Tortoise
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Timeline for baby N.
2 Jun 2016, Thu
Baby N was born at 34 weeks, weighing 3lb 9oz. "His clinical condition was “excellent” but he had haemophilia, a blood disorder. Subsequent investigations found him to have a mild version of the disease, and children of his age do not bleed for no reason, particularly in the throat, the prosecution say. The prosecution say Lucy Letby used Child N's haemophilia as a "cover" to attack him."
Unknown time -
LL texted a colleague about baby N: “we’ve got a baby with haemophilia. everyone bit panicked by seems of things although baby appears fine”.
8pm – LL’s night shift – LL was not N’s designated nurse. LL had two babies in room 4.
8.04pm -
LL texted colleague: she was going to “Google” haemophilia.
8.11pm –
LL texted her colleague: “complex condition, yeah 50:50 chance antenatally”.
3 Jun 2016, Fri
1am – N’s designated nurse went on break, leaving N “stable”. He cannot recall which colleague he asked to look after N.
1.05am – N's oxygen saturation levels fell from 99% to 40%, life-threatening levels. "Unusually", for a small premature baby, he was described as "screaming" and cried for 30 minutes. He recovered, while the doctor was then called to another emergency. 1st attempted murder charge.
Medical expert Dr Dewi Evans said he believed the deterioration of N was consistent with some kind of inflicted injury which caused severe pain, or him having received an injection of air.
Dr Sandie Bohin said such a profound desaturation followed by a rapid recovery, in the absence of any painful or uncomfortable procedure, suggested an inflicted painful stimulus. She said – “this is life threatening and screaming was most unusual. I have never observed a premature neonate to scream.”
Professor Sally Kinsey describes the collapse on June 3 as dramatic with no recognised medical cause.
The defence say there are "many reasons" why a baby would shout or scream. "It was far more likely to be hunger" - "you certainly won't find evidence of anything else".
14 Jun 2016, Tue
8am – LL’s day shift – designated nurse for baby N
8pm – end of LL’s day shift - baby N in room 3 was “very unsettled” at beginning of the night shift
15 Jun 2016, Wed
5.10am – LL awake and using her phone.
7.12am – LL arrived for her day shift. LL was designated nurse for baby N
Time? - LL texted a colleague “escaped 1, back in 3”. A colleague said LL came into the room to say hello but when her back was turned LL said N had desaturated and assisted with his breathing. The alarm was not sounding. 2nd attempted murder charge. A decision was made to intubate him.
Around 8am – When doctor tried to intubate N his throat was swollen and there was fresh blood in his throat. He couldn’t get the breathing tube down his throat because of swelling. He attempted intubation 3 times. The defence say “regarding the allegation Letby did something to cause Child N to bleed, the prosecution say the intubating doctor already saw blood, because Letby harmed him. The defence disagree and say blood was "not identified until intubation had already happened, or was in the process of happening". “There were three attempts to intubate him. The defence say, again, there was "sub-optimal care" for Child N.”
10am – More than two hours after attempts to intubate N, “1ml fresh blood aspirated from NG tube" recorded by LL on N’s dextrose chart. This bleeding is not recorded anywhere in the medical notes.
11.29am – LL messaged the doctor on Facebook “small amounts of blood from mouth and 1ml from NG. Looks like pulmonary bleed on x-ray. Given factor 8 – wait and see.” Other than that message there is no evidence she brought the bleeding to the attention of any of the medical staff on the ward which the prosecution say is “surprising” given his earlier collapse.
1.53pm – In notes recorded on the computer LL wrote that baby N was “stiff” on handling and extending upper limbs, back arching … settled in between episodes. The prosecution say this is similar to that found in other cases heard so far.
About 2.50pm – Baby N stopped breathing. LL’s nursing notes: "approx. 14:50 infant became apnoeic, with desaturation to 44%, heart rate 90 bpm. Fresh blood noted from mouth and 3mls blood aspirated from NG tube. Drs crash called”. 3rd attempted murder charge
2.56pm – medical staff were crash bleeped.
2.59pm – A consultant was called. While awaiting the consultant a junior doctor looked into N’s airway and saw blood in the throat and a large swelling at the end of his epiglottis, he could only just see the bottom of the vocal cords. He had never seen anything like this before in a newborn baby. A specialist team had to intubate.
4.30pm - The junior doctor's retrospective notes recorded: "desaturated this afternoon at 2:50pm with blood in the oropharynx + blood in the NG tube. Improved with bagging. Elective intubation planned following ??? unsuccessful attempts with 2 registrars and 2 consultants cords difficult to visualise”
Eventually N was transferred to Alder Hey where “he recovered quickly”. He did not suffer any other “spontaneous bleeds” at any time as a result of his condition.
Medical expert Dr Dewi Evans said the blood seen in Child N's stomach had originated there, caused not from intubation attempts but "instead some preceding trauma". He suggested that “thrusting” a NG tube into the back of the throat might be the mechanism used to inflict the injury.
Dr Sandie Bohin suggested only two possible explanations; either inflicted trauma or a spontaneous bleed. She considers the latter less likely as the haemophilia was 'only moderate'. Dr Bohin’s view was that the likely cause of the bleeding was trauma to the mouth, to the throat or to the oropharynx, most likely from a NGT or suction catheter.
Professor Sally Kinsey excluded the possibility of a pulmonary haemorrhage - in other words, bleeding in the lungs, causing the collapse on June 15. In her opinion such bleeding would not have occurred spontaneously in a child with Child N's degree of haemophilia and swelling [in the throat] was evidence of trauma. Professor Kinsey also ruled out heavy-handed intubation as a cause.
LL could not explain (in police interview) not notifying anyone about the blood recorded at 10am.
