowels. If the signs were worsening, then surgery would be carried out.
Plans for 1-2 weeks down the line were to insert radioactive dye into the bowels to test for bowel obstructions.
By 4pm on October 14, Child I's signs had improved.

11:00am

Dr Harkness says NEC is difficult to diagnose without carrying out surgery, and suspected NEC is usually treated with antibiotics.
He says he remembers Child I's death, and the parents coming back a few times over the following year.

LIVE: Lucy Letby trial, Thursday, February 2

Tweets

Court now being read a statement from Dr David Harkness. His notes from October 14 2015 recorded that Child I had suffered two cardiac arrests - both lasting 20minutes or so. He said it was suspected that the infant was suffering from necrotising enterocolitis (NEC)

NEC is a serious condition that can affect newborn babies, where tissue in the bowel (small and large intestines) becomes inflamed

Dr Harkness' notes from 4pm on 14 October stated that Child I's condition was 'much improved'. They also noted that there were plans to put radioactive dye in her bowl to find what was causing problems in her abdomen. It may have required surgery, his notes say

But these were 'all plans for one to two weeks down the line'

https://twitter.com/MrDanDonoghue

 

[Tortoise]

Prosecution evidence, February 2nd 2023, Day 49 - live updates

Child I

Consultant Doctor at Arrowe Park Hospital 15th to 17th October 2015

The next statement is from a consultant doctor at Arrowe Park Hospital. The doctor recalls Child I was transported to the unit on October 15, with suspected NEC/inflammation of the gut, which is "not uncommon" in pre-term babies.

The intention was that Child I would be "conservatively managed" at Arrowe Park.

There was previously discussion on whether Child I should be transported to Liverpool Women's Hospital, but the decision was made to keep Child I in Chester. The following day, following further desaturations, Child I was transferred to Arrowe Park.

11:11am

Child I was "pink, warm and well perfused" and her vital signs were "within normal limits". She was ventilated with oxygen, nil by mouth, on IV fluids then with TPN bags. There was also sedation medication administered.
The plan was to stabilise Child I and continue antibiotics, with seven days of antibiotics and nil by mouth.
An x-ray showed tubes and a long line were in reasonably good positions.
At the end of the shift, Child I was "stable" until a "sudden desaturation" and bradycardia at 12.16am on October 16. She was 'Neopuffed', but there was no chest movement.
A test concluded the breathing tube had potentially moved, so it was removed. At the end of the tube was dark blood, likely from Child I's previous collapse in Chester.
Child I improved in the early hours of October 16 and notes showed no fresh bleeding, and a different form of breathing support began.
Child I was stable in 35% oxygen breathing support, with "no issues" in breathing and it was "reassuring" the tummy looked fine, and the abdomen was soft.

11:15am

Child I was moved to a high-dependency unit at Arrowe Park and her oxygen support requirements were diminishing.
There was "no longer a need" for tertiary requirement care, so Child I could be transferred back to the Countess of Chester Hospital.
A surgical plan was discussed for Child I, with a dye inserted into Child I to check for bowel obstructions, which would show on an X-ray.
On October 17, the transfer back to the Countess of Chester Hospital was confirmed, with Child I being transported back at 11am.

LIVE: Lucy Letby trial, Thursday, February 2

Tweets

We're back. Statement from a consultant doctor at Arrowe Park Hospital is being ready. Child I arrived at the Wirral hospital on October 15, with suspected NEC/inflammation of the gut, which is 'not uncommon' in premature infants

The intention was that Child I would be 'conservatively managed'. She was placed on nil by mouth and antibiotics. 'Vital signs were within normal limits' at this stage, doctor's notes stated

The court has heard that at 00:13 on 16 October the infant had a 'sudden episode' of bradycardia (slow heartate) after suction through her breathing tube - which is a 'normal procedure' that nurses carry out

She was paced on a neopuff manual ventilator and eventually stabilised

Child I continued to improve on October 16 and the decision was taken to move her back to the Countess of Chester Hospital the following day

Child I left Arrowe Park and was moved back to the Countess of Chester at 11am on 17 October 2015

https://twitter.com/MrDanDonoghue

 

[Tortoise]

Prosecution evidence, February 2nd 2023, Day 49 - live updates

Child I

Claire Hocknell, Intelligence Analyst - Electronic Evidence - Late October 2015

11:25am

Claire Hocknell, intelligence analyst for Cheshire Police, has returned to talk the court through the sequence of events for Child I, focusing on the 'fourth event' in late October 2015.
The sequence continues from Child I returning to the Countess of Chester Hospital at October 17, with charts and observations shown from October 22, after Letby had been off work.

11:27am

Nurse Ashleigh Hudson records, for October 22 at 3.04am, that Child I was 'pink and well perfused', with saturation levels above 96%, abdomen 'soft and non-distended'.
Child I was 'unsettled at start of shift and rooting, settled with dummy. Settled and sleeping at present'.

11:39am

Nurse Caroline Oakley recorded, for 8am on October 22, Child I's observations were satisfactory.
Further observations by a colleague said Child I was 'pink, alert, active handling well'.
At the end of the day, Child I was noted to be very hungry.
Hourly observations, the prosecution say, were carried through the day and were "unremarkable".
Letby begins her night shift that evening. A slide is shown to the court showing Child I was in room 1 with one other baby. Ashleigh Hudson was the designated nurse for both babies.
Letby was the designated nurse for a baby in room 2 and one in room 3. Another baby in room 3 was Child G. Two babies were in transitional care, and there was another baby whom the prosecution have been unable to confirm their location for that night.

11:40am

Asheligh Hudson records Child I, at the start of her shift at 7.45pm on October 22, was 'unsettled and rooting at start of shift, settled with dummy and containment holding'.

11:45am

Letby messages a colleague to say that night had 'only 8 babies' in the unit, and there is a discussion over transporting a baby to Stoke.
She adds: "I think I need to see greys anatomy !!!"
Later in the conversation, Letby messages to say Child I "had abdo scan that was fine".

11:47am

Letby messages colleague Jennifer Jones-Key, who had enquired "How's work". Letby replies that one of the babies she is looking after that night is being transported out that night.
The prosecution say that would then leave her with one designated baby that night.

11:50am

Ashleigh Hudson records at 10.57pm, 'long line removed due to constant occlusions. Neonal nurse Lucy Letby unable to flush...'
The long line was removed and the TPN [nutrition bag] was moved to a peripheral line.
Child I was observed to 'tolerate this very well'. 'Sucrose offered, but happy with dummy'. Child I was 'pink and well perfused'.

12:06pm

The jury is returning after a 10-minute break, and the trial is now resuming.
Claire Hocknell is continuing to talk through the sequence of events, from 11pm on October 22, 2015. An observation chart shows three-hourly observations are made for Child I through the day (eg 11am, 2pm, 5pm, 8pm), but no record is made at 11pm.

12:10pm

Nurse Ashleigh Hudson records a retrospective note at 11.57pm that Child I was "very unsettled...due to huger as rooting. Dummy offered and containment holding to no effect."
"After repositioning, [Child I] became quiet, apnoeic and dusky in appearance. With help of neonatal nurse Lucy Letby, repositioned [Child I] on to her back, and at first applied Neopuff with 30% O2..."
A crash call was made to the unit at midnight. Cardiac compressions began.
Dr Rachel Chang records, at midnight, confirming being crash called and giving chest compressions.
Ashleigh Hudson records consultant paediatrician Dr John Gibbs is also called to the unit. He arrives, according to swipe data unit, at 12.06am.

