It didn't sound like there was any cause for concern. The baby had a full tummy. No other symptoms to indicate a traumatic liver injury or imminent collapse.
I'd like to know how long she was away on her vacay and how many sudden collapses there were that required crash carts and dozens of adrenaline shots and intubations during her time away.
Because the first day back, baby O had one, and died. ..and the next night his brother P also died. Both were her designated babies.
And the night after that baby Q inexplicably collapsed. Why would all of this happen right when she came back on the unit?
some of her texting, has echoes IMO of when she texted that "Sophie the new girl had him" after the death of baby C, but Sophie was out of the room -
Letby messages the nursing colleague to say Child O 'went very suddenly' and 'had a big tummy overnight but
just ballooned after lunch and went from there'.
[...]
Letby says the other two babies were being screened, as
it was not known why Child O had collapsed.
[...]
Letby said
Child O had died on the student's first day of a four-week placement. She adds who was on duty that day.
The nurse replies: 'Lots of consultants then'
Recap: Lucy Letby trial, Wednesday, March 8
some of the detail shown in court during opening speech that wasn't covered in yesterday's reporting -
Letby also had the responsibility of supervising a student nurse that day.
The designated nurse [my note - LL or Sophie Ellis (time of note not stated)] recorded 'no nursing concern - observations normal' for Child O.
There are three records of feeds by Letby, at 8.30am, 10.30am, and 12.30pm - the earliest signed by the student nurse, the latter two signed by Letby.
[this was in yesterday's report - In a note made by the doctor at 1.15pm, there was '1x vomit post feed' with 'abdomen distended'.]
Child O was put on to IV fluids as a precaution.
Child O's heart rate was 160-170, blood gases were low, and raised CO2 level.
The doctor recorded the results as 'not normal' for a child breathing on their own and treated for suspected 'NEC'.
It was thought down to Child O's swallowing of air or the passing of a stool earlier.
An x-ray taken at the time showed a moderate amount of gas in the bowel loops throughout the abdomen.
[this was in yesterday's reports - Letby noted at 8.35pm - 'reviewed by registrar at 1.15pm - [Child O] had vomited (undigested milk) tachycardic and abdomen distended. NG tube placed on free drainage … 10ml/kg saline bolus given as prescribed along with antibiotics. Placed nil by mouth and abdominal x ray performed. Observations returned to normal”.]
Prior to Child O's collapse, a colleague said of Child O: "“he doesn’t look as well now as he did earlier. Do you think we should move him back to [room] 1 to be safe?"
Letby did not agree.
Letby had taken Child O's observations at 2.30pm as 100% oxygen saturations and normal breathing rates.
From her phone, she was on Facebook Messenger at the time, and at 2.39pm, the door entry system recorded her coming into the neonatal unit.
Within a few minutes of that, Child O suffered his first collapse.
Letby called for help,
having been alone with Child O in room 2 at the time.
Child O's heart rate and saturations had dropped to dangerously low levels. A breathing tube was inserted by the medical staff and he was successfully resuscitated. He was kept on a ventilator.
At 3.49pm, Child O desaturated again. doctors removed the ET and replaced it "as a precaution". Letby's written notes suggest she was the one who called for help.
Child O suffered a further collapse at 4.15pm which required CPR. Those efforts were unsuccessful and Child O died soon after treatment was withdrawn at 5.47pm.
A consultant doctor noted Child O had an area of discoloured skin on the right side of his chest wall which was purpuric.
He noted a rash at 4.30pm, which had gone by 5.15pm, and did not consider it purpura, but unsure what it was or what had caused it.
The doctor was particularly concerned about Child O's death as he was clinically stable before these events, his collapse was so sudden and he did not respond to resuscitation as he should have.
Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders
