Introduction
This page contains evidence heard for child L & M (twins) and child N.
Lucy Letby Case page contains live reporting links and opening statements including opening statements for each child.
Refer to
Wiki Navigation to locate pages for other babies.
Child L & M (twins) & Child N
Child L & M (twins)
Child L - attempted murder (by insulin)
Prosecution Opening Statement (child L)
Background (child L)
Child L was born in April 2016. It is the prosecution case Letby poisoned Child L, while also attacking Child M - the twin.
Child L's blood glucose level was noted to be low and he was treated with a dextrose infusion. His condition improved and he was stable by the day-time shift of April 9.
Incident (child L)
Letby came on duty that day at 7.30am.
By this time, the prosecution say, Letby was supposed only to be working day shifts because the consultants were concerned about the correlation between her presence and unexpected deaths and life-threatening episodes on the night-shifts.
In the hours that followed, Child L's glucose levels fell abnormally low. He was given additional doses of glucose, but they proved ineffective.
The answers to these levels were found after a lab sample sent to the Royal Liverpool Teaching Hospital laboratory came back with results some time later.
The results of the
test were "grossly abnormal", but nothing was done about it as Child L had, by the time the results came back, returned to normal.
The reading was "at the very top of the scale" the equipment could measure, the court hears.
There was no correspondingly high level of C-peptide: it was within the normal range. The only explanation for this anomaly is that what was being measured was synthetic insulin, which had not been prescribed to Child L but was stored and readily available in the neonatal unit.
The court is shown an 'infusion therapy prescription sheet', a written record of the dextrose bag fed to Child L.
The bag was running from noon on April 8, when it had been set up an hour earlier by Letby and another nurse.
Prosecutor Nicholas Johnson KC: "We say Lucy Letby added insulin to that bag of dextrose. She did it deliberately to kill [Child L].
"She had failed to kill [Child F] so gave an increased dose."
Letby had been present for the birth of Child L. She cared for him on his first day and the prosecution say would have been aware of his mild hypoglycaemia.
Child L's blood sugar level remained "dangerously low" through the day.
At 4.30pm, a new infusion bag was required and this was being applied when Child L, the twin brother, was being taken ill.
Medical experts (child L)
The prosecution says medical expert evidence is this was a case of insulin poisoning, administered intravenously via Child L's liquid feed.
Police interviews (child L)
In police interview, Letby said she was aware of Child L's low blood sugar levels and knew the insulin was kept in a locked fridge, with a variety of other drugs. Keys were passed around nursing staff and there was no record of who held the keys at any time.
She agreed the insulin could not have been administered accidentally, but denied being responsible.
Her explanation was it must have been in one of the bags already being received.
The prosecution say that is not a credible possibility.
Prosecution Opening Statement (child m)
Background (child m)
Child M was born in good condition and was assessed as requiring 'special care'.
He had an unexpected life-threatening event at about 4pm on April 9, at the same time his twin's blood sugar was gangerously low.
The prosecution say "he came close to death", but "within four hours he was able to breathe unsupported in air."
Incident (child m)
At 3.30pm, a fluid bag was attached to Child M. At 3.45pm, he received intravenous antibiotics.
The notes showed Letby was one of two to administer the medicine. Digital records show Letby's colleague was using the computer at 3.45pm.
At 4pm, Child M's monitor alarmed and Letby was first to the cot.
The emergency was such that doctors were called urgently.
The consultant, Dr Ravi Jayaram attended and noticed unusual patches of discolouration on Child M’s skin which he thought particularly noticeable because of Child M’s skin tone. He thought the patches unusual because normally, if a baby arrests and there is not enough oxygen moving round the body, the baby is uniformly pale, grey or blue. What he saw he thought similar to what he had seen during the resuscitations of Children A and B.
Child M did not respond well to resuscitation. Six doses of adrenaline followed in 25 minutes and treatment was "about to be withdrawn", when Child M "suddenly improved".
Dr Jayaram could not find any cause for the sudden collapse, but the discolouration he saw caused him to suspect an air embolism.
At 9.14pm, Letby noted Child M was tensing his limbs, curling fingers and toes and rotating hands and feet inwards - signs of brain damage.
On the following night-shift, Child M had what the prosecution called a 'speedy recovery', although he did suffer further desaturations.
Medical experts (child m)
Medical expert Dr Dewi Evans said the rapid recovery would not have meant infection or a lung problem was ikely. His conclusion was airway obstruction or air embolus.
A paediatric neuroradiologist reviewed a brain scan on May 2016 and found brain damage for Child M, likely caused by the cardio-respiratory collapse on April 9.
Paperwork
Mr Johnson says when Letby's home was searched in 2018, a handwriten log of drugs administered during Child M's collapse was found, and she had made a note of the collapse in her diary.
'LD [Long day] - twin resus'.
Police Interviews (child m)
In police interview, Letby agreed she had connected a fluid bag to Child M and had co-signed for medication at 3.45pm but could not be sure if she had administered it.
She thought she must have taken the notes home 'by accident', and had simply noted what had happened in her diary.
She denied that the notes were a "souvenir" and denied deliberately trying to harm Child M. She could think of no reason how he would have suffered an air embolism.
The prosecution says the cases of Child E-F and Child L-M are similar, in that one suffered an insulin overdose and the other an IV air embolism.
Mr Johnson: "We suggest that coincidences like that simply do not happen innocently. Someone was responsible and the only credible candidate is Lucy Letby."
