UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #12

[Sweeper2000]

<modsnip: Quoted post was removed>
i was wondering if there would be any signs of injury inflicted before the 9 pm mark as alleged? In one case dr evans suggested any painful stimulus can cause a desat but as far as I know that wasn’t present with baby E. indeed a doctor checking the baby around ten after the alleged trauma found the baby with an undramatic presentation I was wondering if that was likely? Also would there be swelling or redness around the injury site?

 

[Tortoise]

2:00pm

The trial is now resuming following its lunch break. Dr Smith will continue to give evidence.

2:06pm

Dr Smith says he would not have played any part in the connection of Child K to the ventilator at the neonatal unit, following transfer, and would not have had any knowledge of how to do so, as that connection would be a task carried out by nurses.

2:12pm

Dr Smith says he remembers coming back into the neonatal unit early on February 17, probably for labelling blood bottles.
He does not recall where the nurses were, but recalls Dr Ravi Jayaram giving breaths to Child K via the Neopuff, and that was already under way. He said the readings, while unable to recall what they were precisely, "were not improving", and further measures were to be carried out.
The explanation for a "sudden deterioration" was either the breathing tube being dislodged or blocked.
The "correct decision" was for the tube to be removed.
Breathing mask support was supplied to Child K without a tube. Child K's oxygen saturation levels improved and Child K was reintubated.
A morphine bolus was administered to help the reintubation process.

2:13pm

Dr Smith says he did not see any evidence of trauma, and if there was anything obvious to show that, he would have informed Dr Ravi Jayaram, but he "did not see anything".

Recap: Lucy Letby trial, Monday, February 27

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more, is…

www.chesterstandard.co.uk

 

[Tortoise]

2:19pm

The prosecution ask if the Countess team followed the advice from Arrowe Park to take x-rays of Child K to check for tube placement. Dr Smith confirms they did, and a chest x-ray was carried out.
The radiology report said, from the x-ray, the ET tube was 'in satisfactory position' following the reintubation, along with the NG tube, while a UVC line required further adjustment.
The radiology report also recorded possible lung infection, which Dr Smith was expected in babies of Child K's gestational age.

Recap: Lucy Letby trial, Monday, February 27

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more, is…

www.chesterstandard.co.uk

 

[marynnu]

I agree you also have to consider why LL told mum that the blood was due to the NGT rubbing and that the Dr was going to review ..yet did not call Dr for a further 40 mins

Dr Bohin concluded air embolism because of the pink fleeting blotches on abdomen

I still struggle with that explanation given to the mother, to be honest. IMO NGTs are just too soft. And after initially considering them as a possible instrument used to cause the gastric bleeding, Dr. Evans dismissed them for that very reason as I recall.

 

[Tortoise]

2:23pm

Dr Smith re-examined Child K at 6.15am, when it had been noted Child K had lower saturations, with a blood gas reading which was "not good" and "worse than the previous gas".
The tube was 'pulled back' to improve the oxygen saturation levels, but the readings had 'not improved'.
The decision was then taken to remove the tube from Child K. 'Bagging' breathing support was provided to stabilise oxygen saturation levels, and Child K was reintubated once again.
Child K had responded 'very quickly' to the 'bagging' support.

2:25pm

Dr Smith says, from the notes, there is nothing to say the tube removed from Child K was blocked, and his memory has nothing to add to that.

2:27pm

A repeat x-ray reported: 'Satisfactory position of the ET tube. NG tube in situ...this would benefit from advancement by 5-10mm. UVC in satisafactory position.'
A lung infection was still suspected for the left lung, which appeared increased in density - 'looking more white', and reduced in volume compared to the right lung.

2:29pm

Dr Smith later wrote a transfer letter to Arrowe Park Hospital, which summarised the care given to Child K at the Countess of Chester Hospital, including details of intubations, medication administrations and a blood result.