12:12pm

Child I was put on to a ventilator, was more alert, and crying.
The abdomen was soft and not distended prior to ventilation, the court hears.
An x-ray is carried out at 12.23am.

12:16pm

Child I was extubated and 'coped well', was 'relatively settled' and 'sucking dummy' at about 12.35am.
Dr John Gibbs recorded Child I had been 'resisting ventilation', so was extubated.
The cause was recorded as 'likely generalised lung collapse'.
Int he plan: 'If further similar collapses will need full ventilation (with paralysis)'.
Nurse Ashleigh Hudson records informing the parents of what happened.

12:19pm

At 1.06am, there is a further event for Child I - another collapse, the prosecution tells the court.
Nurse Ashleigh Hudson records: 'Child I became unsettled again. Dummy/sucrose offered with no effect. Slowly became dusky and O2 dropped to 60s, HR 70s. Ran to labour ward theatre to inform [senior staff].'
Letby was one of two nurses administering breathing support to Child I via Neopuff.
Dr Rachel Chang is recalled to the unit, arriving at 1.12am.
Compressions restarted and Child I was reintubated. At this time, Child I's mother had rung the hospital and she was advised to attend hospital immediately, the court hears.

12:25pm

Adrenaline is administered to Child I and Dr John Gibbs is called to the unit again. He arrives at the unit at 1.23am.
A saline bolus is administered to Child I at 1.22am. The medication is co-signed by Lucy Letby and Christopher Booth.
Dr Gibbs records, for 1.25am, Child I had 'poor perfusion - mottled, purple-white'. Sats were in the '70s, pulse 50-60'.
More adrenaline is administered, along with sodium chloride and atropine.

12:28pm

A dose of 10% glucose is administered at 1.38am, co-signed by Ashleigh Hudson and Christopher Booth.
Another dose of adrenaline, the fifth, is made at 1.40am, co-signed by Lucy Letby and Christopher Booth.
The administration of calcium gluconate is made at 1.40am. A sixth dose of adrenaline is made for administering at 1.43am.
Compressions stopped at 1.45am, having begun at 1.16am. Dr John Gibbs adds Child I 'remained mottled and poorly perfused'.

12:32pm

At 1.50am, Dr John Gibbs records: 'HR to 70, sats 70-80 and no pulse palpable. Cardiac compressions restarted at 1.50am'.
Another dose of adrenaline, the seventh, is made at 1.56am, followed by an eighth at 2am.
Dr John Gibbs records Child I was 'not responding to prolonged resuscitation and although her heart was beating there was no effective circulation.
'2.10am hr 40/min on monitor - no pulse (but heartbeat audible without cardiac compression)'.
Ashleigh Hudson records she and Lucy Letby had spoken to the parents about what had happened, and a decision was made to bathe Child I.
Child I's time of death was recorded as 2.30am on October 23, 2015.

12:37pm

Ashleigh Hudson records, at 6.25am: 'NGT on free drainage, produced 2mls. Minimal aspirations of clear mucus and air++ during both resuscitations'.
A colleague of Letby messages her at 6.51am: 'Hey u ok? Good shift? x'
Another colleague messages Letby at 11.58am: 'You ok? I heard about last night. Did you have [Child I]? Xx'

12:46pm

Caroline Oakley records at the end of the day, '[Child I] with parents and family in bedroom 2...
'They have expressed they are very unhappy with AHCH [Alder Hey Children's Hospital] for failing to accept [Child I] for her barium enema, and want her back from AHCH post-mortem ASAP. Bereavement co-ordinator has spoken to them...'

12:57pm

A post-mortem examination of Child I takes place on October 26.
On November 5, Letby searches for the mum of Child E and F, then the mum of Child G, then the mum of Child I in the space of three minutes between 11.41-11.44pm, on her day off.

Recap: Lucy Letby trial, Thursday, February 2

Tweets

Police intelligence analyst Claire Hocknell is now in the witness box. She's taking the court through the sequencing evidence for the fourth and final incident in relation to Child I

The fourth event takes place between October 22 and 23 2015. The Crown say at some point during this period Ms Letby injected air into the youngster's stomach. Child I died at 02:30 on October 23.

Notes from Ashleigh Hudson, who was Child I's designated nurse, in the early hours of October 22 note that the infant was 'pink and well perfused' and that she was gaining weight

Notes from nurse Caroline Oakley, timed 08:00 on 22 October, state that Child I's condition was 'satisfactory'

Prosecutor Nick Johnson summarises that for that afternoon and into the evening Child I's charts are fairly 'unremarkable'

Door swipe data shows Ms Letby arrived on the unit at 19:24, along with a number of other members of staff for the night shift

Ms Letby was assigned to Nursery 3 on the neonatal unit that night and was responsible for a child not part of this case. Child I was in nursery 1, Ashleigh Hudson was her designated nurse

Messages now being shown to court from that night to a colleague, who wasn't on shift. Ms Letby messaged: 'Just went to tell baby's parents that transport coming...bedroom door answered after lots of what sounded like scrambling in tiny lacey dress hardly covering anything'

Colleague responded 'OMG' - several more messages of a social nature go back and forth. We're now approaching 22:30 on 22 October

A note from Ashleigh Hudson records that Child I's long line was removed shortly before 23:00 as there were issues flushing it. Notes record that she was 'pink and well perfused' at this time

Just before midnight on October 22 (going into 23) Child I became unsettled. She collapsed and would require cardiac compressions.

Nurse Ashleigh Hudson records that around midnight Child I became 'quiet, apnoeic and dusky in appearance'. With help from Ms Letby, the nurses used a neopuff to try and stir the infant - but it had no effect. A crash call soon went out to the on-call registrar

Registrar Dr Rachel Chang records that after this episode, at 00:30 Child I was extubated - she noted that Child I was 'relatively settled' and was 'sucking her dummy'

Nurse Ashleigh Hudson records that at 01:06am on 23 Child I again became unsettled, she 'slowly became dusky'. The nurse 'ran' to get Dr Chang. Compressions were started again, she was reintubated. Child I's mum was 'asked to come in immediately'

At 01:16 the first dose of adrenaline was given, a second was given shortly after. Dr Chang called for help from a senior colleague

Consultant paediatrician Dr John Gibbs' notes from 01:25 record that Child I had 'poor perfusion' was 'mottled' and 'purple-white'. A third dose of adrenaline was administered at this time

A fifth dose of adrenaline is administered at around 01:40, a sixth dose is administered three minutes later at 01:43
Dr Gibbs' notes record that at 01:45 compressions were stopped. They started at 01:16. Her heart rate again dropped and compressions restarted at 01:50. The seventh dose of adrenaline is administered at 01:56, the eighth administered at 02:00
At 02:10, Dr Gibbs' notes record that Child I was 'not responding' to treatment. Decision was taken to stop resuscitation - Child I was then handed to parents. Her time of death was recorded at 02:30

