2:43pm
A feeding chart for June 23 is shown to the court for Child Q.
A '2ml milky' aspirate is recorded at 2030. At this point, the court hears, Child Q had received a total of 3.5ml of milk.
Letby said "you would hope" the aspirates would be decreasing throughout this time.
A 3ml aspirate is recorded at 3am on June 24. Letby says it "wouldn't be of great concern...but ideally we would want the aspirate [to be] the least possible".
At the time of the handover on the morning of June 25, Letby said she noticed from the observation chart he was "on the cold side" and she would want him reviewed by a doctor before the 9am feed.
Letby said she was concerned about the temperature, Child Q was "on the borderline" of being too cold on the chart, and the incubator temperature was increased from 30.2C to 32C throughout the day. The temperature remained low which Letby said "was a concern".
Letby said she should not feed Child Q until the doctors had reviewed him at 9am.
Letby said she was also caring for an intensive care baby in room 1. She said for cares to be given in room 1, she would have to ensure a nurse remained present in room 2. She informed two nurses when she said she needed to go to room 1.
One nurse was sat at the nursing station and the doctors were starting their ward round at about 9am. Letby said she went to room 1 just after 9am. She does not recall how the room 1 baby was doing.
A neonatal schedule for June 25 is shown to the court. Letby is recorded as making observations at 9am for Child Q. Letby assists a nurse in room 1 for medication at 9.04am.
Letby says she was in room 1 for "a few minutes" and could hear something going on outside the nursery.
"I went out through the door and I could see down the corridor"
Letby went to Child Q's cotside, where there were two nurses present. Letby heard from a colleague Child Q had vomited a 'mucusy vomit'. He had stopped and "recovered" by the time Letby arrived.
Letby's notes: '[0800]...observations as charted - temperature low, incubator increased x2. Tachycardiac. Active and alert...abdomen soft and non-distended.
'0910 [Child Q] attended to by S/N Lappalainen - he had vomited clear fluid nasally and from mouth, desauration and bradycardia, mottled++. Neopuff and suction applied. Reg attended. Air++ aspirated from NG Tube.'
Letby says all this was relayed to her, and not from her observation.
Nurse Minna Lappalainen wrote: 'Baby found to be very mucousy, clear mucus from nasopharynx oropharynx removed. Clear fluid+++ O2 via Neopuff...Dr...emergency to attend...NGT used to aspirate stomach by nurse Lucy Letby.'
Letby confirms the description of the type of fluid was the only one she heard. She did not administer the Neopuff breathing support.
Letby confirms she continued to care for Child Q after he was transferred to room 1.
2:48pm
Mr Myers asks, in the context of the trial and every day at the hospital, whether this had been a significant event.
Letby: "This wasn't a significant event - this is something we deal with on a routine basis. Not that it's not important...he needed minimal intervention."
Mr Myers: "And in the course of the day, did [Child Q] have any further collapse?"
Letby: "No."
Lety's notes: '...respiratory rate declining...and intermittent pauses in breathing...blood gas stable but on downward trend and [Child Q] appearing 'tired'. Oxygen requirement developing. Discussed with consultant Gibbs and decision made to electively intubate...uneventful intubation...care handed over'
Letby says, other than Child Q requiring CPAP, there were no other outstanding issues for him.
A nursing note by Lucy Letby for Child Q is shown for June 29 and June 30. Letby confirms she was Child Q's designated nurse for those days. She does not recall, outside of the notes, being the designated nurse for Child Q those days.
The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…
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