LIVE: Lucy Letby trial, Monday, February 27

 

[Tortoise]

2:33pm

Benjamin Myers KC, for Lucy Letby's defence, is now asking questions in respect of the events for Child K.
He says Child K was born in extreme prematurity, and asks if there would inevitably be problems for the baby girl's care, particularly in relation to the lungs. Dr Smith agrees.
Dr Smith remembers being in the room when Child K's resuscitation efforts were taking place, and they were going well.
He says neonates with this gestation need a lot of support and resuscitation.
He cites a study that babies of that gestation age, found a 75% survival rate. Mr Myers suggests that figure could be more like 40-50% from another study. Dr Smith says he has cited the most recently available study he looked at.

2:36pm

Mr Myers says a tertiary unit is the most suitable place for treating babies of Child K's gestational age.
Dr Smith says they are more experienced at a tertiary unit, but level 2 units (such as the Countess of Chester Hospital at this time) have the equipment and have staff capable of treating babies of this gestational age, for the short term.
He says the correct thing to do would be to contact the level 3 unit in advance to enquire if transfer to there was possible in advance of birth.

Recap: Lucy Letby trial, Monday, February 27

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more, is…

www.chesterstandard.co.uk

 

[Tortoise]

2:39pm

He says seeing Child K's bruising on her hands and feet at birth was not something he had seen frequently in births, and was more likely seen by staff at tertiary centres. He said he had asked for an expert opinion on the subject of the bruising.

2:45pm

Dr Smith says level 2 centres do not look after babies of this prematurity, long term.
He says if mothers of 23-week gestational arrived at the hospital via ambulance, and delivery was imminent, that delivery would take place at the nearest hospital, with a set procedure in place to arrange transport to a tertiary centre when viable.
Dr Smith recalls it would have been better if he had written his own independent notes, in addition to Dr Ravi Jayaram's complete notes. He added he did write up the transfer letter listing the events and care for Child K.
Mr Myers asks why would Dr Jayaram write up those notes in the first place. Dr Smith says he would also have been on the paediatric unit on that night shift. He says as long as a senior doctor has been involved in writing, then the notes would be 'completed'. He says that 'ideally', he would have written notes up himself, independently.

2:54pm

Mr Myers asks about the initial intubation process for Child K.
He asks if Dr Jayaram should be the one to do that process, as the more senior doctor.
Dr Smith says: "No, not if the baby is stable."
He says the decision to take over could be the 'wrong decision' as the doctor carrying out the procedure would be familiar with the placement of where everything is.
Mr Myers asks if it's standard practice guidance for babies to be intubated within 15 minutes of birth. Dr Smith says he is not familiar with that number, and asks Mr Myers where that guidance has come from.
Dr Smith says if that was the number that is standard practice, then he would go with that. He says there are two different numbers for how long it was after birth for intubation to have taken place - one of them is 12 minutes.

Recap: Lucy Letby trial, Monday, February 27

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more, is…

www.chesterstandard.co.uk

 

[GoodDayToYouSir]

How do we know it's a common surname?

The internet. The solution to, and cause of, all problems .

 

[GoodDayToYouSir]

2:39pm

He says seeing Child K's bruising on her hands and feet at birth was not something he had seen frequently in births, and was more likely seen by staff at tertiary centres. He said he had asked for an expert opinion on the subject of the bruising.

2:45pm

Dr Smith says level 2 centres do not look after babies of this prematurity, long term.
He says if mothers of 23-week gestational arrived at the hospital via ambulance, and delivery was imminent, that delivery would take place at the nearest hospital, with a set procedure in place to arrange transport to a tertiary centre when viable.
Dr Smith recalls it would have been better if he had written his own independent notes, in addition to Dr Ravi Jayaram's complete notes. He added he did write up the transfer letter listing the events and care for Child K.
Mr Myers asks why would Dr Jayaram write up those notes in the first place. Dr Smith says he would also have been on the paediatric unit on that night shift. He says as long as a senior doctor has been involved in writing, then the notes would be 'completed'. He says that 'ideally', he would have written notes up himself, independently.

