Chester Standard (new link):
2:01pm
The trial is due to hear the prosecution's version of events surrounding the circumstances of Child L this afternoon.
2:15pm
The next case concerns twin brothers.
Mr Johnson refers to Child L first.
Child L - attempted murder (by insulin)
2:16pm
Child L was born in April 2016. It is the prosecution case Letby poisoned Child L, while also attacking Child M - the twin.
2:19pm
Child L's blood glucose level was noted to be low and he was treated with a dextrose infusion. His condition improved and he was stable by the day-time shift of April 9.
Letby came on duty that day at 7.30am.
By this time, the prosecution say, Letby was supposed only to be working day shifts because the consultants were concerned about the correlation between her presence and unexpected deaths and life-threatening episodes on the night-shifts.
2:21pm
In the hours that followed, Child L's glucose levels fell abnormally low. He was given additional doses of glucose, but they proved ineffective.
The answers to these levels were found after a lab sample sent to the Royal Liverpool Teaching Hospital laboratory came back with results some time later.
The results of the test were "grossly abnormal", but nothing was done about it as Child L had, by the time the results came back, returned to normal.
2:22pm
The reading was "at the very top of the scale" the equipment could measure, the court hears.
There was no correspondingly high level of C-peptide: it was within the normal range. The only explanation for this anomaly is that what was being measured was synthetic insulin, which had not been prescribed to Child L but was stored and readily available in the neonatal unit.
2:25pm
The court is shown an 'infusion therapy prescription sheet', a written record of the dextrose bag fed to Child L.
The bag was running from noon on April 8, when it had been set up an hour earlier by Letby and another nurse.
Prosecutor Nicholas Johnson KC: "We say Lucy Letby added insulin to that bag of dextrose. She did it deliberately to kill [Child L].
"She had failed to kill [Child F] so gave an increased dose."
2:26pm
Letby had been present for the birth of Child L. She cared for him on his first day and the prosecution say would have been aware of his mild hypoglycaemia.
Child L's blood sugar level remained "dangerously low" through the day.
At 4.30pm, a new infusion bag was required and this was being applied when Child L, the twin brother, was being taken ill.
2:29pm
The prosecution says medical expert evidence is this was a case of insulin poisoning, administered intravenously via Child L's liquid feed.
In police interview, Letby said she was aware of Child L's low blood sugar levels and knew the insulin was kept in a locked fridge, with a variety of other drugs. Keys were passed around nursing staff and there was no record of who held the keys at any time.
She agreed the insulin could not have been administered accidentally, but denied being responsible.
Her explanation was it must have been in one of the bags already being received.
The prosecution say that is not a credible possibility.
2:32pm
Child M was born in good condition and was assessed as requiring 'special care'.
He had an unexpected life-threatening event at about 4pm on April 9, at the same time his twin's blood sugar was gangerously low.
The prosecution say "he came close to death", but "within four hours he was able to breathe unsupported in air."
2:37pm
At 3.30pm, a fluid bag was attached to Child M. At 3.45pm, he received intravenous antibiotics.
The notes showed Letby was one of two to administer the medicine. Digital records show Letby's colleague was using the computer at 3.45pm.
At 4pm, Child M's monitor alarmed and Letby was first to the cot.
The emergency was such that doctors were called urgently.
The consultant, Dr Ravi Jayaram attended and noticed unusual patches of discolouration on Child M’s skin which he thought particularly noticeable because of Child M’s skin tone. He thought the patches unusual because normally, if a baby arrests and there is not enough oxygen moving round the body, the baby is uniformly pale, grey or blue. What he saw he thought similar to what he had seen during the resuscitations of Children A and B.
2:38pm
Child M did not respond well to resuscitation. Six doses of adrenaline followed in 25 minutes and treatment was "about to be withdrawn", when Child M "suddenly improved".
Dr Jayaram could not find any cause for the sudden collapse, but the discolouration he saw caused him to suspect an air embolism.
2:39pm
At 9.14pm, Letby noted Child M was tensing his limbs, curling fingers and toes and rotating hands and feet inwards - signs of brain damage.
On the following night-shift, Child M had what the prosecution called a 'speedy recovery', although he did suffer further desaturations.
2:41pm
Medical expert Dr Dewi Evans said the rapid recovery would not have meant infection or a lung problem was ikely. His conclusion was airway obstruction or air embolus.
A paediatric neuroradiologist reviewed a brain scan on May 2016 and found brain damage for Child M, likely caused by the cardio-respiratory collapse on April 9.
2:44pm
Mr Johnson says when Letby's home was searched in 2018, a handwriten log of drugs administered during Child M's collapse was found, and she had made a note of the collapse in her diary.
'LD [Long day] - twin resus'.
In police interview, Letby agreed she had connected a fluid bag to Child M and had co-signed for medication at 3.45pm but could not be sure if she had administered it.
She thought she must have taken the notes home 'by accident', and had simply noted what had happened in her diary.
She denied that the notes were a "souvenir" and denied deliberately trying to harm Child M. She could think of no reason how he would have suffered an air embolism.
2:45pm
The prosecution says the cases of Child E-F and Child L-M are similar, in that one suffered an insulin overdose and the other an IV air embolism.
Mr Johnson: "We suggest that coincidences like that simply do not happen innocently. Someone was responsible and the only credible candidate is Lucy Letby."
2:46pm
Child N - attempted murder (three allegations)
Child N, a boy, was born in June 2016. He was a couple of weeks premature and he was admitted to the neonatal unit. His clinical condition was "excellent".
The prosecution say there are three separate occasions on which Lucy Letby tried to kill him.
The prosecution continues its opening in the trial of Lucy Letby, accused of multiple baby murders at the Countess of Chester Hospital.
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. I was just curious if the doctor was the initial person who had taken notice of this emerging pattern and reported it or maybe it was starting to be talked about within colleagues.
