UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #4

[Noseyposy76]

I am finding these discussions fascinating because I think there is usually a consensus of guilt on these threads. I know that for myself, I am generally convinced of the defendant's guilt during a trial. I am trying to think why there is so much doubt in this case when we all know that the bar is high for the CPS to decide to prosecute. I googled the Code for Crown Prosecutors and it states Crown Prosecutors must be satisfied there is enough evidence to provide a "realistic prospect of conviction" against each defendant. In addition, it must be in the public interest for the CPS to bring the case to court.( The Code for Crown Prosecutors | The Crown Prosecution Service )

The decision to hold a 6 month trial with the associated costs of the trial and hiring expert witnesses will not have been made lightly. So why is there so much doubt this time (including me!)? Is it because LL is young and female and white and blonde? Or is the idea of a nurse murdering babies too abhorrent to accept? I feel for some reason we are identifying with her and thinking how awful it would be to be in her shoes if she is innocent. But why?

Just my thoughts and ideas.

I really appreciate your post, this thread is certainly divided! I think it is always important to question ourselves, as so often our opinions are based on personal biases, especially when most of the facts remain unknown. Here are my thoughts:

Why this case even peaked my interest, is because it took them so long to actually charge LL from her first and subsequent arrest. It made me suspect that they didn’t have a particularly strong case against her. My continued doubt is based on what has been presented so far…

As for her appearance, I think many of us have probably been shocked in the past by crimes committed by those with the faces of angels. Know I learnt my lesson on judging a book by it’s cover from what happened to poor Christopher Jeffries.

I expect any good human being would find the idea of a nurse being responsible for such monstrous acts hard to accept. But as we have seen a lot of cases recently, parents have been the actual perpetrators, so would it really be that difficult for us to reconcile the possibility of a nurse.

But yes, I have certainly put myself in her shoes. To be accused of something so heinous if innocent, would be absolutely horrific and unimaginable to live with.

With regard to the decision of bringing this to trial for 6 months remains to be seen. But if innocent LL wouldn’t be the first or the last to be wrongly accused.

 

[Marantz4250b]

These expert witnesses and witnesses to the events are taking the stand on oath and providing evidence for the Jury.
For the two (so far) who saw the rash ...both were quite clear they had not ever seen anything like it before or since. Both having worked with neonates closely for a long time.
These witnesses have been cross examined by defence who as yet have not shown any reason not to believe this.
This is the information the Jury have to use to make their decision they cannot start looking for their own version of events.
Obviously there's a lot of information still to come that may discredit that but not as yet.
The amount of people on social media coming up with all sorts of medical reasons for air and rashes is amazing.
I'm all for critical thinking and keeping an open mind on what the court tell us but I just don't get this need to "self defend"

All good points here but, on the subject of the highlighted part, if they had never seen it before and it is so fantastically rare then how can they say that it is a consequence of an air embolism, let alone an unlawfully and intentionally administered one?

 

[Tortoise]

All good points here but, on the subject of the highlighted part, if they had never seen it before and it is so fantastically rare then how can they say that it is a consequence of an air embolism, let alone an unlawfully and intentionally administered one?

I think possibly you're conflating the doctors/nurses evidence with the experts we have yet to hear from.

It's the hospital staff who saw the skin discolouration and as far as I'm aware they haven't given opinions on what caused it or what it's 'consistent with'.

 

[Powermjp]

Just because doctors are wrong "sometimes" doesn't mean they are never to be trusted as evidence.

People make mistakes, but there is a difference between anecdotal mistakes they have made in your personal life, to them swearing an oath in court firstly.

And even so the general logic is just a little silly, because of course some doctors make mistakes, some people make false accusations of assaualt, does that mean we are to never believe these victims? There should be no link between them and each case needs to be on its own merit. Do we never trust police to give evidence because some are bad? Eye witness sometimes are wrong, do we just never count these in a court case then?

Do these people want to live in a world with no experts in any field giving evidence in court because others in the field have made mistakes which are totally different to the court case and hold 0 bearing? And we should just discredit the experts?