2:54pm

Mr Myers asks about the initial intubation process for Child K.
He asks if Dr Jayaram should be the one to do that process, as the more senior doctor.
Dr Smith says: "No, not if the baby is stable."
He says the decision to take over could be the 'wrong decision' as the doctor carrying out the procedure would be familiar with the placement of where everything is.
Mr Myers asks if it's standard practice guidance for babies to be intubated within 15 minutes of birth. Dr Smith says he is not familiar with that number, and asks Mr Myers where that guidance has come from.
Dr Smith says if that was the number that is standard practice, then he would go with that. He says there are two different numbers for how long it was after birth for intubation to have taken place - one of them is 12 minutes.

Recap: Lucy Letby trial, Monday, February 27

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more, is…

www.chesterstandard.co.uk

Do any of you medical wizards have an opinion on what does cause bruising on hands and feet at birth?

 

[Tortoise]

"On Monday, Nick Johnson KC, prosecuting, told jurors: "It is alleged Lucy Letby interfered with the endotracheal (ET) tube and Dr Ravi Jayaram walked in to the immediate aftermath of that." [...]

Dr Jayaram noted that at 3:50am there was a "sudden deterioration" in Child K’s condition as her blood oxygen levels fell to 40%.

The breathing tube was then removed and her oxygen rate "recovered pretty quickly" after she received rescue breaths through a facemask, the court was told.

[...]

In his opening address last October, Ben Myers KC, defending, said the "probable cause" for the tube dislodgement at 3:50am was the child inadvertently moving it herself."

10%
ITV - https://www.itv.com/news/granada/2023-02-27/nurse-tried-to-murder-baby-within-two-hours-of-her-birth

 

[Cluedoneit]

well it happened 2 years after she was no longer doing nursing, and a couple of months before her arrest. She apparently remembered the baby despite her only being in the hospital for a matter of hours before LL went off shift, and not being her designated nurse.

The defence has said she also searched parents of babies not included in the charges, but I'm not sure when that stopped.

It would be very interesting to know how much time she spent scrolling through the Facebook pages of the alleged victims families versus the other families she searched. <modsnip: sub judice> It would be good for the jury to know when she searched non Allegedly harmed families and in what pattern. they could then see how much weight this evidence should be given. If for example she constantly searched families whose baby it’s certain died of natural causes with a similar pattern to Baby E&F’s family, then this evidence means little in my opinion. But, if the only baby she repeatedly searched with those that he is alleged to have harmed, and the others were only searched once or twice, then the evidence would have a greater significance in my opinion.

sorry for the errors, my dictation software doesn’t like me today !

 

[Tortoise]

2:59pm

Dr Smith is asked about lung surfactant which a note records as being administered at 3am, and if that, at about 35 minutes after intubation, is 'too long'.
Dr Smith says if there is good oxygen saturation recorded at the time, and Child K is stable, that would not be an issue, but if guidance is to administer that surfactant five minutes after intubuation, then that would be considered too long.

3:01pm

Dr Jayaram's note is shown to the court, written retrospectively. Dr Smith points out the note of surfactant administration is recorded as being made at '0245'.

Recap: Lucy Letby trial, Monday, February 27

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more, is…

www.chesterstandard.co.uk

 

[Tortoise]

3:11pm

Mr Myers asks about the insertion of a central line, done 'several hours' after Child K was born. Dr Smith says the procedure requires assistance, is difficult, takes time, needs a sterile environment and a stable baby. It also requires x-rays afterwards.
The line is 1mm thick being put into an umbilical cord line that is 1-2mm thick. It is, in this instance, 'a non-emergency UVC'.
Mr Myers says this is a procedure which, 'ideally' should be done by a consultant neonatologist at a tertiary centre.
Dr Smith says ideally, the baby would be born at a tertiary centre, but in these circumstances, the most experienced staff available at a level 2 centre, who are capable of this type of procedure, would carry out the procedure.
Mr Myers asks if it was 'too long' a time period. Dr Smith said the baby would not have been compromised by a longer time period.
Mr Myers asks if it was 'sub optimal'. Dr Smith says it would depend on the circumstances and the condition of the baby, and in Child K's case, the 'correct thing to do' was to prioritise the airway and breathing support, and lines could be put in later.
Mr Myers asks if the insertion of the line at this time fell outside the 'golden hour' principle.
Dr Smith says there is no difference in the method of the administration of initial medicines - the UVC was one option, but there are others.
Dr Smith agrees with Mr Myers the initial administration of antibiotics fell outside the 'golden hour' principle timing. The antibiotics were administered at 4.40am, according to electronic prescription records, sometime after the first hour of Child K's birth which ended at 3.12am.
Dr Smith adds, from a blood test, there was no marker of infection, but if was sub-optimal that the antibiotics and vitamin K (administered at 4.20am) were not administered in the first hour, and cannot recall why that was the case.

