Timeline for O
June 21 LL is on holiday
2.24pm weighing 4lb 7oz O born via c section at 33+5 weeks. Born well and needed just a little oxygen support
June 22
10.45 CBG carried out
13.00 donor milk feeds commenced
6.29pm nurse O'brien notes: 'No signs of increased work of breathing...CBG carried out this AM at 1045, good result....respiratory rate remains stable. Baby nursed in incubator...temp within normal limits.' Fluid requirements checked and correct...10% dextrose infusing via cannula in left hand, site became puffy throughout day....feeds of donor EBM also commenced at 1300hr, currently having 4mls 2 hr...'
7.30pm night shift begins. Nurse Elllis designated nurse for O, P.
11pm ECG dots removed
June 23
Nurse Ellis tells court the oxygen saturation readings were recorded as 'very good - what we would like', at 97% and above. Child O was recorded as not requiring additional oxygen, and was on Optiflow.
2.19am nurse Ellis notes '[incubator] temperature reduced due to temperature of 37.3C - to check hourly as appropriate. All other observations stable. Pink, warm and well perfused....abdo full but soft.'
Nurse Ellis tells court Child O was reviewed towards the end of that night shift as he had "quite a full abdomen".
5.30am cannula removed as no longer needed.
6.30am optiflow weaned down as O coping well
6.41am unknown notes PN nutrition bag stopped as Child O had reached full feeds of donor expressed breast milk, and was 'tolerating well'.
6.41 antibiotics stopped as no longer required
7.30am LL day shift begins, designated nurse for O, P and unknown baby in nursery room 2
7.32am nurse Ellis? notes 'Abdomen looks full slightly loopy. Appeared uncomfortable after feed. Reg Mayberry reviewed. Abdo soft, does not appear in any discomfort on examination. Has had bowels open. To continue to feed but to monitor'
12.10pm Dr records brain scan for Child O noting normal observations.
12.30pm LL records a fluid chart with 'trace aspirates'.
13.15pm A doctor's notes 'vomits and has distended abdomen. 'Trace aspirate...no bile 1x vomit post feed No blood'. 'Unlikely NEC, most likely distention secondary to PMec.'
13.15pm Letby notes: Child O had vomitted [undigested milk], tachycardiac and abdomen distended. NG tube placed on free drainage...blood gas poor as charted...saline bolus given as prescribed with antibiotics. Placed nil by mouth and abdominal x-ray performed. Observations returned to normal'
Prior to 2.40pm x-ray report of 'possible onset of sepsis' by a consultant radiologist said Child O's appearance had improved on a subsequent image. 'NEC or mid gut volvulus cannot be excluded'.
2.40pm A doctor notes: 'Called to see [Child O] at [about] 1440. Desaturation, bradycardia and mottled. Bagged up and transferred to Nursery 1. Neopuff requirement in 100% oxygen...'
2.40pm Letby notes: 'Approx 1440 [Child O] had a profound desaturation to 30s followed by bradycardia. Mottled++ and abdomen red and distended...'
2.46pm shift leader Melanie Taylor enters NICU
3pm Consultant writes 'Child O intubated about 3pm when [doctor colleague's] fast bleep went off. Arrived to find [Child O] was being bagged. Desat to 35...'
3.03-3.08 The doctor records Child O was intubated 'at first attempt'.
3.49pm bleep data shows crash call made
3.51pm LL notes Drs crash called due to desaturation to 30s with bradycardia, minimal chest movement and air entry observed. Reintubated...'
Morphine administered around this time, no exact time given.
4.15pm A doctor records a further collapse and chest compressions commence.
4.19pm LL notes retrospectively CPR commenced 16:19 and medications/fluids given as documented...IV fluids 10% glucose...morphine...'
4.26pm Adrenaline given as well as a prescription for sodium bicarbonate.
4.30pm Dr Brearey records he is called back
5pmish LL notes: 'Placed back on to ventilator. Dopamine commenced....Flecks of blood from NG tube. Discolouration to abdomen. Unable to obtain heel prick...due to poor perfusion.'
5.47pm O dies After 30 mins of resus Dr Brearey notes
LL does incident report 30 June to say resources not available on unit' to deal with resus and that 'staff obtained equipment from children's ward' and that there was a 'delay in this happening due to staff being needed for infant care needs'
Based on
Recap: Lucy Letby trial, Wednesday, March 8
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