Drawing conclusions from personal experience on doctors has no relevance in my opinion to these experts giving evidence, unless the defence can discredit them.

 

[notsure]

Just because doctors are wrong "sometimes" doesn't mean they are never to be trusted as evidence.

People make mistakes, but there is a difference between anecdotal mistakes they have made in your personal life, to them swearing an oath in court firstly.

And even so the general logic is just a little silly, because of course some doctors make mistakes, some people make false accusations of assaualt, does that mean we are to never believe these victims? There should be no link between them and each case needs to be on its own merit. Do we never trust police to give evidence because some are bad? Eye witness sometimes are wrong, do we just never count these in a court case then?

Do these people want to live in a world with no experts in any field giving evidence in court because others in the field have made mistakes which are totally different to the court case and hold 0 bearing? And we should just discredit the experts?

Drawing conclusions from personal experience on doctors has no relevance in my opinion to these experts giving evidence, unless the defence can discredit them.

All excellent points, but surely the knowledge that doctors and nurses can be fallible, coupled with the fact that they are stating their own retrospective opinions and not always incontrovertible facts, may sometimes lead to a reasonable doubt in the mind of the lay person.

 

[JosieJo]

All good points here but, on the subject of the highlighted part, if they had never seen it before and it is so fantastically rare then how can they say that it is a consequence of an air embolism, let alone an unlawfully and intentionally administered one?

As far as I am aware we have had no one on the stand stating they feel its an air embolus rash as yet ?

 

[JosieJo]

They all said that they'd never seen the particular colouring on babies before. They have said that the colouring is "consistent with" an air embolism.

By that choice of words, from more than one medical professional, it suggests that they have seen AE's but not with that particular skin colouring. Alternatively, they haven't seen an AE so are quoting from medical texts/theory.

So, have they seen an AE before but without that colouring or; have they never seen a AE and recognised that it was one by the colouring? The former is the most logical explanation, surely? If the latter were the case then they'd presumably immediately realise it due to the extremely rare colouration and give treatment to suit?

In any event, and with the above in mind, we still have the words "consistent with" to deal navigate. Those words are not synonymous with "caused by". Coincidence does not equal causation. Something consistent with one thing may also be consistent with many other medical conditions - and someone has already mentioned it being consistent with an inability to control temperature.

I dont know exact figures but I think air embolus especially hospital acquired are rare.
I worked in the NHS for 34 years and I honestly have never seen one

 

[Tortoise]

So I've been back through the trial reports and we have four witnesses to the unusual skin blotches, two to child A and two to child B.


Child A -

Registrar Dr David Harkness -
“The skin patterns I had never seen before and I have only seen again at the CoCH." [on child E]

“There was very unusual patchiness on his skin which I had not seen before. There were patches of blue/purple colour, patches of red and of white.” “all over the body”


Neonatal nurse/Night-shift leader -
“never seen a baby look that way before, a skin discolouration on a pattern she had never seen before. White with purple blotches with a bit of blue and it had come on very suddenly. He looked cyanotic.”


Child B -

Claire Hocknell – Police Intelligence Analyst - going through Child B's medical notes for 10th June -

12.50am consultant’s notes - “Suddenly purple blotching of body all over with slowing of heart rate”

2.40am – nursing notes - “purple discolouration almost resolved – cause ??..”



The mother and grandmother also mention mottling on child B but it's not clear from the reports that they saw it themselves or were told about it. The mother does say however that the consultant had never seen it before and wanted to photograph it.

 

[Charlot123]

Years ago, a senior medical consultant, an expert in his field, diagnosed me with a rare condition because of a distinctive rash he noticed on my legs. Afterwards, I realised that this "rash" was actually a pattern of indentations caused by sitting with my handbag pressing the fabric of my skirt against my lap. This and other misdiagnoses over the years have led me to realise that experts are not infallible.