Ms Letby, after a prior conversation with Child I's parents, helped to bathe the infant
Court now being show messages sent between Ms Letby and a nursing colleague, who cannot be named for legal reasons, on that morning.
Ms Letby, speaking about Child I, said 'we tried everything, just don't think she was strong enough this time'

Court is shown Ms Letby's messages to Ashleigh Hudson that evening asking her how she is doing. Ms Hudson said, at 18:09, that she is 'feeling much better'. She asks how Ms Letby is feeling - she responds telling Ms Hudson she should be proud of herself, she says she's okay

Court is also shown messages between Ms Letby and another colleague, who cannot be named for legal reasons. In these messages she says she spoke to a manger about certain staff 'not pulling their weight' at the hospital
Ms Letby said in that conversation that she was told Drs at the hospital 'speak very highly of her' and that she needs to be 'confident' in her role and not feel the need to prove herself

At 23:41 court told that Ms Letby carried out Facebook searches for a number of parents of other babies in this case


https://twitter.com/MrDanDonoghue

 

[Tortoise]

Prosecution evidence, February 2nd 2023, Day 49 - live updates

Child I

Letby's Sympathy Card

The funeral of Child I takes place on November 10. At 7.34am that day, Letby has a photo taken of a sympathy card she has written to send to the parents. The card is titled 'Your loved one will be remembered with many smiles'. It adds, in Letby's handwriting, 'Lots of love, Lucy x' on the front.

On the other side of the card, Letby has a handwritten message, in which she wrote: "There are no words to make this time any easier.

"It was a real privilege to care for [Child I] and get to know you as a family - a family who always put [Child I] first and did everything possible for her..."

The message concludes with Letby saying she was sorry she could not attend the funeral.




The sympathy card written by Lucy Letby for Child I. Picture recovered from Lucy Letby's phone. (Image: Crown Prosecution Service.)

1:29pm

Previously, the court heard from the prosecution that Lucy Letby was asked by police about a sympathy card she had sent to the child's parents. She said it was not normal to do so - and this was the only time she had done so.

Recap: Lucy Letby trial, Thursday, February 2

Tweets

Court has just been shown an image of a condolence card Ms Letby sent to the family Child I ahead of her her funeral on 10 November

https://twitter.com/MrDanDonoghue

 

[Tortoise]

Prosecution evidence, February 2nd 2023, Day 49 - live updates

Child I

Nurse Ashleigh Hudson - Night Shift 22nd/23rd October 2015 - Designated Nurse

2:12pm

Nurse Ashleigh Hudson is now being recalled to give evidence in the case of Child I.

2:20pm

The nurse is asked to look at nursing notes she had compiled early on October 22, a summary of the care provided to Child I.
She says Child I's heart rate was normal, the respiration rate was slightly elevated on a one-off reading, while her temperature was stable.
She was in room 1 of the neonatal unit, but "not an intensive unit baby" at this time. She was placed there as "a precaution measure" due to her recent medical history.
She was in an incubator, again as a precautionary measure due to her recent history, the court hears.
The nurse said the oxygen saturation levels, recorded as "96% and above", were "optimal".

2:25pm

Child I was "pink and well perfused", with "minimal aspirates recorded, clear fluid. Abdomen soft and non-distended," according to nurse Hudson's notes.
"She was a very stable baby considering the weeks prior," the nurse tells the court.

2:26pm

Child I would still have been classed as an 'HDU' baby [high dependency], as nurses would have had to check the long lines every hour, the court hears.
The nurse says she does not recall anything of note happening during that night shift on October 21-22.

2:31pm

Nurse Hudson recalls she was aware Child I was facing a medical procedure at another hospital which was 'urgent, but not an emergency'.
She said she took over care of Child I at 7.45pm on October 22. The prosecution ask why it would be 7.45pm rather than, say, 8pm. The nurse replies the handover was likely briefer than usual, as there was not a lot of information to pass on for Child I from the day shift at this point.
Child I's observations for heart rate and respiratory rate were satisfactory, while the temperature and oxygen saturation readings were "optimal".
Child I was not receiving ventilator support at this time.

2:36pm

Child I was "unsettled and rooting at start of shift" and the longline was removed due to constant occlusions. Lucy Letby was "unable to flush," so paediatric registrar Rachel Chang was informed.
Nurse Hudson's note continues: 'Dressing stripped and line pulled back, still not flushing, so removed.'
'No Oedema or duskyness'
The nurse recalls Child I reacted to the procedure "very well". Sucrose was offered, but Child I was happy with dummy. The baby girl was "pink and well perfused at this time, awake and alert".
The sucrose was sugar water which would be offered as pain relief, but if the child was happy enough to stay with the dummy, the sucrose would not be "pushed further".

2:38pm

The nurse said Child I was "generally quite easy to settle" and would settle "quite quickly", and would be "quite happy" when put into a cot or incubator.

2:40pm

The nurse recalls the events leading up to midnight.
She says, just prior to midnight, Child I was very unsettled, and tried the usual methods of containment holding, sucrose and dummy, which did not work.
She tried repositioning Child I so she was on her stomach, which sometimes settled her, but Child I continued to be very unsettled and cry.
She says sucrose would be administered for a child as a comfort measure to a child who was otherwise nil by mouth.
Child I would be placed on her stomach with her head to one side.
She said the measures to settle her "would generally work" with Child I and with other babies in general.

2:43pm

The nurse says she was familiar with Child I's crying, and this was an "atypical" episode.
She said it was a "type of cry I hadn't experienced her make before - loud, relentless, almost constant.
"Just a constant, very loud [cry] - something I had not heard from her before."
The repositioning was the last of the calming measure attempts.
Within seconds of that, Child I "became very quiet" and had "pauses in her breathing".
The nurse said she turned the child back on to her back and shouted for help.
"Was there a problem at this stage?" the prosecution ask.
Nurse Hudson: "Yes."
She said Child I's oxygen levels started to decrease, along with her heart rate. Ventilation breaths were given by nurse Hudson, with Lucy Letby providing assistance.

2:49pm

The nurse said after less than a minute, after realising it was an "acute episode", a crash call would be made to alert doctors.
The nurse recalls, from her notes, Child I was apnoeic, and dusky in appearance."
A Neopuff device was used to provide breathing support with 30% oxygen. 'Neopuff applied due to colour and apnoea.
'Colour didn't improve and [oxygen saturation and heart rate] began to drop rapidly until [oxygen saturation] 47% and [heart rate] 50. Neopuff increased to 50% then 100% with no effect."
Cardiac compressions began, and Child I was placed on a ventilator. Child I had become 'more alert and crying. Abdomen soft and non-distended prior to resuscitation, no change from handover."
Child I was recorded to be fighting the ventilator. The nurse says that was a sign Child I had recovered quite quickly, but keeping the child on the ventilator in that condition could cause lung damage, so a decision was taken to remove her from the ventilator.
Child I was "seemingly displaying normal behaviour despite what had happened" as she was also 'still rooting'.

