UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #14

[Sweeper2000]

In my opinon:

Anything that causes increased intra-abdominal pressure could cause a collapse if the pressure is high enough. This is because the abdominal contents will displace the space needed for the lungs to expand. This idea is not in question; it is basic physiology. The lungs need room to expand while you breathe. If the increased intrabdominal pressure is not resolved then even positive pressure ventilation may not be able to overcome the resistance and permit a resuscitation. Typically babies have increased intra-abdominal pressure due to illness or after surgery. They are already critically ill and sometimes on a ventilator to begin with. Usually there is little that can be done about the intra-abdominal pressure in those cases - sometimes they have to surgically open the belly or open it back up and sometimes that helps and sometimes it does not.

The reason why Dr. Evans has hypothesized that air in the NG tube contributed to, for instance, Baby I's first 3 collapses, is because there was evidence of excessive air in the stomach, *and* the baby was able to be resuscitated. On the other hand, babies who are suffering from the illness or surgical complications I described earlier... they aren't suddenly "fine" once the resuscitation is over. They're still very ill. Evans suggests that Baby I eventually died of an air embolism during her fourth collapse, when they were unable to resuscitate her.

As for your second bolded question, can you explain more what you are wondering here?

Lucy Letby trial: Baby girl 'killed by injection of air into her stomach'

Prosecutors alleged Lucy Letby tried three times to kill the baby girl before she succeeded on her fourth attempt.

news.yahoo.com

I get what your saying. So Babies in an already weakened state would be more prone to more severe effects from Compromised breathing in a collapse?

i suppose the second question is Related to the first. Dr evans suggestion in one about the “robust” resus efforts what exactly does he mean by that? would this Particular resuscitation have been any different from any other or indeed any different from any other collapse in the cases?

if there are also different levels of skill in different resus efforts then does it follow that the routine approach to resus efforts is documented to the degree that would enable investigators to distinguish one effort from another? I understand we have thorough documentation for medication ie adrenaline but not sure about the physical side of resus efforts. Just thinking that if they didn’t document the decompress in the stomach how do they know it wasn’t all in vain?

 

[Sweeper2000]

Surely though if you feel undecided about how fatal a splinted diaphragm may be after resus you would need to know how many died in this case?

I’ve got at least one. I’m sure it’s mentioned in others though.

 

[magikarpmagikarp]

I get what your saying. So Babies in an already weakened state would be more prone to more severe effects from Compromised breathing in a collapse?

i suppose the second question is Related to the first. Dr evans suggestion in one about the “robust” resus efforts what exactly does he mean by that? would this Particular resuscitation have been any different from any other or indeed any different from any other collapse in the cases?

if there are also different levels of skill in different resus efforts then does it follow that the routine approach to resus efforts is documented to the degree that would enable investigators to distinguish one effort from another? I understand we have thorough documentation for medication ie adrenaline but not sure about the physical side of resus efforts. Just thinking that if they didn’t document the decompress in the stomach how do they know it wasn’t all in vain?

By robust, Evans means they gave it a really good go. Not that I have ever seen a half-hearted effort at resuscitating a baby - people tend to give it their all. But the Neonatal Resuscitation Program (kind of like the AHA for CPR) recommends that after about 20 minutes of adequate chest-moving ventilation, chest compressions, epinephrine, etc (high quality resuscitative efforts), it's time to think about ceasing efforts. That is a recommendation that is based on current evidence about outcomes. So saying it was robust is saying they didn't call it right at 20 minutes even though that would have been within professional guidelines and no one would say they hadn't tried hard enough even if they did stop at 20 minutes. This doesn't suggest that other resuscitations were lacking or that the outcome was dictated by how long they tried. In fact he is saying the opposite, that the condition of the baby as well as the potential cause of collapse is reflected in the baby's response to resuscitation, both in the cases where the efforts failed to revive the baby and in the efforts that were successful.

Along these lines yes, let's say the resuscitations was done poorly, yes that can be reflected in the documentation. But usually in these situations people are doing the best they can. Most babies who have a collapse are back as soon as effective positive pressure ventilation is applied, and that can take from 30-60 seconds to 3-5 minutes depending on whether intubation is needed, etc. (These are estimations, not set in stone figures, and there are ALWAYS outliers.) But usually the baby's response is very fast. It's unusual to need to code a baby for 30 minutes.