Once upon a time, my child wanted to be Optimus Prime for the Halloween. I ordered the costume and we tried it on. The next day, my husband called me, hysterical about child's rash, everywhere, including his feet and soles. I advised to take the boy to a local hospital, assuming that ER doctors see most rashes. Three hours later, he was discharged with an advise to give benadryl and the diagnosis "rash on unknown origin". By that time, I realized that Optimus Prime was a whole body costume, so I ended up washing it. The costume lost all its nice gleam and whatever made it stiff, and at the same time, the rash began to fade. I still hold that hospital in high esteem, btw, but - rashes could be anything.

 

[Dotta]

Once upon a time, my child wanted to be Optimus Prime for the Halloween. I ordered the costume and we tried it on. The next day, my husband called me, hysterical about child's rash, everywhere, including his feet and soles. I advised to take the boy to a local hospital, assuming that ER doctors see most rashes. Three hours later, he was discharged with an advise to give benadryl and the diagnosis "rash on unknown origin". By that time, I realized that Optimus Prime was a whole body costume, so I ended up washing it. The costume lost all its nice gleam and whatever made it stiff, and at the same time, the rash began to fade. I still hold that hospital in high esteem, btw, but - rashes could be anything.

But I think there is a difference between blotches and rash, no?

 

[Tortoise]

But I think there is a difference between blotches and rash, no?

Yes this has variously been described as patterns, patches, discolouration and blotching.

Another quote from Dr Harkness - which sounds very much like streaking, or a blood thing, to me. Not to be too technical of course

“This was bright red patches… that means you have blood going round your body.”

Dead baby had ‘extraordinary’ discoloured patches on skin, Lucy Letby trial told

The newborn twin died at the Countess of Chester Hospital just over 24 hours after his premature birth.

www.independent.co.uk

 

[Dotta]

Yes this has variously been described as patterns, patches, discolouration and blotching.

Another quote from Dr Harkness - which sounds very much like streaking, or a blood thing, to me. Not to be too technical of course

“This was bright red patches… that means you have blood going round your body.”

Dead baby had ‘extraordinary’ discoloured patches on skin, Lucy Letby trial told

The newborn twin died at the Countess of Chester Hospital just over 24 hours after his premature birth.

www.independent.co.uk

This is what I understood - as newborn babies' skin is almost translucent, all blood abnormality is visible.
Blotches of blood appeared
and seemed to be caused by weakening heart beat.

Rash is something different - usually caused by allergy.

MOO as Im not a medic.

 

[magikarpmagikarp]

I joined just to comment on the blotching. I hope my post adheres to the rules. I have been a bedside nurse in a regional perinatal facility/NICU in the US for almost a decade. The multiple comments from multiple doctors and nurses about the unusual coloration definitely caught my attention.

Mottling, or skin with a lacy appearance, sometimes called cutis marmorata, is something we see in the NICU a fair amount. It's caused by poor skin perfusion, and can be a sign of something as simple as cold stress, or as sinister as hypotension secondary to sepsis, acidosis due to respiratory failure, and so on. With cold stress, it resolves with increasing the environmental temperature. With hypotension, it improves when circulation improves. When it's acidosis, it improves when the acidosis is corrected.

The doctors and nurses who saw the blotching on the babies at CC were definitely familiar with what we call "mottling" from poor skin perfusion. It would not have been noted as unusual. Cutis marmorata in neonates usually causes a uniformly lacy appearance, either all over the exposed limbs or all over the body. This sounded different. It sounded like they were describing whole patches of the body that were white, red, or blue. I don't recall reading that any staff suggested it signified air embolism, just that it was striking and unusual.

With that said, I use a vein transilluminator when I place peripheral IVs on infants, and after I place the PIV, I flush the vessel with saline. Watching the movement of the saline through the illuminated vessels is striking, as the blood moves out of the way, to be replaced by saline, to be replaced by blood. It travels in a branching fashion, following the branching of the vessels. It is not hard to imagine that if air bubbles were passing through circulation, the tissue there would be deprived of blood (causing whiteness); then it would become cyanotic (causing blueness). The redness could be the blood returning. So each area would have its own color, causing a patchy discoloration that shifts and then fades. I was able to find an article which describes exactly this coloration in induced air embolism (in the heart tissue of dogs rather than the skin tissue of people, but blood vessels are blood vessels and tissue is tissue), and they explain the redness as "reactive hypermia" or the rush of blood coming back to the previously ischemic area. ("THE SIGNIFICANCE OF AIR EMBOLISM DURING CARDIOPULMONARY BYPASS" by Spencer, Rossi, Yu and Koepke, from 1965) Later if I have time I will see if I can find additional information.

