UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #11

[marynnu]

He didn't - he continued to be hypoglycemic for 12+ hours.

As for how, there could have been a forgotten hanging drip - also another thing that happens.

Most likely it is some sort of intentional administration, but there's a lot of details missing.

This baby was certainly hypo until at least midnight. He was still receiving a bag checked by LL (by now 12.5%). I believe the infusion was changed to 15% around 4am, following insertion of a long line, but don't quote me on that!

 

[marynnu]

I believe they were receiving starter TPN?

And who was adding the 50% glucose?

To get a higher concentration than 10%, there is a standard formula. An amount of the fluid is removed from a 500ml bag & replaced by 50% glucose. As always it's prescribed by a doctor and checked by 2 nurses.
It would be unusual for babies, especially 33 weekers, to receive TPN so soon IMO.

 

[katydid23]

Dan O'Donoghue


I'm back at Manchester Crown Court where the murder trial of nurse Lucy Letby is continuing. We'll be hearing from Dr John Gibbs this morning, who has since retired but was previously a consultant paediatrician at the Countess of Chester Hospital

Dr Gibbs examined Child M on the morning of 10 April. He said he queried whether infection/sepsis was the cause of the boy's cardio/respiratory collapse the previous day - 'it transpired he didn’t have either of those, so there was no proper explanation', Dr Gibbs said

Dr Gibbs said subsequent X-rays and heart scans offered no explanation for the child's collapse

Dr Gibbs said Child M 'still wasn’t behaving normally' on April 10, he was 'quiet and breathing slow' but he said that was 'explicable for a child that had very nearly died the previous afternoon'. The baby did eventually stabilise and was later discharged

 

[sapphireminds]

[Re baby F] It's not an assumption, it's from a professor's analysis of the results, based on what happened to baby's sugars when the bag was removed because the line was changed, and subsequent readings when a TPN bag was reattached. The defence accepts it was in the TPN.

<modsnip>

I don't see where the defense accepted that. And maybe I'm confusing the two hypoglycemias, I've been busy for a while and because of the chaotic way it's all presented, it's hard to keep track.

 

[Tortoise]

Testimony re. Child L not being on TPN

"Child L was admitted to the neonatal unit at 10.30am, and had observations taken by Lucy Letby, with a blood sugar reading of 1.9 recorded at 10.58am.
He was treated with a 10% dextrose (sugar) infusion.

10:41am

Lucy Letby's note, written in retrospect at 5.42pm, noted the blood sugar reading of 1.9, with the registrar commencing dextrose and expressed breast milk."

Recap: Lucy Letby trial, Wednesday, February 15
--

"The court is now hearing evidence from Amy Davies, a neonatal practitioner who was employed in the neonatal unit at the Countess of Chester Hospital in April 2016. At the time, she was in Band 6.
She says she does not have any independent recollection of Child L.
From her notes, she was on the day shift on April 8, 2016, as shift leader. Lucy Letby was the designated nurse for Child L on the 8th, and Ms Davies confirms she assisted in the care.
She is asked if there was a specific pathway for babies with low blood sugar. Ms Davies confirms there was, and would involve giving milk before giving IV fluids with glucose, but each case differed.

Cross-Examination


Mr Myers says the policy was milk first, then IV fluids, in normal circumstances. He says circumstances mean a doctor might change that and go to IV fluids.
Ms Davies agrees.
Mr Myers says there are three types of nutrition bag available - start-up bags for the baby's first couple of bags, maintenance bags, and specifically prescribed TPN bags which would have a baby's name on it. Ms Davies agrees.
She tells the court the bag for Child L wouldn't have been referred to as a start-up bag, but would have been a standard 10% dextrose bag, as prescribed, to be infused."

Recap: Lucy Letby trial, Wednesday, February 15

 

[Sweeper2000]

@Tortoise was just wondering if you could link your post about the convo LL had with the nurse who said she was having a run of very bad luck pls?? Context of it was your suggestion that the nurse was switched on or something along those lines.

 

[sapphireminds]

To get a higher concentration than 10%, there is a standard formula. An amount of the fluid is removed from a 500ml bag & replaced by 50% glucose. As always it's prescribed by a doctor and checked by 2 nurses.
It would be unusual for babies, especially 33 weekers, to receive TPN so soon IMO.

That's the point of starter TPN though, to be able to give it when the baby is born, instead of waiting for a customized TPN prepared bag. But I may have confused the two hypo cases, because there was one whose custom TPN was d/c'd and then starter TPN was switched in.

 

[Tortoise]

I don't see where the defense accepted that. And maybe I'm confusing the two hypoglycemias, I've been busy for a while and because of the chaotic way it's all presented, it's hard to keep track.

re child F

defence opening speech - Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement

The defence say Child F's TPN bag was put up by Letby in August 2015 and hours later there were blood sugar problems. That bag was replaced, in the absence of Letby, but the problems continued.
The sample taken came from "the second bag", the defence say.

--

cross-examination of Professor Hindmarsh - Recap: Lucy Letby trial, Friday, November 25

1:12pm

Mr Myers refers to the level of contamination in the TPN bags.

 

[Tortoise]

@Tortoise was just wondering if you could link your post about the convo LL had with the nurse who said she was having a run of very bad luck pls?? Context of it was your suggestion that the nurse was switched on or something along those lines.

I'm not sure what you're asking for - do you mean link my post in this thread yesterday or link to the original testimony?