All my opinion only.

 

[magikarpmagikarp]

I get what your saying. So Babies in an already weakened state would be more prone to more severe effects from Compromised breathing in a collapse?

Sort of but not quite. What I am saying is that babies who collapse because they are very sick will still be sick after they are resuscitated. Resuscitation didn't fix or change that. But a baby who is fine, then has a collapse, then is fine again... that's a whole other kettle of fish. I believe that is literally why this trial is happening. JMO

 

[Cardgame]

Sort of but not quite. What I am saying is that babies who collapse because they are very sick will still be sick after they are resuscitated. Resuscitation didn't fix or change that. But a baby who is fine, then has a collapse, then is fine again... that's a whole other kettle of fish. I believe that is literally why this trial is happening. JMO

This is such a helpful clarification, thank you. I hadn't completely understood before why it was so relevant that the collapsing babies were fine after being resuscitated.

 

[katydid23]

The Trial of Lucy Letby

@LucyLetbyTrial


In this episode Caroline and Liz examine what the prosecution say happened to Baby N, a premature baby boy admitted to the Countess of Chester Hospital with the blood-clotting condition haemophilia.

Lucy Letby is accused of attempting to murder him by thrusting a piece of medical tubing or equipment down his throat, causing him to bleed and collapse.

Jurors heard how 7 doctors couldn't get a tube into Baby N’s mouth to help him breathe because of ‘substantial’ swelling in his throat. Eventually, a team from Alder Hey Children’s Hospital in Liverpool was brought in but, Lucy Letby appeared ‘agitated’ by their arrival.

After Baby N was stabilised, Lucy Letby hugged his mother and said, ‘I hope he’s alright,’ before her son was transferred.



https://open.spotify.com/episode/3gNkSaXNJCJWaPD0WsXhbq?si=cb27a366982b467b&nd=1

 

[marynnu]

there Is allot of things I’m still curious about. The most recent insulin case is one. Again seems more bags than one was contaminated but it’s the difference in dextrose that interests me. Again is the assumption that all the bags had insulin in Them?

im also not seeing how air in the ng tube could be lethal. The problems that causes I would have thought were treatable. Splinted diaphragm fixed by positive pressure ventilation and it not being particularly lethal if treated. I’m even interested to know how the resus efforts can differ. Dr evans says it was a very robust thirty min resus effort, how on earth does that thirty mins differ from other cases where there was a death?

Not sure about elsewhere, but in this context in the UK "robust" means something done thoroughly & correctly which stands up to scrutiny. So you can have robust research, a robust enquiry etc.

 

[Tortoise]

Dan O'Donoghue

@MrDanDonoghue
·
28m

The murder trial of nurse Lucy Letby continues at Manchester Crown Court this morning. I'll be bringing live updates as we hear further evidence in relation to Child O, who Ms Letby is said to have killed in June 2016 via the injection of air. She denies all charges

Dan O'Donoghue

@MrDanDonoghue
·
28m

The boy was one of triplets and his brother, referred to as Child P, died just over 24hours later after also being allegedly attacked by Ms Letby

Dan O'Donoghue

@MrDanDonoghue
·
1m

Court is currently being read agreed evidence. First statement is from Amy Davies, who was a neonatal practitioner in 2016, she recalls having no concerns about the triplets in the days after their birth in late June 2016

 

[katydid23]

Dan O'Donoghue

The murder trial of nurse Lucy Letby continues at Manchester Crown Court this morning. I'll be bringing live updates as we hear further evidence in relation to Child O, who Ms Letby is said to have killed in June 2016 via the injection of air. She denies all charges

The boy was one of triplets and his brother, referred to as Child P, died just over 24hours later after also being allegedly attacked by Ms Letby.

Court is currently being read agreed evidence. First statement is from Amy Davies, who was a neonatal practitioner in 2016, she recalls having no concerns about the triplets in the days after their birth in late June 2016

 

[katydid23]

We were posting at same time @Tortoise. lol

You should keep on because I have to go to bed soon.

 

[Tortoise]

We were posting at same time @Tortoise. lol

You should keep on because I have to go to bed soon.

no, you're doing the night-shift

haha, only kidding, sweet dreams, see you in the morning!