If I put myself in the shoes of the staff, and saw that kind of patchiness on a baby, I would have thought it striking and unusual as well. If it was my first time seeing it, and perhaps my first or second time caring for a baby who had died, I might think that it was due to the changes of the skin at death. I would not have recognized it as *possibly* signifying an air embolism at that time, though.

I also found it especially difficult to think of alternate explanations for the swollen and bloody airways of babies on CPAP, and the case of the baby whose abdomen was completely full of air to the point that the baby went into respiratory failure and died. Usually that sort of thing is caused by a bowel infection with a lot of tissue death but it sounds like there was no evidence of infection for this baby.

 

[Charlot123]

But I think there is a difference between blotches and rash, no?

No. We had the rash on the whole body, arms, legs, palms and soles. Sparing the face.

It is unclear now what exactly the staff saw. I suspect given the stress of what happened later, and the fact that blotches/rash disappeared, it is not going to be used as evidence ((

 

[catgreen]

I joined just to comment on the blotching. I hope my post adheres to the rules. I have been a bedside nurse in a regional perinatal facility/NICU in the US for almost a decade. The multiple comments from multiple doctors and nurses about the unusual coloration definitely caught my attention.

Mottling, or skin with a lacy appearance, sometimes called cutis marmorata, is something we see in the NICU a fair amount. It's caused by poor skin perfusion, and can be a sign of something as simple as cold stress, or as sinister as hypotension secondary to sepsis, acidosis due to respiratory failure, and so on. With cold stress, it resolves with increasing the environmental temperature. With hypotension, it improves when circulation improves. When it's acidosis, it improves when the acidosis is corrected.

The doctors and nurses who saw the blotching on the babies at CC were definitely familiar with what we call "mottling" from poor skin perfusion. It would not have been noted as unusual. Cutis marmorata in neonates usually causes a uniformly lacy appearance, either all over the exposed limbs or all over the body. This sounded different. It sounded like they were describing whole patches of the body that were white, red, or blue. I don't recall reading that any staff suggested it signified air embolism, just that it was striking and unusual.

With that said, I use a vein transilluminator when I place peripheral IVs on infants, and after I place the PIV, I flush the vessel with saline. Watching the movement of the saline through the illuminated vessels is striking, as the blood moves out of the way, to be replaced by saline, to be replaced by blood. It travels in a branching fashion, following the branching of the vessels. It is not hard to imagine that if air bubbles were passing through circulation, the tissue there would be deprived of blood (causing whiteness); then it would become cyanotic (causing blueness). The redness could be the blood returning. So each area would have its own color, causing a patchy discoloration that shifts and then fades. I was able to find an article which describes exactly this coloration in induced air embolism (in the heart tissue of dogs rather than the skin tissue of people, but blood vessels are blood vessels and tissue is tissue), and they explain the redness as "reactive hypermia" or the rush of blood coming back to the previously ischemic area. ("THE SIGNIFICANCE OF AIR EMBOLISM DURING CARDIOPULMONARY BYPASS" by Spencer, Rossi, Yu and Koepke, from 1965) Later if I have time I will see if I can find additional information.

If I put myself in the shoes of the staff, and saw that kind of patchiness on a baby, I would have thought it striking and unusual as well. If it was my first time seeing it, and perhaps my first or second time caring for a baby who had died, I might think that it was due to the changes of the skin at death. I would not have recognized it as *possibly* signifying an air embolism at that time, though.

I also found it especially difficult to think of alternate explanations for the swollen and bloody airways of babies on CPAP, and the case of the baby whose abdomen was completely full of air to the point that the baby went into respiratory failure and died. Usually that sort of thing is caused by a bowel infection with a lot of tissue death but it sounds like there was no evidence of infection for this baby.

