I find it odd that the baby was extubated and 'put up such a fight' when it was suspected she was dying of an infection that was about to take her life. Usually when dying of life threatening infection like NEC, babies will be pale and listless and lack the energy to respond to interventions due to the complete lack of reserves.
UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #10
- Thread starter sleuth777
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I don't think anybody does think that LL talking about patients is evidence of her being a murderer.
A few bits from the Daily Mail/ PA agency about yesterday's evidence that wasn't in the Chester Standard updates
"She told junior prosecutor Simon Driver: “It was the type of cry I had not myself experienced her make before.
“It was very loud. It was relentless, almost constant. There was no stopping or starting, no fluctuating and constantly very loud.”
[...]
Miss Hudson replied: “It was loud. It was almost like a repetitive noise. Relentless.
“From my interpretation it would indicate distress. The cause of that, I can’t be sure.”
She said the cry was “markedly different” to the noise Child I made when hungry.
On the afternoon of October 23, Letby messaged a colleague: “Dr Gibbs (consultant) was great, we tried everything. Just don’t think she was strong enough this time.
“Sad isn’t it.”
Another nursing colleague later messaged: “Yeah they (Child I’s parents) weren’t happy she has to have post mortem x.”
Letby replied: “Hmm I can understand that but I think it’s of benefit to know x.”
[...]
Letby was absent from work from October 17 until the night of Child I’s fatal collapse, the court heard."
Letby wrote sympathy card to baby´s grieving parents, murder trial...
"She told junior prosecutor Simon Driver: “It was the type of cry I had not myself experienced her make before.
“It was very loud. It was relentless, almost constant. There was no stopping or starting, no fluctuating and constantly very loud.”
[...]
Miss Hudson replied: “It was loud. It was almost like a repetitive noise. Relentless.
“From my interpretation it would indicate distress. The cause of that, I can’t be sure.”
She said the cry was “markedly different” to the noise Child I made when hungry.
On the afternoon of October 23, Letby messaged a colleague: “Dr Gibbs (consultant) was great, we tried everything. Just don’t think she was strong enough this time.
“Sad isn’t it.”
Another nursing colleague later messaged: “Yeah they (Child I’s parents) weren’t happy she has to have post mortem x.”
Letby replied: “Hmm I can understand that but I think it’s of benefit to know x.”
[...]
Letby was absent from work from October 17 until the night of Child I’s fatal collapse, the court heard."
Letby wrote sympathy card to baby´s grieving parents, murder trial...
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It seems LL struggled in the 'early days' but became more hardened as the deaths went on.
The pattern to me is almost like an 'over identification' in the early days, followed by a sort of 'distancing' which became more obvious after child C and LL took on more of a 'expert role' predicting the probable cause of death.
Others have mentioned how this 'over identification' seems to be making a come back with the sympathy card in the case of child I.
It is interesting to think about what causes these 'differing' relationships with the circumstances over time.
The unprecedented collapses and deaths occured in abundance before LL adopts more of a victim mindset 'Why does it always happen to me?'
We have seen tones of empathy being communicated to colleagues about the babies parents. Why was this more apparent in some cases than others? Is there a common denominator between the parents she sympathised with and those who she didn't?
For example, was particularly unsympathetic towards a particular cohort of parents?
"On Thursday, February 2, Manchester Crown Court was told Letby captured a photograph of the card on the morning of November 10 after she finished a night shift – hours before Child I’s funeral.
[...]
“Thinking of you today and always – sorry I cannot be there to say goodbye.
“Lots of love Lucy x”
[...]
Lucy Letby wrote sympathy card to baby’s grieving parents
[...]
“Thinking of you today and always – sorry I cannot be there to say goodbye.
“Lots of love Lucy x”
[...]
Lucy Letby wrote sympathy card to baby’s grieving parents
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Dan O'Donoghue
@MrDanDonoghue
·
34m
I'm back at Manchester Crown Court this morning for the murder trial of nurse Lucy Letby. We'll be continuing to hear evidence in relation to the death of Child I in October 2015. Recap of yesterday's proceedings here
Dr Arthurs is now being asked about Child E's twin, Child F, who the Crown say was also attacked by Ms Letby but survived
Dr Arthurs says an air embolis is not present and to see it there would have to be 'a lot of air' and the radiograph would have to have been 'done almost immediately' after the injection
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In the case of child I are the defence not claiming that the baby's death was a consequence of her extreme prematurity? Though NEC is not referenced as the cause of death, the only noteworthy concerns that I've seen so far in relation to child I seem to relate to bowel problems. The cautious feeding regimes reflect that feeding was an ongoing issue for child I that kept rearing it's head time and time again. There's no evidence to suggest that the issue resolved. So, if not foulplay, what are the defence proposing led to the cause of death?