16-22 Jun 2016 – LL in Ibiza
2 Jun 2016, Thu
Baby N was born at 34 weeks, weighing 3lb 9oz. "His clinical condition was “excellent” but he had haemophilia, a blood disorder. Subsequent investigations found him to have a mild version of the disease, and children of his age do not bleed for no reason, particularly in the throat, the prosecution say. The prosecution say Lucy Letby used Child N's haemophilia as a "cover" to attack him."
Unknown time -
LL texted a colleague about baby N: “we’ve got a baby with haemophilia. everyone bit panicked by seems of things although baby appears fine”.
8pm – LL’s night shift – LL was not N’s designated nurse. LL had two babies in room 4.
8.04pm -
LL texted colleague: she was going to “Google” haemophilia.
8.11pm –
LL texted her colleague: “complex condition, yeah 50:50 chance antenatally”.
3 Jun 2016, Fri
1am – N’s designated nurse went on break, leaving N “stable”. He cannot recall which colleague he asked to look after N.
1.05am – N's oxygen saturation levels fell from 99% to 40%, life-threatening levels. "Unusually", for a small premature baby, he was described as "screaming" and cried for 30 minutes. He recovered, while the doctor was then called to another emergency. 1st attempted murder charge.
Medical expert Dr Dewi Evans said he believed the deterioration of N was consistent with some kind of inflicted injury which caused severe pain, or him having received an injection of air.
Dr Sandie Bohin said such a profound desaturation followed by a rapid recovery, in the absence of any painful or uncomfortable procedure, suggested an inflicted painful stimulus. She said – “this is life threatening and screaming was most unusual. I have never observed a premature neonate to scream.”
Professor Sally Kinsey describes the collapse on June 3 as dramatic with no recognised medical cause.
The defence say there are "many reasons" why a baby would shout or scream. "It was far more likely to be hunger" - "you certainly won't find evidence of anything else".
14 Jun 2016, Tue
8am – LL’s day shift – designated nurse for baby N
8pm – end of LL’s day shift - baby N in room 3 was “very unsettled” at beginning of the night shift
15 Jun 2016, Wed
5.10am – LL awake and using her phone.
7.12am – LL arrived for her day shift. LL was designated nurse for baby N
Time? - LL texted a colleague “escaped 1, back in 3”. A colleague said LL came into the room to say hello but when her back was turned LL said N had desaturated and assisted with his breathing. The alarm was not sounding. 2nd attempted murder charge. A decision was made to intubate him.
Around 8am – When doctor tried to intubate N his throat was swollen and there was fresh blood in his throat. He couldn’t get the breathing tube down his throat because of swelling. He attempted intubation 3 times. The defence say “regarding the allegation Letby did something to cause Child N to bleed, the prosecution say the intubating doctor already saw blood, because Letby harmed him. The defence disagree and say blood was "not identified until intubation had already happened, or was in the process of happening". “There were three attempts to intubate him. The defence say, again, there was "sub-optimal care" for Child N.”
10am – More than two hours after attempts to intubate N, “1ml fresh blood aspirated from NG tube" recorded by LL on N’s dextrose chart. This bleeding is not recorded anywhere in the medical notes.
11.29am – LL messaged the doctor on Facebook “small amounts of blood from mouth and 1ml from NG. Looks like pulmonary bleed on x-ray. Given factor 8 – wait and see.” Other than that message there is no evidence she brought the bleeding to the attention of any of the medical staff on the ward which the prosecution say is “surprising” given his earlier collapse.
1.53pm – In notes recorded on the computer LL wrote that baby N was “stiff” on handling and extending upper limbs, back arching … settled in between episodes. The prosecution say this is similar to that found in other cases heard so far.
About 2.50pm – Baby N stopped breathing. LL’s nursing notes: "approx. 14:50 infant became apnoeic, with desaturation to 44%, heart rate 90 bpm. Fresh blood noted from mouth and 3mls blood aspirated from NG tube. Drs crash called”. 3rd attempted murder charge
2.56pm – medical staff were crash bleeped.
2.59pm – A consultant was called. While awaiting the consultant a junior doctor looked into N’s airway and saw blood in the throat and a large swelling at the end of his epiglottis, he could only just see the bottom of the vocal cords. He had never seen anything like this before in a newborn baby. A specialist team had to intubate.
4.30pm - The junior doctor's retrospective notes recorded: "desaturated this afternoon at 2:50pm with blood in the oropharynx + blood in the NG tube. Improved with bagging. Elective intubation planned following ??? unsuccessful attempts with 2 registrars and 2 consultants cords difficult to visualise”
Eventually N was transferred to Alder Hey where “he recovered quickly”. He did not suffer any other “spontaneous bleeds” at any time as a result of his condition.
Medical expert Dr Dewi Evans said the blood seen in Child N's stomach had originated there, caused not from intubation attempts but "instead some preceding trauma". He suggested that “thrusting” a NG tube into the back of the throat might be the mechanism used to inflict the injury.
Dr Sandie Bohin suggested only two possible explanations; either inflicted trauma or a spontaneous bleed. She considers the latter less likely as the haemophilia was 'only moderate'. Dr Bohin’s view was that the likely cause of the bleeding was trauma to the mouth, to the throat or to the oropharynx, most likely from a NGT or suction catheter.
Professor Sally Kinsey excluded the possibility of a pulmonary haemorrhage - in other words, bleeding in the lungs, causing the collapse on June 15. In her opinion such bleeding would not have occurred spontaneously in a child with Child N's degree of haemophilia and swelling [in the throat] was evidence of trauma. Professor Kinsey also ruled out heavy-handed intubation as a cause.
LL could not explain (in police interview) not notifying anyone about the blood recorded at 10am.
16-22 Jun 2016 – LL in Ibiza