2:56pm

The nurse says this episode, at about midnight, was a "very quick resuscitation" from her recollection, and no medication needed to be administered.
The court hears Ashleigh Hudson "managed to get through to [Child I's] parents after many attempts" regarding the first resuscitation. She said it was to be expected as it was the middle of the night.
Afterwards, Child I was "seemingly back to normal" with "nothing to cause concern" during that time after the first resuscitation.
Just after 1am, she was near, but not inside, nursery room 1.

3:03pm

The nurse says she was first alerted to Child I desaturating either from an alarm sounding on the monitor or from Child I crying.
Nurse Hudson recalls: "Lucy was already with her [at the incubator], trying to settle her. At that time [Child I's] observations were normal."
She says child I was crying "the same cry I had heard her display the first time [that night].
"Loud and relentless and unlike any other cry I had heard make prior to this night shift."
"My initial concern was she was obviously breathing...my concern was the cry was that she was going to have another episode of collapse."
She recalls articulating that concern to Lucy Letby within 60 seconds of being there.
The nurse says she said words along the lines of: "She's going to do it again, it's the same cry."
Letby responded with words of "reassurance": "She just needs to settle," Ashleigh Hudson recalls Letby saying.
Child I became quiet, with pauses in breathing, and she became bradycardiac and her saturations "started to drift".
Oxygen delivery began again, along with ventilation breaths. They shouted for help from colleagues.

3:09pm

Nurse Hudson says she does not recall direct further communication with the parents, as the staff were "all in the thick of it" trying to resuscitate Child I.
The court is shown the October 23, 6.25am note by Ashleigh Hudson: "*NGT on free drainage, produced 2mls. Minimal aspirations of clear mucus and air++ during both resuscitations. Green stool and urine present post resus."
The nurse said, given previous abdominal issues for Child I, she had wanted to "make clear" what was observed during those resuscitations.

Recap: Lucy Letby trial, Thursday, February 2

Tweets

Child I's designated nurse Ashleigh Hudson is now in the witness box recalling the events of late October 2015

Ms Hudson is taking the court through her notes recorded in the early hours of 22 October. States that Child I is 'pink and well perfused' - states that she was 'settled with dummy' and sleeping

We're now looking at Ms Hudson's notes from the evening of October 22. They show that Child I's observations were again 'satisfactory'

Ms Hudson says from what she remembers of Child I she was 'generally quite easy to settle' with a dummy, 'she was quite happy once you put her back in the incubator or cot and just leave her be'

Asked what she remembers about what would prove to be Child I's fatal collapse, she says 'I remember she was unsettled, crying, so I attended to her in the incubator to try and settle her. I tried the usual measures, they didn't seem to work. It was quite a relentless cry'

Ms Hudson says she remembers repositioning Child I on her stomach, as this tended to settle her - it didn't work on this occasion

Asked if her crying was typical, she said: 'in my experience atypical. It was a type of cry that I hadn't myself heard her make before, it was very loud, relentless, there was no stopping and starting. No fluctuation, just constant, very loud'

She said within seconds of putting the infant on her stomach, she became 'very quiet' and began having trouble breathing. She called for help and Ms Letby arrived to assist

Soon after, Ms Hudson says senior doctors were crash bleeped to assist.

Ms Hudson explains that the infant stabilised and then just after 1am, she alerted to Child I desaturating again either from an alarm or from Child I crying. She said: "Lucy was already with her, trying to settle her. At that time (Child I's) observations were normal."


https://twitter.com/MrDanDonoghue

 

[Tortoise]

Prosecution evidence, February 2nd 2023, Day 49 - live updates

Child I

Nurse Ashleigh Hudson - Night Shift 22nd/23rd October 2015 - Designated Nurse

Cross-Examination

3:22pm

Ben Myers KC, for Letby's defence, is now asking nurse Ashleigh Hudson questions.

3:25pm

He says the questions he is to ask, while technical, are not for lack of sympathy.
He says that in between the shifts she was looking after Child I, she was aware there had been further arrests and desaturations. Nurse Hudson agrees, and agrees that Child I was "very ill" when she had gone to Arrowe Park Hospital.
He asks if Child I needed to be looked at closely, and "there is always the potential for deterioration".
Nurse Hudson: "Yes."
"She is never completely out of the woods?"
"Yes."
"You can never become complacent."
"That was my view at the time."

3:27pm

Mr Myers says nurse Ashleigh Hudson was in the first 8-9 months of trained care at the time in October 2015, and would not have been intensive trained at this stage.
Ms Hudson says there were certain medical procedures which she would not be trained for at this stage, and it meant when those needed to take place, other staff, such as Lucy Letby, would do them for her.

3:29pm

Mr Myers asks if Child I looked unsettled at times because she was getting hungry.
"Yes."
"And at times can they be quite shouty and angry [when hungry]?"
"Yes."
Mr Myers refers to the night shift of October 21-22, to the nurse's note 'unsettled at start of shift and rooting, settled with dummy'. He asks if that was the behaviour exhibited because Child I was hungry. Ms Hudson agrees.

3:37pm

Mr Myers refers to a note by colleague Caroline Oakley, which notes 'unsettled at times; obviously very hungry but settles with dummy'.
Another note, by Ms Hudson, for the start of the night shift on October 22, records '[Child I] was unsettled and rooting at start of shift [7.45pm], settled with dummy and containment holding.'
Mr Myers says the issue of the long line had to be resolved during the night, which was resolved between 10.15-11pm.
Ms Hudson replies Child I was "very sensitive". Mr Myers said due to the cannula insertion and long line removal, Child I was not receiving fluid via the long line at this point.
He asks if the handling of the lines can have a disturbing effect on the baby, would there be an increase of the monitoring?
Ms Hudson says the monitoring did continue, it was just not recorded on the observation chart at 11pm, and was still visible on the electronic monitor.

3:39pm

Mr Myers says "All the things you would normally do to settle [Child I] didn't work?" [just before midnight]
Ms Hudson replies she called for help once she noticed Child I was "seemingly in distress, clinically", after noticing gaps in breathing after repositioning Child I. Letby arrived in response to the call for help.

3:42pm

Ms Hudson explains the note '[Child I] was very unsettled - ? due to hunger as rooting." She says the '?' means she was not sure of the cause.
Mr Myers asks if Neopuff was used up to the point of ventilation. Ms Hudson replies she was not sure, she would give Neopuff assistance in response to what could be seen at the time.
Child I 'attempted to cry' before being ventilated.

3:45pm

Mr Myers said Ashleigh Hudson was aware of Child I's history of abdominal distentions.
Ms Hudson replies she paid "specific attention" to the abdomen with this knowledge, and noted it was 'soft, non-distended' at this time.
Mr Myers said Child I recovered and 'looked better than before the incident took place?'
Ms Hudson: "Yes."

3:47pm

At 1.06am, Child I deteriorated once more.
Ms Hudson said she was alerted either via an alarm or Child I crying.
Mr Myers said once she entered, Lucy Letby was trying to settle Child I with a dummy. "Was this, in effect a repeat of what had gone on earlier?"
"Yes."
"You said you were concerned there was going to be a repeat...and Lucy Letby was trying to reassure you...she was going to be all right?"
"Yes."