Recap: Lucy Letby trial, Monday, February 27

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more, is…

www.chesterstandard.co.uk

 

[marynnu]

Do any of you medical wizards have an opinion on what does cause bruising on hands and feet at birth?

Not bruising as such, but blueish hands & feet are normal with newborns & perhaps more noticeable IMO with very prem babies as their skin is so transparent. I suspect if you have a normal delivery a very tiny fragile baby might get a little bruising too, but don't quote me!

 

[Tortoise]

I still struggle with that explanation given to the mother, to be honest. IMO NGTs are just too soft. And after initially considering them as a possible instrument used to cause the gastric bleeding, Dr. Evans dismissed them for that very reason as I recall.

needs to be considered in relation to the other cases too IMO -


"The doctor saw "fresh blood" in Child N's throat, which the prosecution say was the same seen in Childs C, E and G."
Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders

 

[Tortoise]

3:34pm

After a short break, Mr Myers is continuing to question Dr Smith.
He refers to the intubation attempts made for Child K. Dr Smith says he used a 2.5 tube at first, then a smaller 2.0 tube was used, successfully.
Mr Myers asks about an air leak which was reported. Dr Smith says he was aware, and made reference to it in his third statement to police.
The 3.30am reading of '94' for air leak, Dr Smith does not know what that means, as it does not correlate to any of the other readings. He says the blood gas record for Child K was good, and the oxygen saturation for Child K was good, and oxygen requirement had come down. He says he does not believe that would mean only 6% (100% minus 94) of oxygen was getting into Child K.
He said a large air leak would result in a change to a larger ET tube being considered, but that process would require reintubation.
He said, knowing there was good oxygenation and good gas, that would reduce the need for reintubation.
He adds that a tertiary neonatologist with more experience of ventilators might give a different opinion, but they would need to be called to give evidence. Dr Smith adds he also does not know what the 'resistance' figure on the chart signifies either.

LIVE: Lucy Letby trial, Monday, February 27

 

[Tortoise]

3:39pm

Mr Myers asks about the reintubation of the tube for Child K, which involved a larger tube. Dr Smith says the first ET tube was working fine, then it was not, and reintubation was required.
The morphine bolus was applied to have "a sedative effect" on Child K.

LIVE: Lucy Letby trial, Monday, February 27

 

[Tortoise]

3:42pm

The desaturation at 6.15am is referred to.
Dr Smith says the ET tube was pulled back, but saturation levels continued to decrease, so the ET tube was removed and bagging commenced.
The saturation levels improved, and Dr Smith says that meant there "was a problem with the tube".
Mr Myers says pulling the tube back and seeing no change [prior to the tube's removal] meant there was no problem with the positioning of the tube.
Dr Smith says the cause of the tube's movement could have been it 'slipping' from the clamp, for this deterioration.

Recap: Lucy Letby trial, Monday, February 27

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more, is…

www.chesterstandard.co.uk

 

[Tortoise]

3:44pm

Dr Smith says he did not recall any injury/blood/trauma with Child K, and if he had done so, he would have referred it to Dr Ravi Jayaram and asked them to take over the intubation process.

3:47pm

Mr Myers asks if, hypothetically, he had seen blood before intubation, if he would have checked for the source of it.
Dr Smith says it would depend on the amount of blood seen that would lead to how concerned he would be. He said if he had seen blood-stained secretions, he would make a note of it.

Recap: Lucy Letby trial, Monday, February 27

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more, is…

www.chesterstandard.co.uk

 

[Tortoise]

I'm not sure this questioning about trauma or bleeding has been explained.