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Dan's tweets seem to be posted out of order---I cant make sense of it
here is the link for anyone who wants to try and figure it out:
https://twitter.com/MrDanDonoghue
https://twitter.com/MrDanDonoghue
T
here is the link for anyone who wants to try and figure it out:
https://twitter.com/MrDanDonoghue
https://twitter.com/MrDanDonoghue
T
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STARTING AGAIN:
Dan O'Donoghue
https://twitter.com/MrDanDonoghue
36m
Replying to
@MrDanDonoghue
Consultant paediatric radiologist Owen Arthurs is first up in the witness box this morning. He's giving expert evidence on CT scans, X-rays and other images in this case
https://twitter.com/MrDanDonoghue
@MrDanDonoghue
·
31m
Dr Arthurs published a study in 2015 on the prevalence of air, post mortem, in infants. That study looked at 48 children. Of the 48, six were comparable to this case - but in each of those cases there were clear explanations for the presence of air in vessels
30m
He agreed with prosecutor Nick Johnson that it is 'very rare' to find air vessels without an obvious explanation
·
27m
We've gone backwards a little in timeline (the expert wasn't able to make it to court earlier), Dr Arthurs is discussing the case of Child E. It is alleged that Ms Letby fatally injected air into the bloodstream of the baby in June 2015
Court is now being shown a radiograph of Child E. Dr Arthurs agrees there is 'no significant abnormalities' present.
Prosecutor Nick Johnson asks if an air embolis would show up on such a radiograph
Dr Arthurs says an air embolis is not present and to see it there would have to be 'a lot of air' and the radiograph would have to have been 'done almost immediately' after the injection
Dr Arthurs is now being asked about Child E's twin, Child F, who the Crown say was also attacked by Ms Letby but survived
https://twitter.com/MrDanDonoghue
18m
Dr Arthurs says he can make no real comment on the case of Child F. We're now moving to Child G. Ms Letby is accused of attempting to murder the premature girl three times in September 2015
16m
The prosecution alleges Ms Letby overfed Child G with milk through a nasogastric tube or injected air into the same tube
·
12m
Dr Arthurs is taking the court through radiographs, taken at Arrowe Park Hospital and the Countess of Chester, of Child G.
Dan O'Donoghue
https://twitter.com/MrDanDonoghue
36m
Replying to
@MrDanDonoghue
Consultant paediatric radiologist Owen Arthurs is first up in the witness box this morning. He's giving expert evidence on CT scans, X-rays and other images in this case
https://twitter.com/MrDanDonoghue
@MrDanDonoghue
·
31m
Dr Arthurs published a study in 2015 on the prevalence of air, post mortem, in infants. That study looked at 48 children. Of the 48, six were comparable to this case - but in each of those cases there were clear explanations for the presence of air in vessels
30m
He agreed with prosecutor Nick Johnson that it is 'very rare' to find air vessels without an obvious explanation
·
27m
We've gone backwards a little in timeline (the expert wasn't able to make it to court earlier), Dr Arthurs is discussing the case of Child E. It is alleged that Ms Letby fatally injected air into the bloodstream of the baby in June 2015
Court is now being shown a radiograph of Child E. Dr Arthurs agrees there is 'no significant abnormalities' present.
Prosecutor Nick Johnson asks if an air embolis would show up on such a radiograph
Dr Arthurs says an air embolis is not present and to see it there would have to be 'a lot of air' and the radiograph would have to have been 'done almost immediately' after the injection
Dr Arthurs is now being asked about Child E's twin, Child F, who the Crown say was also attacked by Ms Letby but survived
https://twitter.com/MrDanDonoghue
18m
Dr Arthurs says he can make no real comment on the case of Child F. We're now moving to Child G. Ms Letby is accused of attempting to murder the premature girl three times in September 2015
16m
The prosecution alleges Ms Letby overfed Child G with milk through a nasogastric tube or injected air into the same tube
·
12m
Dr Arthurs is taking the court through radiographs, taken at Arrowe Park Hospital and the Countess of Chester, of Child G.
from opening speeches -
For Child I, the defence say her death was a result of "ongoing clinical problems caused by her extreme prematurity".
The air embolus is "not accepted" as a cause by the defence. The defence say CPAP treatment may have caused 'CPAP belly' in Child I, causing a distended abdomen.
Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement
The defence do not accept Letby caused any harm to Child I and her "collapses and ultimately death were part of a series of clinical problems which may well have been inevitable given her extreme prematurity.”
https://www.itv.com/news/granada/20...n-alleged-to-have-been-murdered-by-lucy-letby
I haven't been able to find what the prosecution experts said for all four collapses, but here's Daily Mail write up of prosecution opening which may give some idea -
[1st collapse] -
"X-rays revealed a massive amount of gas in her stomach and bowel, and her lungs appeared 'squashed' and of small volume. It was the prosecution case that this air had been injected into the baby's stomach."
[Final collapse] -
"He [Dr Evans] also believed an IV bolus of air had been injected into her bloodstream around midnight on October 22-23. 'In support of that, he points to Baby I screaming – followed quickly by her collapse,' Mr Johnson said. "
[...]
"Mr Johnson told the jury: 'Baby I was born very early and very small. But she survived the first two months of her life and was doing well by the time Lucy Letby got her hands on her.
'What happened to Baby I followed the pattern of what had happened to others before and what was yet to happen to others. All of a sudden, out of nowhere, came vomiting, breathing problems and critical desaturations'.
In the first incident there had been a vomit followed by lots of air and some milk; in the second Letby had been seen 'coolly watching Baby I who was in crisis'; in the third the infant pumped with air; and in the fourth the designated nurse returning in response to the alarm and finding Letby standing over her."
Lucy Letby 'tried to kill baby girl four times before succeeding'
The prosecution said the post mortem showed no sign of NEC or any other bowel problem.
Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement
See the timeline I posted above, they were awaiting an examination of the bowel but baby I died a matter of days before that was due to take place.
Thanks @Tortoise, you saved me a good half an hour! So was this the 'dye in the bowel treatment' they are referring to? ( That has been scheduled in for a later date?)
If a contrast study has been delayed for that long with known feeding / bowel issues then I can not without good conscience say that this was not a systematic failing.
Child I's journey closely reflects my own and a contrast study to detect what was causing these bowel problems should have helped solve the riddle. For example if there was a bowel perforation, the dye would have leaked out and would have shown on this special type of x-ray. I really hope that Liverpool womens did not delay in having this procedure (which is different to a normal x-ray)
These types of contrast studies can only be carried out at a few hospitals (usually surgical units)
Is this why parents were fuming that Alderhay did not accept them? Because they could have given them the contrast study providing vital information about what was going on internally. Not send them back to CoC before they have fully completed their investigation.
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Dan O'Donoghue
·
30m
Dr Arthurs says 'there isn’t anything specific' to suggest Child G was suffering from sepsis/NEC or any other infection. He said 'there's nothing on the X-rays that would really provide a diagnosis' for Child G's condition
We're now moving on to Child H. Ms Letby is accused of trying to kill the infant on two occasions in September 2015. The prosecution claim she first attacked Child H in the early hours of 26 September and then again the following morning
Jurors previously heard Child H, who was born six weeks premature, needed treatment for a pneumothorax, which occurs when air leaks into the space between the lung and chest wall.
On the evening of 24 September 2015, Dr Alison Ventress inserted a pigtail chest drain to prevent any accumulation of air within the chest. However, in the early hours of 25 September more air had accumulated a second drain was inserted
Ms Letby's defence counsel Ben Myers KC previously claimed that Dr Ravi Jayaram inserted the second drain in the "wrong place". Dr Arthurs is now going over the X-rays of Child H which show the drains
Dr Arthurs notes that the position of the drains have moved, but he says that the 'precise location isn’t really critical if it’s having the desired effect if it’s draining the pneumothorax' - essentially supporting what Dr Jayaram has previously said here
Which 'known feeding/bowel issues' are you referring to?