Thanks, that is very helpful - and welcome to you!

 

[Charlot123]

I wanted to respond to someone’s comment about opinions split. I don’t think it is the case. I never worked with preemies. The realization that they are so sensitive to cold (have basically no body fat), the sad words of the nurse (Taylor) who emphasized their extreme vulnerability, and the birth weight of one baby, 500 g, all was shocking. Life that weighs the same as the loaf of bread, probably, smaller, on your palm.

At the same time, what a testimony to modern medicine, they save these babies, the smallest ones to survive in the world were 21 weeks at birth.

Because of all posted above, the accusation is very strong.

One wants the justice to be more than diligent.

All of this being said, feeling very compassionate towards the parents of the victims.

 

[Charlot123]

I joined just to comment on the blotching. I hope my post adheres to the rules. I have been a bedside nurse in a regional perinatal facility/NICU in the US for almost a decade. The multiple comments from multiple doctors and nurses about the unusual coloration definitely caught my attention.

Mottling, or skin with a lacy appearance, sometimes called cutis marmorata, is something we see in the NICU a fair amount. It's caused by poor skin perfusion, and can be a sign of something as simple as cold stress, or as sinister as hypotension secondary to sepsis, acidosis due to respiratory failure, and so on. With cold stress, it resolves with increasing the environmental temperature. With hypotension, it improves when circulation improves. When it's acidosis, it improves when the acidosis is corrected.

The doctors and nurses who saw the blotching on the babies at CC were definitely familiar with what we call "mottling" from poor skin perfusion. It would not have been noted as unusual. Cutis marmorata in neonates usually causes a uniformly lacy appearance, either all over the exposed limbs or all over the body. This sounded different. It sounded like they were describing whole patches of the body that were white, red, or blue. I don't recall reading that any staff suggested it signified air embolism, just that it was striking and unusual.

With that said, I use a vein transilluminator when I place peripheral IVs on infants, and after I place the PIV, I flush the vessel with saline. Watching the movement of the saline through the illuminated vessels is striking, as the blood moves out of the way, to be replaced by saline, to be replaced by blood. It travels in a branching fashion, following the branching of the vessels. It is not hard to imagine that if air bubbles were passing through circulation, the tissue there would be deprived of blood (causing whiteness); then it would become cyanotic (causing blueness). The redness could be the blood returning. So each area would have its own color, causing a patchy discoloration that shifts and then fades. I was able to find an article which describes exactly this coloration in induced air embolism (in the heart tissue of dogs rather than the skin tissue of people, but blood vessels are blood vessels and tissue is tissue), and they explain the redness as "reactive hypermia" or the rush of blood coming back to the previously ischemic area. ("THE SIGNIFICANCE OF AIR EMBOLISM DURING CARDIOPULMONARY BYPASS" by Spencer, Rossi, Yu and Koepke, from 1965) Later if I have time I will see if I can find additional information.

If I put myself in the shoes of the staff, and saw that kind of patchiness on a baby, I would have thought it striking and unusual as well. If it was my first time seeing it, and perhaps my first or second time caring for a baby who had died, I might think that it was due to the changes of the skin at death. I would not have recognized it as *possibly* signifying an air embolism at that time, though.

I also found it especially difficult to think of alternate explanations for the swollen and bloody airways of babies on CPAP, and the case of the baby whose abdomen was completely full of air to the point that the baby went into respiratory failure and died. Usually that sort of thing is caused by a bowel infection with a lot of tissue death but it sounds like there was no evidence of infection for this baby.

Thank you very much. Neonatology is such a specific area of medicine, we do need a lot of explanations; I think explanations and opinions of people like you weigh so much more than tabloids in this complex case.

 

[Tortoise]

I joined just to comment on the blotching. I hope my post adheres to the rules. I have been a bedside nurse in a regional perinatal facility/NICU in the US for almost a decade. The multiple comments from multiple doctors and nurses about the unusual coloration definitely caught my attention.

Mottling, or skin with a lacy appearance, sometimes called cutis marmorata, is something we see in the NICU a fair amount. It's caused by poor skin perfusion, and can be a sign of something as simple as cold stress, or as sinister as hypotension secondary to sepsis, acidosis due to respiratory failure, and so on. With cold stress, it resolves with increasing the environmental temperature. With hypotension, it improves when circulation improves. When it's acidosis, it improves when the acidosis is corrected.

The doctors and nurses who saw the blotching on the babies at CC were definitely familiar with what we call "mottling" from poor skin perfusion. It would not have been noted as unusual. Cutis marmorata in neonates usually causes a uniformly lacy appearance, either all over the exposed limbs or all over the body. This sounded different. It sounded like they were describing whole patches of the body that were white, red, or blue. I don't recall reading that any staff suggested it signified air embolism, just that it was striking and unusual.

With that said, I use a vein transilluminator when I place peripheral IVs on infants, and after I place the PIV, I flush the vessel with saline. Watching the movement of the saline through the illuminated vessels is striking, as the blood moves out of the way, to be replaced by saline, to be replaced by blood. It travels in a branching fashion, following the branching of the vessels. It is not hard to imagine that if air bubbles were passing through circulation, the tissue there would be deprived of blood (causing whiteness); then it would become cyanotic (causing blueness). The redness could be the blood returning. So each area would have its own color, causing a patchy discoloration that shifts and then fades. I was able to find an article which describes exactly this coloration in induced air embolism (in the heart tissue of dogs rather than the skin tissue of people, but blood vessels are blood vessels and tissue is tissue), and they explain the redness as "reactive hypermia" or the rush of blood coming back to the previously ischemic area. ("THE SIGNIFICANCE OF AIR EMBOLISM DURING CARDIOPULMONARY BYPASS" by Spencer, Rossi, Yu and Koepke, from 1965) Later if I have time I will see if I can find additional information.

If I put myself in the shoes of the staff, and saw that kind of patchiness on a baby, I would have thought it striking and unusual as well. If it was my first time seeing it, and perhaps my first or second time caring for a baby who had died, I might think that it was due to the changes of the skin at death. I would not have recognized it as *possibly* signifying an air embolism at that time, though.

I also found it especially difficult to think of alternate explanations for the swollen and bloody airways of babies on CPAP, and the case of the baby whose abdomen was completely full of air to the point that the baby went into respiratory failure and died. Usually that sort of thing is caused by a bowel infection with a lot of tissue death but it sounds like there was no evidence of infection for this baby.

Thank you for joining.

As you say, none of the reports say that hospital staff recognized or suggested air embolism.

Reading between the lines, as regards the defence stance, I think this is going to come down to a matter of timing.

We've only heard from one expert so far, Professor Owen Arthurs, consultant paediatric radiologist from Great Ormond Street Hospital. As reported, he examined a post mortem x-ray of Child A, which showed an "unusual" line of gas in front of the spine running from the stomach to just beyond the heart ("not found in cases of natural causes deaths in babies"), and also gas in the stomach and heart which he said was "normal".

(links - Recap: Lucy Letby trial, Friday, October 21 and Lucy Letby trial: Emotional nurse felt final heartbeat of newborn twin 'murdered', court hears )

He agreed with the defence that

- the presence of a UVC or long line for some time could lead to air in the system
- air can be distributed in the system during CPR
- one possibility is air administration, other possibilities are through resuscitation or post mortem changes

In my totally unqualified opinion, if it was air from the UVC/long line, ie a regular procedure, these registrars/consultants and nurses would have seen it many times before, and not solely on babies that collapsed within minutes of LL attending to them. If it was from resuscitation or post mortem changes it wouldn't have been there at the time of the collapse. That's why I mention timing. That's just my laypersons way of looking at it.

MOO

 

[JosieJo]

I joined just to comment on the blotching. I hope my post adheres to the rules. I have been a bedside nurse in a regional perinatal facility/NICU in the US for almost a decade. The multiple comments from multiple doctors and nurses about the unusual coloration definitely caught my attention.

