& what exactly has she allegedly done to q or is it nxt wk we find out ty
These are notes from prosecution Opening Statements===they are not evidence because we don't know if they will successfully submit all of this as evidence yet
Chester Standard:
Child Q - attempted murder allegation
Child Q was born on June 22 - the day after Child O and P. He was premature but a good weight, and on CPAP for the first 20 hours.
He was admitted to the neonatal unit as he needed breathing support, but was initially stable.
He had a catheter in place via his umbilicus for nutrition, however he was well enough to commence feeding via his NGT. Initially he was put into room 1.
Nursing staff noted small amounts of bile when they checked his NGT on June 23-24. These were not of sufficient concern to stop him being fed milk.
A different nurse was Child Q's designated nurse on the night shift for June 24. She monitored him through the night, and fed him 0.5ml of milk every 2 hours at 3am, 5am and 7am.
The nurse was content with the condition, although the blood gases deteriorated slightly, so she referred the results to a doctor. The doctor reviewed them and was not concerned.
The day shift on June 25, Letby was on duty and was Child Q's designated nurse. Child Q had been moved into room 2.
Letby made notes on Child Q's fluid/feeding chart at 8am. Child Q was receiving nutrition Babiven via a UVC.
Just after 9am, Letby and the nurse were together in nursery 2, and it was feeding time. The other nurse attended to another child in the room.
According to the record, Child Q's heart and respiratory rates both increased for a short period of time.
But, the prosecution say, the feeding chart shows something 'unusual'.
That chart is shown to the court. The 9am fluid chart, in Letby's handwriting, appears unfinished, with numbers noted for fluids, but no record for the feed or Letby's signature initials at the bottom of the 9am column.
The prosecution suggests something caused Letby to leave halfway through doing this.
Letby signed for medication for another baby at 9.04am.
The other nurse agreed to keep an eye on Child Q at 9am.
A few minutes later, Child Q's monnitor alarms activated to alert staff to a deterioration in his condition.
Mr Johnson: "We say that Lucy Letby had sabotaged [Child Q] and had injected him with air and a clear fluid into his stomach via the NGT. She was trying to kill him."
The nurse called for help and was joined by another nurse. Child Q had been sick and nurses used a suction catheter while respiratory support was given. Lucy Letby appeared soon afterwards together with doctors who were responding to the call for help.
Medical notes indicates doctors were called to the unit at 9.17am as Child Q had "just vomited" and oxygen saturation levels were in the "low 60s".
The prosecution say medical staff gave him assistance with breathing using a Neopuff device and applied suction to clear his airways. The records indicate not only had his oxygen dropped but also his heart rate. He is described as “mottled” in appearance and, most significantly, a substantial amount of air was aspirated from his stomach via the NGT.
Mr Johnson tells the court the air had been put in there by Letby, as if the feeding chart had been followed correctly at 9am, the person feeding - Letby - would have aspirated Child Q's stomach to check there was nothing there before administering the 0.5ml milk feed.
Another nurse's medical note on an 'apnoea/brady/fit chart' notes: "09:10; brady 98; desat 68; fit ?; baby found to be very mucousy, clear mucous from nasopharynx oropharynx removed clear fluid +++.
"O2 via neopuff given post suctioning. Dr... emergency called to attend.
"NGT used to aspirate stomach by Nurse L Letby”
The prosecution say given that Letby was Child Q's designated nurse and she performed the aspiration of air, it might be thought surprising that she did not make the note – yet she did make notes in records of other babies’ notes at about the same time.
Mr Johnson: "We question whether this is an attempt by her to create a documentary alibi."
Computerised nursing notes made by Letby for that morning: "“09:10hrs [Child Q] attended to by SN... – he had vomited clear fluid nasally and from mouth, desaturation and bradycardia, mottled ++. Neopuff and suction applied. [Registrar] attended. Air ++ aspirated from NG tube”.
Following the collapse, blood was taken to test for infection and other parameters. A venous blood gas test showed results suggesting that he was unwell but this had resolved by 11.12am. He was started on a course of antibiotics as a precaution.
The doctor's view recorded at the time said Child Q's collapse was a result of “presumed sepsis with jaundice”.
At that stage a chest x ray was taken which showed nothing untoward. The more detailed blood tests were recorded at 1.50pm and showed slightly abnormal results which were treated.
Child Q had made a reasonable recovery through the day and at 7.20pm was "looking tired". Doctors took the decision to intubate him because his respiratory rate was down to 19 (low)and his heart rate was between 160-200 bpm (high). At that stage his blood gas readings were good.
The proseution say Lucy Letby was "worried" when she got home that night.
She texted a doctor at 10.46pm and asked "do I need to be worried about what Dr G was asking?"
The doctor sought to put her mind at rest and told her that Dr G was only asking to make sure that the normal procedures were carried out. She replied that after Child Q had collapsed she (LL) had walked into the equipment room and Dr G had been asking the other nurse who was present in the room (when Child Q had collapsed) and how quickly someone had gone to him because she (LL) had not been there.
She continued her texts to the doctor, telling him that she had needed to go to her designated baby in room 1.
The following day, Child Q's gases were unsatisfactory, but he had been extubated 4 hours earlier and was in air with high saturations.
Medical staff noted a 'mildly dilated loop of bowel' on Child Q's left side and raised the possibility of NEC and surgery.
Child Q was transferred to Alder Hey, where he quickly stabilised and no surgery was required.
The prosecution say this was "another child who had suffered life-threatening problems and...when out of the orbit of Lucy Letby, he made a rapid recovery."
Other than three days the following week, that was the last time Lucy Letby worked in the neonatal unit at the Countess of Chester Hospital, the court is told.
Medical expert Dr Dewi Evans said Child Q's collapse was due to 'inappropriate care', and he had been injected with air via the NGT.
The significant amount of air aspirated from his stomach 'could not have arisen in any other way'.
Dr Sandie Bohin noted Child Q was well up until June 25 and believed something happened between 9am and his collapse.
He was only being fed what Dr Bohin describes as “tiny” amounts of milk yet he had taken in “copious amounts of air” from the NGT. This was abnormal.
The effect of a large volume of air in the stomach would “squash” the lungs leading to desaturation and instability. Although a baby may recover quickly after such an event, he may remain unstable for some time thereafter.
She agreed with Dr Evans’ conclusion that events were consistent with the introduction of a large amount of air via the NGT.
A professor reviewed brain imaging of Child Q taken in November 2019 - more than three years later. He found evidence of abnormalities which whilst they were not diagnostic of him having suffered a brain injury as a result of being given excessive air and liquid via his NGT, they could be explained.
In Letby's home search, officers recovered the handover sheet from the morning of June 25 which included Child Q's name. This was a document which should not have left the hospital.
When interviewed by police, Letby agreed Child Q had been well enough for her to leave him on the morning of June 25.
When asked about the excess air aspirated from his stomach, she suggested babies sometimes gulp air when they vomit. She denied putting excess air down the NGT.
Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement