Baby E---opening statement description of events:
At 9pm on August 3, 2015, the mother decided to visit her twin sons, and "interrupted Lucy Letby who was in the process of attacking Child E", the prosecution say, although the mum "did not realise it at the time".
12:21pm
Child E was 'acutely distressed' and bleeding from the mouth.
The mum said Letby attempted to reassure her the blood was due to the NGT ittirating the throat.
"Trust me, I'm a nurse," Mr Johnson told the court.
12:22pm
Letby said the registrar would be down to review Child E, and urged her to return to the postnatal ward.
The mum called her husband when she got to the labour ward, in a call lasting four minutes and 25 seconds, at 9.11pm.
Letby made a note in Child F's records (Child F being the twin of Child E), "after she had got rid of" the mum, Mr Johnson said.
The next time the mum visited Child E, he was in terminal decline.
The prosecution say the mum was "fobbed off" by Lucy Letby.
Two records are made at 4.51am, after Child E had died.
The later note records: "Mummy was present at the start of shift attending to cares. Visited again approx. 22:00. Aware that we had obtained blood from his NG tube and were starting some different medications to treat this. She was updated by Reg xxxxx and contained [Child E]. Informed her that we would contact her if any changes. Once [Child E] began to deteriorate midwifery staff were contacted. Both parents present during resus."
The prosecution say Letby's note suggests the mum was present at the start of the shift (7.30pm-8pm), and returned at 10pm, when "neither is true".
The prosecution say 9pm was an important time, as it was the time Child E was due to be fed, by his mother's expressed breast milk.
The mum said that is why she attended at 9pm. "She was bringing the milk".
The phone call at 9.11pm to her husband also fits the mum's timing, the prosecution add.
Letby's notes also show: "prior to 21:00 feed, 16ml mucky slightly bile-stained aspirate obtained and discarded, abdo soft, not distended. SHO [Senior House Officer] informed, to omit feed."
The prosecution say the nursing notes made are false, and fail to mention that Child E was bleeding at 9pm.
They mention a meeting that neither the registrar or the mother remember.
A record of feeds - a feeding chart - is shown to the court.
At 9pm, Letby has recorded information to detail the volume of fluids given via the IV line and a line in Child E's left leg, and the 9pm feed is 'omitted'.
In the 10pm column is '15ml fresh blood'.
The SHO said he had no recollection of giving advice to omit the 9pm feed.
He was on the paediatric ward most of that night, until Child E entered a terminal decline.
He believes the only time he had anything to do with Child E was in a secondary role to the registrar in an examination at 10.20pm.
The registrar recalled being told Child E had suffered a blood-flecked vomit.
[So Lucy never called them at 9 to report bleeding from the mouth--she waited an hour and left a message about vomit w/flecks of blood]
He does not recall seeing any blood on Child E's face, but regarded the presentation as undramatic.
But "around half an hour to an hour later there was a large amount of fresh blood which had come up" Child E's tube.
The prosecution said:
"This was the first indication of any serious problem so far as the medical staff were concerned.
"There was a further loss of 13 mls of blood at 23:00 hrs."
"13mls may not sound much, but [the doctor] had never seen a small baby bleed like this."
This was the equivalent to 25 per cent of Child E's blood volume, a figure which the prosecution say is an under-estimate in context.
The prosecution add that at 11.40pm, Child E suffered a sudden desaturation.
His abdomen "developed a striking discolouration with flitting white and purple patches."
CPR was started, but Child E "continued to bleed".
Although Letby was participating in the resuscitation of Child E, she co-signed for medication given to another baby in room 4.
Child E was pronounced at at 1.40am.
Medical expert Dr Sandie Bohin agreed the cause of death was air embolus and acute bleeding.
She concluded that the cause of the bleeding was unknown but acknowledged “fleetingly rare” possible natural causes that could not be ruled out in the absence of a post-mortem.
Dr Bohin concentrated on the abdominal discolouration and concluded that air was deliberately introduced via an intravenous line.
Lucy Letby is on trial in the UK, charged with the murders of 7 infants and the attempted murder of 15 other infants.
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(but I have done a neonatal course and do have certification in my nursing specialty...I'm not a "nurse practitioner" - i don't prescribe drugs, I give them.)
thirlwall.public-inquiry.uk