Mottling, or skin with a lacy appearance, sometimes called cutis marmorata, is something we see in the NICU a fair amount. It's caused by poor skin perfusion, and can be a sign of something as simple as cold stress, or as sinister as hypotension secondary to sepsis, acidosis due to respiratory failure, and so on. With cold stress, it resolves with increasing the environmental temperature. With hypotension, it improves when circulation improves. When it's acidosis, it improves when the acidosis is corrected.

The doctors and nurses who saw the blotching on the babies at CC were definitely familiar with what we call "mottling" from poor skin perfusion. It would not have been noted as unusual. Cutis marmorata in neonates usually causes a uniformly lacy appearance, either all over the exposed limbs or all over the body. This sounded different. It sounded like they were describing whole patches of the body that were white, red, or blue. I don't recall reading that any staff suggested it signified air embolism, just that it was striking and unusual.

With that said, I use a vein transilluminator when I place peripheral IVs on infants, and after I place the PIV, I flush the vessel with saline. Watching the movement of the saline through the illuminated vessels is striking, as the blood moves out of the way, to be replaced by saline, to be replaced by blood. It travels in a branching fashion, following the branching of the vessels. It is not hard to imagine that if air bubbles were passing through circulation, the tissue there would be deprived of blood (causing whiteness); then it would become cyanotic (causing blueness). The redness could be the blood returning. So each area would have its own color, causing a patchy discoloration that shifts and then fades. I was able to find an article which describes exactly this coloration in induced air embolism (in the heart tissue of dogs rather than the skin tissue of people, but blood vessels are blood vessels and tissue is tissue), and they explain the redness as "reactive hypermia" or the rush of blood coming back to the previously ischemic area. ("THE SIGNIFICANCE OF AIR EMBOLISM DURING CARDIOPULMONARY BYPASS" by Spencer, Rossi, Yu and Koepke, from 1965) Later if I have time I will see if I can find additional information.

If I put myself in the shoes of the staff, and saw that kind of patchiness on a baby, I would have thought it striking and unusual as well. If it was my first time seeing it, and perhaps my first or second time caring for a baby who had died, I might think that it was due to the changes of the skin at death. I would not have recognized it as *possibly* signifying an air embolism at that time, though.

I also found it especially difficult to think of alternate explanations for the swollen and bloody airways of babies on CPAP, and the case of the baby whose abdomen was completely full of air to the point that the baby went into respiratory failure and died. Usually that sort of thing is caused by a bowel infection with a lot of tissue death but it sounds like there was no evidence of infection for this baby.

Thank you so much for explaining this so clearly
That fits with the Dr saying some were bright red area which he felt showed some blood was still traveling around the body

 

[magikarpmagikarp]

Thank you for joining.

As you say, none of the reports say that hospital staff recognized or suggested air embolism.

Reading between the lines, as regards the defence stance, I think this is going to come down to a matter of timing.

We've only heard from one expert so far, Professor Owen Arthurs, consultant paediatric radiologist from Great Ormond Street Hospital. As reported, he examined a post mortem x-ray of Child A, which showed an "unusual" line of gas in front of the spine running from the stomach to just beyond the heart ("not found in cases of natural causes deaths in babies"), and also gas in the stomach and heart which he said was "normal".

(links - Recap: Lucy Letby trial, Friday, October 21 and Lucy Letby trial: Emotional nurse felt final heartbeat of newborn twin 'murdered', court hears )

He agreed with the defence that

- the presence of a UVC or long line for some time could lead to air in the system
- air can be distributed in the system during CPR
- one possibility is air administration, other possibilities are through resuscitation or post mortem changes

In my totally unqualified opinion, if it was air from the UVC/long line, ie a regular procedure, these registrars/consultants and nurses would have seen it many times before, and not solely on babies that collapsed within minutes of LL attending to them. If it was from resuscitation or post mortem changes it wouldn't have been there at the time of the collapse. That's why I mention timing. That's just my laypersons way of looking at it.

MOO

Yes, I agree. One minor detail though: air of this quantity from the long line or UVC is a theoretical risk of both procedures but it is not a standard occurrence. It would be considered a "never" event (ie very serious), and it would be quite rare.