3:50pm

Mr Myers refers to the family communication note, in which it was discussed with parents for Child I to be bathed, to make hand and foot prints, have photographs and gave consent for hair to be cut, and kept in the memory box.
Ms Hudson said this was the first time she had been involved with this bereavement procedure, and Lucy Letby assisted, before colleague Caroline Oakley later took over and completed the procedure.

Re-Examination

3:52pm

The prosecution rise to clarify the noise made by Child I.
"It was loud, almost like a repetitive noise, relentless. In my interpretation, it would indicate distress, and was markedly different from before when she would express hunger, for instance."

Judge's Question

The judge asks Ms Hudson for this 'rooting gesture' to be explained.
Ms Hudson says it's a classic gesture by babies, usually done before they cry. It can be a very specific behaviour where they rock their heads and stick their tongue out, smacking their lips.

3:53pm

That concludes the evidence from nurse Ashleigh Hudson.

5:30pm

The trial will resume tomorrow (Friday, February 3), with further evidence being delivered in the case of Child I.

Recap: Lucy Letby trial, Thursday, February 2

Tweets

Ben Myers KC, defending, is now questioning Ms Hudson

Mr Myers asks with a baby like Child I if there was 'always potential for a deterioration?', Ms Hudson says 'yes'... agrees that she was 'never completely out of the woods'

Mr Myers asks if, at this time, Ms Hudson was intensive care trained - she says she was not

Mr Myers asks if it seemed to her that 'there were points she seemed to be unsettled' - Ms Hudson agrees. She says she was exhibiting behaviour that she thought showed she was hungry

Mr Myers is taking Ms Hudson back over her notes from Child I's collapse at midnight on October 22

That concludes Ms Hudson's evidence. Court now doing a bit of housekeeping work with placement of evidence in various bundles


https://twitter.com/MrDanDonoghue

 

[Tortoise]

Prosecution evidence, February 2nd 2023, Day 49 -

Child I


"Miss Hudson replied: “It was loud. It was almost like a repetitive noise. Relentless.

“From my interpretation it would indicate distress. The cause of that, I can’t be sure.”

She said the cry was “markedly different” to the noise Child I made when hungry.

On the afternoon of October 23, Letby messaged a colleague: “Dr Gibbs (consultant) was great, we tried everything. Just don’t think she was strong enough this time.

“Sad isn’t it.”

Another nursing colleague later messaged: “Yeah they (Child I’s parents) weren’t happy she has to have post mortem x.”

Letby replied: “Hmm I can understand that but I think it’s of benefit to know x.”

[...]

Letby was absent from work from October 17 until the night of Child I’s fatal collapse, the court heard."

10% - Letby wrote sympathy card to baby´s grieving parents, murder trial...

 

[Tortoise]

Prosecution evidence, February 2nd 2023, Day 49 -

Child I

"On Thursday, February 2, Manchester Crown Court was told Letby captured a photograph of the card on the morning of November 10 after she finished a night shift – hours before Child I’s funeral.

[...]

“Thinking of you today and always – sorry I cannot be there to say goodbye.

“Lots of love Lucy x”

[...]

10% Chester Standard - Lucy Letby wrote sympathy card to baby’s grieving parents

 

[Tortoise]

Prosecution evidence, February 3rd 2023, Day 50 - Tweets https://twitter.com/MrDanDonoghue

Professor Owen Arthurs, Great Ormond Street Hospital, Prosecution Medical Expert Witness - Consultant Paediatric Radiologist

Consultant paediatric radiologist Owen Arthurs is first up in the witness box this morning. He's giving expert evidence on CT scans, X-rays and other images in this case

Dr Arthurs published a study in 2015 on the prevalence of air, post mortem, in infants. That study looked at 48 children. Of the 48, six were comparable to this case - but in each of those cases there were clear explanations for the presence of air in vessels

He agreed with prosecutor Nick Johnson that it is 'very rare' to find air vessels without an obvious explanation

Child E

We've gone backwards a little in timeline (the expert wasn't able to make it to court earlier), Dr Arthurs is discussing the case of Child E. It is alleged that Ms Letby fatally injected air into the bloodstream of the baby in June 2015

Court is now being shown a radiograph of Child E. Dr Arthurs agrees there is 'no significant abnormalities' present. Prosecutor Nick Johnson asks if an air embolis would show up on such a radiograph

Dr Arthurs says an air embolis is not present and to see it there would have to be 'a lot of air' and the radiograph would have to have been 'done almost immediately' after the injection

Child F

Dr Arthurs is now being asked about Child E's twin, Child F, who the Crown say was also attacked by Ms Letby but survived

Dr Arthurs says he can make no real comment on the case of Child F.

Child G

We're now moving to Child G. Ms Letby is accused of attempting to murder the premature girl three times in September 2015

The prosecution alleges Ms Letby overfed Child G with milk through a nasogastric tube or injected air into the same tube

Dr Arthurs is taking the court through radiographs, taken at Arrowe Park Hospital and the Countess of Chester, of Child G.

Dr Arthurs says 'there isn’t anything specific' to suggest Child G was suffering from sepsis/NEC or any other infection. He said 'there's nothing on the X-rays that would really provide a diagnosis' for Child G's condition

Child H

We're now moving on to Child H. Ms Letby is accused of trying to kill the infant on two occasions in September 2015. The prosecution claim she first attacked Child H in the early hours of 26 September and then again the following morning

Jurors previously heard Child H, who was born six weeks premature, needed treatment for a pneumothorax, which occurs when air leaks into the space between the lung and chest wall.

On the evening of 24 September 2015, Dr Alison Ventress inserted a pigtail chest drain to prevent any accumulation of air within the chest. However, in the early hours of 25 September more air had accumulated a second drain was inserted

Ms Letby's defence counsel Ben Myers KC previously claimed that Dr Ravi Jayaram inserted the second drain in the "wrong place". Dr Arthurs is now going over the X-rays of Child H which show the drains

Dr Arthurs notes that the position of the drains have moved, but he says that the 'precise location isn’t really critical if it’s having the desired effect if it’s draining the pneumothorax' - essentially supporting what Dr Jayaram has previously said here

Child I

Dr Arthurs is now moving on to Child I. Ms Letby is accused of injecting air into her stomach via a feeding tube

Dr Arthurs has said there is evidence of pneumatosis (gas within the wall of the small or large intestine) on an X-ray from 30 September of Child I

Dr Arthurs has said Child I had a 'normal' bowel, as per her X-ray on 18 October and into 20 October. Looking at an X-ray from 23, there is a 'massive' dilatation of the stomach

Dr Arthurs says it is 'quite unusual to see babies with this degree of dilatation of the stomach', he says it can cause 'splits in the diaphragm' and that can lead to 'respiratory complications'

Asked how much air it would take to generate such images, Dr Arthurs said: 'We don’t know, I don’t think anybody really knows. Those experiments can’t really be carried out, we can’t experiment on babies giving them 50 or 100mls of air and taking x-rays'

He adds: 'I would guess more than 20mls of air' He is asked, in the absence of another explanation, whether 'someone has deliberately injected air' Dr Arthurs says 'I think that stands to reason'

CROSS-EXAMINATION


We're back after a break for lunch. Ben Myers KC, defending, is now questioning Dr Arthurs

Child H

He's asking Dr Arthurs about Child H and the positioning of her chest drains. Mr Myers asks if he is aware of guidelines on where chest drain should be inserted, in terms of the intercostal space