 

[Tortoise]

Dan O'Donoghue
@MrDanDonoghue
·
24s

A statement from another member of the neonatal team, who cared for Child O on the nightshift of 22 June into 23 June. She recalls seeing Child O with a swollen stomach - she was assigned to give him a milk feed via an NG tube


Dan O'Donoghue

@MrDanDonoghue
·
1m

She raised concern over his stomach to nurse Sophie Ellis - she told her that she was aware and that she had flagged for him to be reviewed by a doctor. But she had been told 'to go ahead' with the feed and 'closely monitor' him

Dan O'Donoghue

@MrDanDonoghue
·
1m

The neonatal worker said she remembers Child O 'squirming a little' when she began the feed

 

[Tortoise]

Dan O'Donoghue
@MrDanDonoghue
·
1m

Dr Stephen Brearey, who was head of the neonatal unit in 2015/16, is now in the witness box. He is recalling his memory of the events of 23 June 2016 - the day Child O died

Dan O'Donoghue

@MrDanDonoghue
·
27s

Dr Brearey wasn't the consultant on call that week - but he was in the hospital for a meeting. He passed through the unit and spoke to another doctor, who cannot be named for legal reasons, and was briefed on Child O. There had been a number of unsuccessful attempts to intubate

 

[Tortoise]

Dan O'Donoghue

@MrDanDonoghue
·
1m

The doctor, who can't be named, told the court last week that he couldn't intubate as there was 'blood' and 'swelling' that prevented him seeing the baby boy's airway

Dan O'Donoghue

@MrDanDonoghue
·
57s

Dr Brearey stayed on the unit and offered to help with efforts to intubate

 

[Tortoise]

I'm getting confused, it was child N who had the swelling and bleeding in the throat and unsuccessful intubations.

The evidence for child O was that he was intubated by doc choc first attempt

last week's sequencing evidence -

"The doctor records Child O was intubated '1503-1508' 'at first attempt'.
Dr Stephen Brearey records for Child O at this time: 'small discoloured ? purpuric rash on right wall'
Child O suffered another event at 3.44pm, the court hears.
Bleep data for a crash call is made at 3.49pm.
A consultant writes a retrospective note '[Child O] had been intubated about 3pm when [doctor colleague's] fast bleep went off. Arrived to find [Child O] was being bagged. Desat to 35...'
Lucy Letby's note 'Drs crash called 15:51 due to desaturation to 30s with bradycardia, minimal chest movement and air entry observed. Reintubated...'"
Recap: Lucy Letby trial, Wednesday, March 8

Wondering if that tweet above about doctor "told the court last week" is the reporter getting confused and ad-libbing

 

[Tortoise]

Dan O'Donoghue

@MrDanDonoghue
·
3m

Manchester Crown Court has previously heard that Child O was in good condition and stable up until the afternoon of 23 June when he suffered a "remarkable deterioration" and died

Dan O'Donoghue

@MrDanDonoghue
·
2m

Dr Brearey has just reviewed a number of Child O's charts from that morning - he said 'none of those results were concerning; and that they were all in the 'normal range' and no evidence of infection

 

[Tortoise]

Dan O'Donoghue

@MrDanDonoghue
·
2m

Court has just been shown an X-ray taken that morning, the radiologist notes 'the appearance is nonspecific but necrotising enterocolitis or mid gut volvulus cannot be excluded'

Dan O'Donoghue

@MrDanDonoghue
·
1m

On another X-ray taken later that day, the radiologist notes 'the bowel is considerably less distended by comparison with the previous image, earlier that day' - notes no evidence of pneumothorax

 

[katydid23]

Our pal Dan does deserve credit for being the only reporter that bothers to tweet most days. I will applaud him for that. But he does sometimes get the babies mixed up, leading to confusion.

 

[Tortoise]

Dan O'Donoghue

@MrDanDonoghue
·
23s

Dr Brearey recalls Child O's first crash shortly after 14:30 on 23 June. He helped intubate the baby boy. He tells the court during this procedure he noticed an 'unusual' rash on the boy's chest

 

[Tortoise]

Dan O'Donoghue

@MrDanDonoghue
·
3m

He said the rash was purpuric was 'noticeable'. He tells the court this was 'very, very concerning' in a neonat - his first thought for the case of the rash was infection. He notes Child O was on antibiotics and a blood test ordered