 

[marynnu]

That's the point of starter TPN though, to be able to give it when the baby is born, instead of waiting for a customized TPN prepared bag. But I may have confused the two hypo cases, because there was one whose custom TPN was d/c'd and then starter TPN was switched in.

I was wondering about that as there is certainly a lot of confusion surrounding Baby F.
In any case, you can't correct hypoglycaemia using TPN as it contains other carefully calculated components which means you can't increase the rate. And nothing is ever added to TPN on the ward.

 

[Sweeper2000]

I'm not sure what you're asking for - do you mean link my post in this thread yesterday or link to the original testimony?

Think it was yesterday but not sure. If you post the link to your post I can then sleuth the rest. Only reason I ask is I thought you had compiled multiple examples of that nurse showing awareness of just how unusual the situation was rather than it being just one convo. If it’s the latter would be good to see the original testimony. Cheers.. or of the features on ws is you can post the number of the post for example 831 then if a user clicks it it takes them to that post. Not sure how to do that yet though..

 

[Tortoise]

Think it was yesterday but not sure. If you post the link to your post I can then sleuth the rest. Only reason I ask is I thought you had compiled multiple examples of that nurse showing awareness of just how unusual the situation was rather than it being just one convo. If it’s the latter would be good to see the original testimony. Cheers.. or of the features on ws is you can post the number of the post for example 831 then if a user clicks it it takes them to that post. Not sure how to do that yet though..

original electronic evidence for that text Recap: Lucy Letby trial, Tuesday, November 22

 

[Sweeper2000]

I’m wondering if we know any background to Jennifer jones key. Ie level of experience, relationship to LL, years of experience and maybe level of training, ie icu or not? Trying to find it but struggling. I thought that text was between LL and mg who seemed to be another top tier nurse.

 

[Tortoise]

tweets - https://twitter.com/MrDanDonoghue


Medical expert Dr Dewi Evans, who was approached by the National Crime Agency to review the case in 2017, is now in the witness box

Dr Evans said from his review of the medical notes, he concluded that Child M's collapse was 'completely unexpected'

Dr Evans said: 'this begs the question whether (Child M) received some noxious substance prior to his arrest or a bolus of air via his long line'

Dr Evans said he ruled out infection (like pneumonia) as the cause of Child M's collapse as he would not 'have made such a prompt respiratory recovery' in the hours after

Cross-Examination

Ben Myers KC, defending, is now questioning Dr Evans. Mr Myers puts it to Dr Evans that if air was injected, it wouldn't just disappear within 30mins. Dr Evans said it would dissipate within the lungs

Dr Evans also says that an 'accidental air injection is virtually unheard of it just doesn’t happen' due to the sophistication of modern medical equipment

Mr Myers puts it to Dr Evans that air is made up of 70/80% nitrogen - which is insoluble in blood at that level, 'it doesn't vanish' Mr Myers said so it would still be present. Dr Evans says it would have dissipated somewhere

Dr Evans says most likely the cardiac compressions resulted in air moving from one side of heart into lung. Mr Myers puts it to the medic that he has no empirical evidence to back up these claims, Dr Evans says it would not be ethical to carry out such research on babies

Mr Myers has brought up a blood gas chart for Child M from April 8. They show it was not monitored for a number of hours - Dr Evans dismisses significance of this, saying 'we try to avoid sticking pins and needles in babies if we can avoid it'

Mr Myers puts it to Dr Evans that Child M's collapse could have been due to 'some residual underlying issue', he disagrees and repeats his belief that air was injected. A claim Mr Myers says he has 'no supporting evidence whatsoever' for

We're now being shown diagrams of the lines from an IV bag to a cannula (Dr Evans said that air could have been injected in through a bung on the line)

Mr Myers is pointing that the bung is there for a rapid injection of say adrenaline and goes into the system very quickly. Dr Evans agrees. That brings to an end Dr Evans' evidence for today - we're now hearing statements of agreed evidence, before another expert after lunch

 

[Tortoise]

Tweets from earlier

tweets - https://twitter.com/MrDanDonoghue

Court has just been read a statement from consultant paediatric cardiologist Dr Arjamand Shauq - he reviewed an ultrasound of Child M's heart on a request from medics at the Countess of Chester. They believed he could have had a thrombosis

Dr Shauq said having reviewed the images the structure 'is not a thombos' but a eustachian valve, which is 'perfectly normal in infants'

 

[Tortoise]

Well done to everyone here for making it to day 60 of the evidence!

I've bought in cakes for you all.

 

[Sweeper2000]

Well done to everyone here for making it to day 60 of the evidence!

I've bought in cakes for you all.

are the people who got banned included in that ? Or do they just get like a third of a cake? Or maybe just a jaffacake instead.

 

[LadyEdgeworth]

Well done to everyone here for making it to day 60 of the evidence!

I've bought in cakes for you all.

Yay!! We couldn't have made it this far without your wonderful timelines, summaries and all your help so biggest slice goes to you of course!

 

[magikarpmagikarp]

Gosh I wish I could actually see Dr. Evans's face in court. And I really wish we could hear all the testimony.

 

[FoxyLoxy1]

Whilst I have no idea whether this lady is guilty or not, the defence are not really swaying me.
Will be interesting when it is their turn to present evidence.

One thing that has stuck out to me is LL texting her colleague that she was "bored" that day. I wonder, JMO, if she is guilty, I wonder if she was creating chaos for an adrenaline high rather than with the direct intention to kill.