Dr Arthurs says that the guidance, to which Mr Myers is referring, 'refers to where they go in terms of the chest wall, not where they are inside chest'

Dr Arthurs accepts that a neonatologist is better placed to comment on positioning of drains and clinical impact

Child I

Mr Myers is now moving on to Child I. He put it to Dr Arthurs that from X-rays alone it was "not possible to establish a precise cause" of the air being present, Dr Arthurs agreed

 

[Tortoise]

Prosecution evidence, February 3rd 2023, Day 50 - Tweets https://twitter.com/MrDanDonoghue

Child I

Registrar Dr Rachel Chang - 22nd/23rd October 2015

Registrar Dr Rachel Chang, who was on shift the night Child I died, is next in the witness box

Dr Chang is being asked about the events of midnight, 22 October 2015. She tells the court she 'cannot remember' how she was alerted to Child I's crash, but she is reading out her notes from that night

Dr Chang said when she was bleeped she would have perceived that as a 'medical emergency'. Her notes show that when she arrived Child I was being manually ventilated

Dr Chang said Child I 'was in cardiac arrest' when she arrived. The infant was stabilised and an X-ray was taken shortly after (she says this is routine for baby like Child I)

The medic is now recalling events from around 1am on 23 October. Again she does not have a recollection of events and is reading out her notes. Child I again needed chest compressions and ventilation

Slight pause as Dr Chang breaks down in tears while recalling the desperate hour long battle to save Child I. Between 1:16am and 2:10am on 23 October the infant was given numerous rounds of CPR and eight doses of adrenaline, to no avail

Reflecting on Child I's death, Dr Chang said: 'I've never been able to truly explain it, it was awful. 'I knew we’d done everything, I trusted everyone around me'


Nurse Caroline Oakley - 23rd October 2015 - Agreed Statement

Prosecution are now reading statements of agreed evidence. First one is from nurse Caroline Oakley - Ms Oakley was on day shifts and wasn't there when Child I died. She described Child I as a 'lovely beautiful but problematic baby'


Nurse Christopher Booth - 23rd October 2015 - Agreed Statement

Another statement from nurse Christopher Booth is being read, he said the events of 23 October were 'very, very distressing for parents' he said the whole team was 'heartbroken' after the death of Child I

 

[Tortoise]

Prosecution evidence, February 3rd 2023, Day 50 - Express and Star 10%

Doctor unable to ‘truly explain’ baby girl’s death, murder trial jury told

Lucy Letby, 33, is alleged to have murdered seven babies and attempted to kill 10 others.

www.expressandstar.com

Child I

Nurse Christopher Booth - 23rd October 2015 - Agreed Statement

“If we were not such a good team we would have crumbled because there were so many horrible things going on.”

Nurse Melanie Taylor - 23rd October 2015 - Agreed Statement

“It was just pure shock. She was stable before that.
“I think her parents came in during resus. I remember them walking into nursery 1 and standing there, not really knowing what to do and myself not knowing what to say.
“The actual resuscitation is a bit of a blur to be honest.
“I remember right at the end, the doctor decided to call it and said we should stop.
“I had been looking at (Child I) and the monitor, thinking she is going to come out of it.
“My heart just dropped. When he said ‘stop’ I was just devastated, especially when I looked at the parents.”

Nursery Nurse Valerie Thomas - 23rd October 2015 - Agreed Statement

"she took a phone call from Child I’s mother who asked for an update from the first collapse.
She said: “I went into room 1 and said (Child I’s) mum was on the phone, not realising (Child I) was being resuscitated there.
“Lucy Letby said her parents should come in.”

 

[Tortoise]

Prosecution evidence, February 3rd 2023, Day 50 - Daily Mail 10%

Expert says 'it stands to reason' Lucy Letby injected baby with air

Letby, 33, originally from Hereford, is on trial accused of murdering seven babies and attempting to murder 10 others. She denies all the charges.

www.dailymail.co.uk

Child I

Today Professor Arthurs said two-dimensional images of the baby's body showed a 'massive' level of swelling in her stomach.

He added: 'It is quite unusual to see babies with this degree of dilation of the stomach'.

Such an enlargement could cause splints in the diaphragm that would then lead to respiratory complications.

Nick Johnson KC, prosecuting, asked how much air it would have taken to produce the images being viewed on a screen by the jury at Manchester Crown Court.

He replied: 'The truthful answer is we don't know, and I don't think anyone really knows, because experiments can't be carried out. We can't experiment on babies, giving them 50 or 100mls of air and taking x-rays'.

Professor Arthurs was aware of instances when medical staff had drawn out 15-20mls of air.

Asked how much air he believed had been injected into Baby I, he said: 'I'm guessing it would be more than that.'

Mr Johnson then asked whether it followed, in the absence of infection, that 'one is left with the inference that someone has deliberately injected air?'

He replied: 'I think that stands to reason.'

 

[Tortoise]

The Trial of Lucy Letby, Episode 14: Baby I, “Our daughter could go from perfectly fine to nearly dying in seconds."

www.mailplus.co.uk

In this episode, Liz and Caroline explain the evidence the jury have heard in relation to a very premature baby girl, Baby I, who Lucy Letby allegedly attacked three times, before murdering her on the fourth attempt.


Jurors heard from a doctor who said she saw Lucy Letby crying on the neo-natal unit and saying: ‘It’s always me when it happens, my babies…” The court was also shown a sympathy card Lucy Letby wrote to the parents of Baby I after she died. Lucy Letby denies all the allegations.

--excerpt -

Text conversation

Dr Alison Ventress: Hope work wasn’t too bad x

LL: Yeah it was ok. Baby I in 1 with distended abdo. Looks a bit rubbish. Having a chill on sofa in my PJs now.

Dr V: Poor baby I, not again. Sounds like well deserved chill on sofa, I’m doing the same. Let’s go and set up our own neonatal unit with all the other faces that don’t fit who often seem to be the best ones.

LL: Let’s do it, in New Zealand.

Dr V: Yeah, come to NZ with me.

LL: plane/smiley with sunglasses/rainbow emojis.

Dr V: Defo come to NZ then! I could use a friendly face!!

LL: Haha not brave enough to up & leave everything.

Dr V: Yeah I’m scared of leaving everything but more of leaving everyone actually.

LL: That’s good then, I couldn’t leave my parents. They would be completely devastated. Find it hard enough being away from me now and it’s only 100 miles.

Dr V: Aww where are they based?

LL: Hereford. I came here to uni & didn’t go back. They hate it & I feel very guilty for staying here sometimes but it’s what I want.

DR V: Yes I feel guilty for being so far away often, especially as my mum is ill. But I’m already 5 hours away, so what’s an extra 20.

10.09pm –

LL: Families are tough aren’t they! ☹ ☹

Dr V: Some more than others!

 

[Tortoise]

Prosecution evidence, February 9th 2023, Day 51 -

10% Chester Standard Lucy Letby trial: Baby 'killed by injection of air into bloodstream'
10% Express - Lucy Letby trial hears baby was killed by injection of air


Child I

Dr Dewi Evans - Prosecution Expert Witness

He stated that, in his opinion, Child I had on the first three occasions been injected with air into her stomach via a feeding tube.