Dr Arthurs is now moving on to Child I. Ms Letby is accused of injecting air into her stomach via a feeding tube
Dr Arthurs has said there is evidence of pneumatosis (gas within the wall of the small or large intestine) on an X-ray from 30 September of Child I
Dr Arthurs has said Child I had a 'normal' bowl, as per her X-ray on 18 October and into 20 October. Looking at an X-ray from 23, there is a 'massive' dilatation of the stomach
Dr Arthurs says it is 'quite unusual to see babies with this degree of dilatation of the stomach', he says it can cause 'splits in the diaphragm' and that can lead to 'respiratory complications'
Asked how much air it would take to generate such images, Dr Arthurs said: 'We don’t know, I don’t think anybody really knows. Those experiments can’t really be carried out, we can’t experiment on babies giving them 50 or 100mls of air and taking x-rays'
He adds: 'I would guess more than 20mls of air' He is asked, in the absence of another explanation, whether 'someone has deliberately injected air' Dr Arthurs says 'I think that stands to reason'
https://twitter.com/MrDanDonoghue
Dr Arthurs has said there is evidence of pneumatosis (gas within the wall of the small or large intestine) on an X-ray from 30 September of Child I
Dr Arthurs has said Child I had a 'normal' bowl, as per her X-ray on 18 October and into 20 October. Looking at an X-ray from 23, there is a 'massive' dilatation of the stomach
Dr Arthurs says it is 'quite unusual to see babies with this degree of dilatation of the stomach', he says it can cause 'splits in the diaphragm' and that can lead to 'respiratory complications'
Asked how much air it would take to generate such images, Dr Arthurs said: 'We don’t know, I don’t think anybody really knows. Those experiments can’t really be carried out, we can’t experiment on babies giving them 50 or 100mls of air and taking x-rays'
He adds: 'I would guess more than 20mls of air' He is asked, in the absence of another explanation, whether 'someone has deliberately injected air' Dr Arthurs says 'I think that stands to reason'
https://twitter.com/MrDanDonoghue
The bowel issues that called for further investigation by both CoC and the level three unit. The same bowel issues that also meant that child I was unable to consistently maintain feeding for any length of time causing him to to be Nil by mouth for intermittent periods throughout the duration of his short life.
That is true and to some point and very valid; but the thing is we aren’t getting a whole deal of more context of her colleagues in these messages so we don’t know a great deal more of what her colleagues are saying; only really points which are relevant to the case. By any means, we must not forget that they are not the ones being accused and standing trial for these awful cases.
It is alleged by the the prosecution she is the perpetrator and her messages form part of that wider picture as to why. What it demonstrates is (even if innocent), she is guilty of misconduct and breaching confidentiality imo. Whether her colleagues are or not, they are not the ones standing trial. Moo
I believe it was Letby who asked the nurse for updates on Baby F's progress after she texted, "Guess what Baby F's glucose levels were?'
The text messages are not meant to be considered as "evidence of murder," but to looked at in context with the events surrounding the messages as they occurred.
If the jury believes Letby poisoned Baby E and F as alleged, then LL asking for updates might not be seen as concern, but the need to know the result of her actions as she could not be there to witness the collapse herself.
Baby I was a girl.
She was born at 27 weeks, had gained 90g 10 days after birth, and was tolerating feeds well.
At six weeks she looked like a full term baby. (gestational age 33 weeks)
At eight weeks she was still gaining weight and feeding normally.
Then at eight weeks, LL fed her, she vomited, and there was enough air in her bowel to splint the diaphragm. So they stopped feeds, but restarted them 24 hours later, and she was fine on breast milk again for the next two weeks.
At 10 weeks, LL was watching her while her nurse popped out of the room for 15 minutes and she stopped breathing for the second time in her life, with air in her bowel. The following night in LL's care she stopped breathing again with sufficient air in bowel to splint the diaphragm. Doctors stopped her feeds and sent her to Arrowe where she became stable again. At that point, 10 days before her death, she was referred for a bowel investigation and put on TPN.
She returned to Countess 5 days before her death, awaiting a bowel investigation, but still gaining weight.
She was only off breast milk for the last 10 days of her 11 week life because doctors wanted to check her bowel. There never was a problem found with her bowel, and therefore it wasn't that she didn't tolerate her feeds it was that she didn't tolerate excess air in her gut squashing her lungs. How that air got there is what this trial is seeking to establish, but it wasn't a lack of diagnosis of a non-existent bowel problem that caused her collapses or her death.
Her last (fatal) collapse, while she was not receiving milk feeds, but receiving TPN, is when the experts say her IV lines were used to administer air into her bloodstream.
JMO
msmarple99
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A thank you for what?
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