Not necessarily. If they are missing clinical signs and not treating them then the baby could deteriorate. If the baby had a high temperature that went unnoticed could it have contributed in some way for eg it may have indicated an infection that could then went untreated which could be fatal for a baby who is already in poor health.
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Thank you for this! Tbh I think the temp is clutching at straws.. it says there were other hours it wasn’t taken, not that it was never taken. Baby was described by more than a couple of people as stable and doing well!
In my boy's SCBU, his temperature was manually recorded every 3 hours with his 'cares' nappy change, feed, mouth refreshing with water drops etc. So it clearly depends (again) on the unit. Something that is becoming terribly apparent is how much basic standards of care vary across trusts and IMO this really needs working on.
Ohh thats interesting! Our Level 2 NICU in my trust doesn’t have these, the only babies that have a temperature probe are the ones being cooled. I can’t imagine that the nurses would choose not to write it down if it was there in black and white on the monitor though if they were doing hourly obs? But who knows what the culture was like there at the time really
Sorry not understanding your point in relevance to my reply (not having a go just actually can’t correlate the response to my post) I understand your actual reply on its own because I absolutely believe they likely had poor care (pretty sure at least one was already admitted they didn’t get good care from the start) I meant if the hospital as a whole was not treating them properly then what would be a valid explanation to why it kept happening to Lucy?
I think they need to clarify the lack of temperature recording further.
Yes probes are used, but not in all babies. These babies were on CPAP so our unit protocol would be temperature probes in situ for constant monitoring of central temp (one probe under the arm) and peripheral temp (second probe on the leg).
A manual temperature is checked in addition at least 6 hourly, more frequently if there are temp issues. But like someone else said, that involves disturbing the baby and less handling the better.
If the court means no manual temp was recorded, I dont see the issue. If no probe temps were recorded, that is a discrepancy as these are permanently attached. She should explain why these weren't recorded.
This baby had a post mortem. Would infection be identified in a PM? I’m assuming so as it would still be in the system.
This is what was said in the opening statements as a refresher:
Medical experts (child a)
The case was referred to the coroner and the cause of Child A's death was 'unascertained' at the time.
Medical expert Dr Dewi Evans suggested Child A's collapse was "consistent with a deliberate injection of air or something else into [Child A]'s circulation a minute or two prior to deterioration," Mr Johnson told the court. Only Letby was present.
Another medical expert said the cause was "not some natural disease process, but a dose of air "deliberately administered".
An independent pathologist described the cause of death was 'unascertained', in that there was nothing in the autopsy that pointed to why Child A had died, but the cause was most likely 'exogenous air administration through the longline or UVC'.
Said explanations are also backed up, the prosecution say, by an independent radiologist.
Defence Opening Statement (child a)
The defence do not accept, for Child A, an air embolus was the cause, but one of "sub-optimal care", as a result of either "lack of fluids" or "various lines put into him, with potential to interfere with his heart rate".
"You will hear in this case, that the air present after death does not indicate an air embolus."
Mr Myers said air present in the abdomen "can happen post-mortem".
This is what was said in the opening statements as a refresher:
Medical experts (child a)
The case was referred to the coroner and the cause of Child A's death was 'unascertained' at the time.
Medical expert Dr Dewi Evans suggested Child A's collapse was "consistent with a deliberate injection of air or something else into [Child A]'s circulation a minute or two prior to deterioration," Mr Johnson told the court. Only Letby was present.
Another medical expert said the cause was "not some natural disease process, but a dose of air "deliberately administered".
An independent pathologist described the cause of death was 'unascertained', in that there was nothing in the autopsy that pointed to why Child A had died, but the cause was most likely 'exogenous air administration through the longline or UVC'.
Said explanations are also backed up, the prosecution say, by an independent radiologist.
Defence Opening Statement (child a)
The defence do not accept, for Child A, an air embolus was the cause, but one of "sub-optimal care", as a result of either "lack of fluids" or "various lines put into him, with potential to interfere with his heart rate".
"You will hear in this case, that the air present after death does not indicate an air embolus."
Mr Myers said air present in the abdomen "can happen post-mortem".
It could have been. A GP took a photo of my daughter as he initially suspected meningitis, but wanted to check with a senior colleague upstairs. He told me he would be taking it on his personal phone and was I OK with that. He deleted it infront of me when he returned.
It's honestly blowing my mind at how neonatal care differs everywhere. We started in a Level 3 before transferring to Level 2 and they were pretty similar.
Hopefully one day standard of care for all NICUs can be some what aligned
I will say though, despite being on the temp probe, there were some nurses who would recheck the twins temps manually, but they tended to be the old school nurses who didn't always trust the technology
When I was visiting my sister and her full term newborn recently the nurse was in and out checking her temp multiple times during the two hour visit. She was on the postnatal ward in a heated cot but they were on it with the checks.
Thanks, yes I see why that would need to be clarified. I take it things would hinge on whether probes were used in that trust or not.
I think the implication is that the previous nurse could have been at fault but then I suppose part of the defence’s plan is to blame others.
I’ve got a feeling that nurse is going to be called as a witness.
Definitely not silly questions! Personally considering the baby was less than 24hrs old at this point I’d probably be doing them every 2hrs, but it varies with what intervention the baby has had. So if the doctors had the incubator doors open to take bloods for example at 2:30pm and I’d just checked the temp at 2pm, I’d still be checking it at 3pm again just incase the temp had dropped whilst the door was open so then I could adjust the incubator temperature accordingly.
Age of prematurity comes into account definitely, especially with them being twins as usually twins have a lower birth weight than singletons and also one twin usually weighs more than the other
Not recording a temperature or less than perfect care would not cause air embolism or insulin poisoning though which is what LL is accused of. She is being accused of deliberate acts of harm not negligence.
Today is agreed facts, so just ‘setting the scene’ so to speak. I am sure when the prosecution starts with their side all the gaps will be filled in and it will be much clearer what actually happened.
Today is agreed facts, so just ‘setting the scene’ so to speak. I am sure when the prosecution starts with their side all the gaps will be filled in and it will be much clearer what actually happened.
Agree. I’d be surprised if Child A was even the first she’d harmed tbh. If he really was the first that died due to her (yes, I do believe she’s done all this) then did she just go too far and then got hooked on the feeling. Were there prior babies to Child A that just recovered, after some meddling. I’m thinking out loud of course. I do realise Child A is where the starting point is, but is that just because A was the first death that didn’t add up and then the patterns went from there.
Have we had the stats yet of what babies sadly were very poorly or infact died out with Lucy being on shift?
The fact the pattern followed her and the fact she is on trial for murder not negligence in my opinion is enough to gather there likely was not other babies dying of insulin poison on other nurses watches.
Even if she is found guilty it’s still negligence on the nhs. How can 7 babies die and a further 10 nearly die while on her watch and not one person picked up something was off sooner than they did. Nah. That’s not right.
I'm trying so hard not to be biased but I genuinely am really struggling to fathom how anyone can believe this is all just coincidence. I really think the fact LL alone is on trial shows there clearly wasn't 22 other instances of death/near death with babies and other nurses. I don't doubt the NHS was unbelievably negligent but the scapegoat thing is honestly mental to me.
I don’t think anyone (and I speak for myself here) is saying it’s a scapegoat situation - what I genuinely don’t understand is how the ‘attempted’ murders have come to that conclusion, and I’m sure there may be more medical evidence to come. I am struggling to understand how retrospectively it can be so certain that the collapses etc weren’t from a genuine medical symptom when it wasn’t deemed at the time?
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