But an “extremely disturbing phenomenon” of Child I’s noted “relentless, loud” crying prior to her final collapse led him to believe a different method was used.

[...]

Asked by prosecutor Nick Johnson KC as to what his conclusion was for the cause of the fatal collapse, Dr Evans replied: “I think she was the victim of air being injected into her blood circulation. This probably explains her crying and distress, and the failure of the medical team second time round to save her life.”

Dr Evans agreed with Ben Myers KC, defending, that Child I had recurrent episodes of a swollen stomach and oxygen desaturations during her time at the unit.

But he disagreed with his suggestion that Child I was “in general a very poorly baby regardless of the events we are looking at”.

Dr Evans said he thought both collapses on the night shift of October 22/23 were due to injections of air which caused a blockage to the passage of blood.

He said he could not say how much, or how quickly, air was administered as there was “not a great deal of research” available on air embolisms in babies.

Dr Evans denied Mr Myers’s assertion that it was “utter guess work” on his part.

The expert said: “It is consistent with what has happened in previous cases here.”



Dr John Gibbs - Consultant Paediatrician - 10% BBC Lucy Letby: Doctor could find no clear cause for baby girl's death


Dr John Gibbs said he had written in his medical notes that he could not assign "a clear cause of death".

[...] he told the court he "could not understand what natural disease could have affected her that she would have recovered so quickly". [...]

He said he returned home once Child I seemed stable, adding she was "settled, sucking her dummy [and] looking like a well baby when I left".
But within 30 minutes, he had been urgently called back to the neonatal ward as Child I had collapsed again, arriving at 01:23. [...]

"I didn't know or couldn't understand why she had collapsed and died," he said, adding he had reported her death to the coroner's office because of this.
"I felt [Child I] needed a post-mortem but it was the coroner's decision," he said.

 

[Tortoise]

Prosecution evidence, February 10th 2023, Day 52 - Chester Standard live updates - Recap: Lucy Letby trial, Friday, February 10

Child I

8:56am

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more, is expected to continue today (Friday, February 10).
We will be bringing you updates throughout the day.

9:17am

This is the 15th week of the trial before a jury. The court did not sit on Monday, Tuesday or Wednesday this week due to juror absence, but resumed on Thursday.

10:33am

The judge is informing members of the jury of a few upcoming days on which the trial will not be sitting. They are February 17, March 13 and March 17. In addition, on February 21, the trial will not be sitting before 1pm.


Dr Sandie Bohin - Prosecution Expert Witness


10:34am

Medical expert Dr Sandie Bohin, who has given evidence before in the trial, has been recalled to give evidence in the case of Child I.

10:42am

Dr Bohin says the cause of the first of Child I's collapses were via air administered into the naso-gastric tube.
She said it would cause the abdomen to distend and "squash" the lungs, further compromising them.
Dr Bohin said, other than the distended abdomen, there were no other symptoms of NEC, a gastro-intestinal condition that Countess staff had considered as a diagnosis.
She tells the court there were no pathological reasons why the abdomen was distended, having seen an x-ray.
Dr Bohin said Countess staff did not always fill in the boxes on the chart whether a naso-gastric tube was removed or replaced. She adds the nursing staff tend to leave naso-gastric tubes in place for several days, as the procedure, while it takes "seconds", can be uncomfortable for the baby.
For the symptom of bruising on the baby girl in the second collapse, Dr Bohin rules out the cause of CPR, and "deduced" it was down to an air embolism.

10:43am

For the third collapse of Child I, Dr Bohin says her opinion, based on the x-ray, the collapse, the distended abdomen and the discolouration, was via air administered into the bowel and vein.

10:48am

For the fourth collapse, in which Child I ultimately died, Dr Bohin says the cause of the collapse was an air embolus, via air administered via an IV line.
She said the "extremely unusual" level of crying by Child I was "very different" and the baby girl must have been in "severe pain", and that led her to believe the cause had been via an air embolus.


Cross-Examination

10:55am

Benjamin Myers KC, for Letby's defence, is now asking Dr Bohin questions.
He says Dr Bohin had peer-reviewed Dr Dewi Evans's reports. She replies she has given an independent report.
Dr Bohin adds she believes Mr Myers is asking if she has merely rubber-stamped Dr Evans's reports, which she says is "less than discourteous", saying she has disagreed with some of his findings and added her own evidence.
She says she has reviewed the case and come with her own opinions, and has not "backed up" Dr Evans's reports.
Mr Myers says Dr Bohin would not have come up with the conclusion of an air embolus without first reading Dr Evans's reports. Dr Bohin disagrees.
She says she has twice seen the symptoms of air embolous, in one case involving a baby. In one case it was during a complicated medical procedure which had risks, and in which a child was seriously ill, and the child had a cardiac arrest as a result of the air embolus.
Dr Bohin is now describing how an air embolus can result in a mottled appearance on the skin and how it can affect the body.

10:59am

Mr Myers suggests Dr Bohin is adapting the air embolism cause to these collapses.
Dr Bohin: "That is not the case."
She tells the court she has looked for pathological causes to explain the collapses, and had not been able to find any.
Mr Myers says Dr Bohin is 'reaching' for air embolism as a 'catch-all' cause. Dr Bohin disagrees.

11:02am

Dr Bohin tells the court when something is "out of the ordinary", it will be noted, as was the case when Dr John Gibbs noted 'mottling' at the time of Child I's first collapse.

11:04am

Mr Myers asks if air embolus presents very specific type of discolourations.
Dr Bohin replies the description of the discolourations can vary among medical staff in a cardiac arrest situation when the staff have other priorities and different notes to make.

11:06am

Mr Myers says Child I failed to put on weight as well as she should have.
Dr Bohin says Child I was very ill and did not put on weight during her time at Liverpool Women's Hospital. At the Countess of Chester Hospital, feeds were stopped due to complications and that meant she could not put on weight.
She says staff at the Countess stopped and started feeds and fortifier, and the reasons for the lack of weight gain were explicable.

11:19am

Mr Myers refers to an event on August 23, 2015 which Dr Bohin had described in her report as "suspicious", when Child I had developed an abdominal distention. This incident was when Lucy Letby was not on duty.
Mr Myers also refers to nursing notes from September 5, 2015, in which Child I was a 'well baby' but 12 hours later, 'desaturations' had been recorded, 'requiring intermittent wafting O2 [oxygen]'. The desaturations continued and Child I's oxygen saturation levels dropped to 60%.
Dr Alison Ventress recorded a 'profound desaturation, down to 50% sats', and was 'quiet, does cry when disturbed, but not usual strong cry', and 'slightly mottled'.
At 11.15pm, Child I had 'another profound desaturation to 50%'. The following morning, at 3.26am, Child I had a 'profound desaturation on ventilator' and Dr Ventress was crash called.
Dr Bohin says this was a baby with an infection who was deteriorating. Child I, had a septic screen, was on antibiotics but continued to slowly decline and was ultimately transferred to Liverpool Women's Hospital.
Dr Bohin says these weren't "sudden, catastrophic collapses" but moderate deterioration in a baby which had an infection.

