"According to Baby I's mother, Letby expressed some concern to her and indicated that the infant would be reviewed by a doctor.
Mr Johnson said: 'When she made the requisite note, Letby reversed the concern, saying that it was Baby I's mother who had raised an issue about her abdomen, writing 'Mum feels it is more distended to yesterday and that I is quiet…not on monitor but nil increased work of breathing'.
He asked the jury: 'Was it Lucy Letby trying to cover for what she was going to do?'
She fed the sleeping baby 35mls of expressed breast milk via the NGT at 4pm. Half an hour later an emergency 'crash call' was put out.
Baby I had vomited, desaturated, her heart rate had dropped and she was struggling to breath. Her airway had to be cleared and she was given breathing support before being moved to Room 1.
X-rays revealed a massive amount of gas in her stomach and bowel, and her lungs appeared 'squashed' and of small volume. It was the prosecution case that this air had been injected into the baby's stomach.
The crisis passed, but medical notes record that Letby adjusted the infant's glucose infusion and gave her an injection of saline.
'Within moments, Baby I deteriorated again. "
Lucy Letby 'tried to kill baby girl four times before succeeding'
Mini timeline and testimony for this date, Wednesday 30th Sep 2015 (LL's day shift) -
8.00am - Letby was looking after three babies in
room three that day, including Child I. (electronic evidence)
abt. 9.00am - Baby I’s mum had a routine of going straight to the hospital after school drop-off. She’d spend the day with her daughter and when she went home at about 4 o’clock her partner, baby I’s father, would take over in the evenings, after he’d finished work. Mother said she would normally attend hospital at
9am each day and do the same thing, checking on Child I, speaking to staff, and
feed (if Child I was not on a feeding tube). She would also meet family in the canteen
. (mother's statement)
10.00am - Feeds are continued for Child I during the day at
10am, 1pm and 4pm, of 35mls expressed breast milk and fortifier.
The 10am feed is by bottle, the 1pm and 4pm are via naso-gastric tube with Child I being recorded as asleep for the latter two feeds. (electronic evidence)
1.00pm - Feed via NG tube - Child I recorded as asleep. A note for the feed at 1pm is read out to the court - 'EBM+fortifier, NGT, vomit aspirated 5ml, ph5'. It is signed by Letby (electronic evidence). A feeding chart showed 35mls was given to Child I when asleep, but Letby had recorded Child I as "handling well and
waking for feeds". (opening speech)
1.36pm - LL's nursing note: Letby records Child I's temperature in the hotcot. She adds, after a note on the 3x8 feeds: "'Abdomen appears full and slightly distended. Soft to touch, [Child I] straining++. Bowels have been opened.
Mum feels it is more distended to yesterday and that [Child I] is quiet. Appears generally pale. Not on monitor...[will continue to monitor situation]" (electronic evidence)
1.48pm - LL's nursing note: "Mummy visiting,
carrying out feeds and cares". (electronic evidence) Mr Myers says the feeding chart for 8am-1.48pm shows one event of mother coming for feed that morning. He says the family communication isn't timed, and can refer to the period of 8am-1.48pm, not the time the note was written at 1.48pm.
abt 3.00pm - Mother said she was changing her daughter’s nappy prior to leaving for the day when LL came on duty.
It would have been around 3pm. LL walked in and stood by the window, about 6ft away from mother and baby. LL said she thought baby’s stomach looked swollen to which mother agreed,
but she appeared okay in herself. LL informed mother she would keep an eye on her and call for a doctor to check her out. A medical staff member checked the belly and noted it was soft, and it would be examined. (mother's statement)
3:00pm - Letby records, for 3pm: 'Reviewed by Drs as [Child I] appeared mottled in colour with distended abdomen and more prominent veins. Advised to continue. Temperature within normal range with hot cot at 38 degrees. Full monitoring recommenced. within normal range.' Observations are commenced more regularly for Child I, the court hears. (electronic evidence)
4.00pm - Feed via NG tube - Child I recorded as asleep. A 35ml feed at 4pm for Child I has an aspirate of 3ml, with Child I 'asleep'. It is signed by Letby's initials. Letby notes: 'did not wake for feed at 1600 therefore NG Tube feed given'.
(electronic evidence)
4.30pm - 4.30pm on the feed chart records, for Child I, 'large vomit and apnoea - nil by mouth'. It is not signed by anyone. Letby notes: 'At 1630 [Child I] had a large vomit from mouth and nose++ suction given. Became apnoeic with bradycardia and desaturation (30s). Help summoned and IPPV given for approx 3min in 100% oxygen to recover. Drs were crash called. 'Transferred to nursery 1...' A doctor [who cannot be named] records he is crash called. He notes 'Chest clear... Abdomen distended, active bowel sounds all zones' (electronic evidence). LL's retrospective note written at 8.26pm - For the family communications: 'Mummy present when reviewed by Drs. Had left unit when [Child I] had large vomit and transferred to nursery 1. [Mother] up to date with current plan.'
4.30pm - Mother says she received a call at home, from the hospital, at around 4.30pm. (mother's statement)
--
The doctor's review at 3pm seems to align with mother's statement. LL says this conversation happened before her note at 1.36pm, but why would LL have waited from 1.36pm to 3pm to call the doctor?
Also noted that mum says it was about 3pm and "LL came on duty" and "LL walked in". Since LL was there for the 1pm feed, and there for the 1.36pm and 1.48pm notes, it seems as if mum wasn't there when LL fed her at 1pm (perhaps in the canteen herself) because she wouldn't have thought LL was returning from an absence or break when the conversation happened. JMO