11:21am

Mr Myers says babies such as Child I can decline quite steeply.
Dr Bohin says babies don't suddenly collapse and have a cardiac arrest without warning. The subsequent events to September 5/6 were "very unusual".

11:22am

Dr Bohin says Child I had chronic lung disease, something which could be diagnosed under the microscope, but it was not affecting her breathing at that time.
Mr Myers says such a condition could lead to an accelerated decline in a baby such as Child I.

11:30am

Dr Bohin said Child I was gaining weight, not as quickly as one might expect, but she had been "very ill" and there had been stop-start points in her feeds.

11:37am

Mr Myers refers to the September 30 incident, in which Dr Bohin says Child I had air administered via the naso-gastric tube.
Dr Bohin says she does not have any idea how much air would have gone down the naso-gastric tube, as it would be "impossible to say".
She says the x-rays showed "massive" distention in the abdomen, and "there had been a change".
For the October 13 incident, in which Dr Bohin says air was administered via the naso-gastric tube and via a vein, Dr Bohin had said she believed the apnoea machine had been switched off or tampered with.
She says, having heard nurse Ashleigh Hudson's evidence, Child I was breathing enough, but very slowly, not to have triggered the apnoea alarm. She says that information was not available when she compiled in her report.

11:41am

Mr Myers says Dr Bohin had recorded there was no evidence the naso-gastric tube was in situ at the time of October 13.
Dr Bohin says staff were "notoriously poor" on noting whether naso-gastric tubes were in situ, inserted, replaced or removed.
Mr Myers says Dr Bohin had said there was no evidence it was in situ as Child I was bottle feeding, so the tube couldn't be in.
"Well, someone could've put one in," Dr Bohin replies.

12:03pm

Lucy Letby's note of 'some bruising/discolouration evident on sternum and right side of chest, ?from chest compressions', written from 19 hours after the incident.
Dr Bohin says this note is not from the time of the incident.
Dr Matthew Neame's note from the time of the October 13 incident is shown to the court, and Mr Myers says there is 'no reference to any discolouration' in that note, which described the collapse and the efforts to stabilise Child I.
Dr Bohin agrees there is not.
Mr Myers suggests the bruising appeared later and the discolouration 'does not link to that incident'.
Dr Bohin says it does, as bruising is not a result of chest compressions. It was first noted 18-19 hours later.
Mr Myers suggests Dr Bohin is using that unrelated evidence to support an air embolism. Dr Bohin disagrees.
After a short break, Dr Neame's note is shown again to the court. Mr Myers says he has been made aware the word 'mottled' appears in the note. Dr Bohin agrees she can see it.

12:11pm

Lucy Letby's note from the morning of October 14 is shown to the court. the note includes 'at 0500 abdomen noted to be more distended and firmer in appearance with area of discolouration spreading on right hand side'.
Dr Matthew Neame's note, made at 5.55am, is shown to the court. Mr Myers asks if it is a note from 5am. Dr Bohin says it does not say it was written retrospectively. She says if that note was related to 5am, then she had missed it.
Mr Myers asks if, from Dr Neame's note showing Neopuff was used, it could have contributed to the distended abdomen. Dr Bohin said it would not have done so to that extent.

12:19pm

Dr Bohin said the team did not have an obvious cause for Child I's deteriorations and she was always going to be transferred out to Liverpool on October 15.
Mr Myers refers to the location of the ET tube, NG tube and long line from a report shown to the jury. He says there is early evidence of NEC. Dr Bohin disagrees, saying the report needs to be taken in conjunction with clinical findings showing Child I had a collapsed lung and an over-inflated lung. Child I was reintubated before transfer.

12:23pm

Mr Myers says Dr Bohin reported for the final collapse, Dr Bohin had recorded air had been administered by the NGT and via an air embolus.
Dr Bohin says she cannot be clear whether both happened on each event, or whether it was one on each.
Mr Myers says Dr Bohin had earlier described how Child I presented at the time.
Dr Bohin said Child I had an NGT in place, but that would not have caused a distended abdomen to the extent shown.
Mr Myers says the air embolus cause was "very speculative" based on Child I's crying.
Dr Bohin says the crying was "very unusual" and air embolus was a "compatible finding" for the cause.

12:25pm

Mr Myers says the repeated collapses would lead a child to become weaker and sadly die.
Dr Bohin said Child I recovered so well from the first collapse she was extubated, and that she was doing well, and the first collapse had no relation to how Child I reacted to subsequent collapses.

Prosecution Re-Examination

12:28pm

The prosecution, led by Nicholas Johnson KC, rises to clarify a few of the questions.
The events around September 5 are discussed, and Dr Bohin said the incident was not notable as Child I had an infection, so there was an identifiable cause, and it was not NEC. She said it was "not a suspicious event" so had no need to flag it up as one.
She tells the court Child I "continued to be unwell and was intubated", and "had a very rocky time for a few days" before "she recovered".
The other events, Dr Bohin said, was when Child I collapsed and recovered "very quickly", or in the last case, "sadly", Child I had died.

12:31pm

The prosecution ask about the October 13-14 collapse, and how quickly a naso-gastric tube can be inserted and removed, and Dr Bohin confirms that can be done in "seconds".
Mr Johnson says there is no evidence "from the records" showing an NGT was in place, but "on the balance of probabilities", that was the cause - Child I receiving excess air via the NGT - which Dr Bohin favoured. Dr Bohin agrees.

12:34pm

That concludes Dr Bohin's evidence for Child I.

 

[Tortoise]

Prosecution evidence, February 10th 2023, Day 52 - Chester Standard live updates - Recap: Lucy Letby trial, Friday, February 10

Child I

Lucy Letby Agreed Summary of Police Interviews

12:38pm

Mr Johnson now talks the court through a summary of Lucy Letby's police interviews for Child I.
For the first incident on September 30, Letby had no independent recollection of it. She said she did not know whether the distended abdomen was her observation or Child I's mother.
For the October 13 incident, she did recall that incident. She said she put on the light when she entered the room with nurse Ashleigh Hudson and noted Child I looked pale. Child I was shallow breathing and gasping, and the apnoea alarm was not activated. Letby could not recall giving Child I treatment prior to that event.
For October 14, Letby said she could not recall that shift.
Letby could not recall the night when Child I died, other than recalling she had died.
She said there was a feeling Child I had been transferred between hospitals too quickly.

12:41pm

Lucy Letby, in a subsequent police interview, said she had sent a sympathy card to the parents, and had taken a photo of the card on her phone.
She denied giving air via the NGT.
For the October 13 incident, Letby agreed it would have been difficult to see if Child I was pale without the lights being on.
She thought she and Ashleigh Hudson had been at the doorway when noting Child I was pale. She could not recall if there was a prior examination. She said “maybe I spotted something that Ashley wasn’t able to spot” because she was “more experienced than Ashley”. She said there was still light coming into the room from the corridor and there would be some natural light.
For October 14 and 22, Letby denied causing Child I any harm.

12:43pm

In a third interview, Letby was asked about texts following the October 14 shift, she agreed she had sent texts to a colleague saying Child I looked 'not good' and had asked to be assigned to her care.
She was asked why she had searched for Child I's mother on Facebook, and said she did not know, and could not recall doing so.