Defence Opening Statement (child L)
For Child F and Child L, the children allegedly poisoned with insulin, the defence "cannot say what has happened".
"It is difficult to say if you don't know," Mr Myers said.
"So much has been said about these. These are not simple allegations which can automatically lead to a conviction."
The defence say Child E's TPN bag was put up by Letby in August 2015 and hours later there were blood sugar problems. That bag was replaced, in the absence of Letby, but the problems continued.
The sample taken came from "the second bag", the defence say.
A professor had given "three possible explanations", none of which identified Letby as a culprit.
For Child L, there were issues with the documentation provided, so those are challenged, the defence say.
There is "nothing to say" Letby was directly involved in the acts.
Defence Opening Statement (child m)
For Child M, the defence say "there is no obvious cause of collapse" in this case, but it is not established the "obvious" one is an air embolus.
"We are back in the territory of blaming Lucy Letby because there is no other cause.
"The mere fact she is there is being used as an explanation."
Agreed Facts (Child L & M)
Sequence of events from records (child L)
Intelligence analyst is talking the court through the sequence of events for Child L and Child M, twin boys born on April 8.
8th April 2016
Child L was admitted to the neonatal unit at
10.30am, and had observations taken by Lucy Letby, with a blood sugar reading of 1.9 recorded at
10.58am.
He was treated with a 10% dextrose (sugar) infusion.
Lucy Letby's note, written in retrospect at 5.42pm, noted the blood sugar reading of 1.9, with the registrar commencing dextrose and expressed breast milk.
At 12.14pm, the blood sugar reading had risen to 2.5.
Lucy Letby records communication with Child L and Child M's parents: "Parents were shown babies in theatre and had a quick cuddle....Photographs given and visiting hours discussed. Daddy visited the unit and had cuddles."
4pm: For Child L, a blood sugar reading of 5.8 is recorded.
Letby records for Child L at birth "Initially had some recession with a raised respiratory rate, quickly normalised and remained self ventilating in air. Blood gases good...
"2 Hourly feeds, NG/bottle. Minimal aspirates obtained..."
Recording communication with the parents: "Parents updated by myself on CLS and photograph taken....fully updated on care by myself and reg Bhowmik. Aware of need for septic screen..."
A 6pm blood gas reading records blood sugar of 3.3
Text Messages (1) (child L)
6.15pm Letby messages a colleague - "Unpacking! Stuff everywhere lol! May do an extra shift this weekend x"
The court previously heard Letby had recently moved into a home near the hospital.
Letby messages her mother: "Think Im going to do tomorrow [Saturday, April 9] as an extra but go in a bit later."
9pm: Child L's blood sugar reading is 2.3.
Letby's colleague Sophie Ellis messages her: "How's the house pal? Xxx"
Letby: "Hey, it feels a bit weird having a whole house but it's good thanks, although stuff everywhere as moved in properly on Tue and been at work Wed, Thurs and today...", followed by a monkey emoji with its hands over its eyes.
Sophie Ellis: "...it'll feel more homely once you've sorted everything out." She also asks about how busy the unit is.
Letby: "...Unit is busy, no-one particularly unwell just volume and few people off sick. I prefer 4 days to 4 nights..."
Letby adds: 'We've got nice mix of babies at the mo really. Shift goes quick anyway!'
10pm: Child L's blood sugar reading is 2.2 at 10pm, then 3.6 at midnight.
9th April 2016
Further medications are administered throughout the night.
Agency nurse Tracey Jones records notes for Child L from the night shift, noting the cannula was knocked out by the baby boy during the night so was reinserted. There had been no contact with the parents during the night.
For the day shift on April 9, 2016, Lucy Letby is a designated nurse for two babies in nursery 1. Mary Griffith is the designated nurse for Child L and Child M, who are the other two babies in room 1.
Four babies are in room 2, three in room 3 and four in room 4. There are seven designated nurses for the neonatal unit babies in total.
10am: Child L records a blood sugar reading of 1.9, pre-feed.
Nurse Mary Griffith records notes, written retrospectively, saying the IV dextrose [infusion] was increased for Child L.
Text Messages (2) (child L)
10.34am: Letby messages colleague Alisa Simpson, wishing her good luck at picking the horses at the Grand National that day, and that her feet don't get too sore.
11am: Child L's blood sugar reading is 1.6.
12pm: A handwritten entry for hypo screen results, not attributed to a name, record results for Child L.
Child L's blood sugar reading is 1.6 at noon, pre-feed.
Letby co-signs a 10% dextrose infusion for Child L, around noon.
12.30pm: Notes for Child M record that designated nurse Mary Griffith took a break.
Text Messages (3) (child L)
Letby is engaged in messaging people between 11.12am and 12.33pm.
Letby messages Alisa Simpson shortly afterwards: "Oh good hope you have a fab time. Im in work doing an extra! x"
Letby also messages her mother, asking if her father was betting on the Grand National, and if so, to put a bet on grey horses for her. Her mother replies that has already been done.
The court hears Letby continues to be involved in messaging, including a group message to colleagues and friends: "Sorry guys mad 4 busy days in work..." then invites the three people to crash at hers, apologising she hasn't fully unpacked yet.
She adds: "Got magnum prosecco and vodka woop. No disco ball but sure we can manage. x"
2pm: Child L's blood sugar reading is recorded as 2.0 at 2pm, and 1.5 at
3pm.
3.35pm: Letby is a co-signer for the administration of medication.
Mary Griffith records a blood sample was taken from Child L at this time, which was taken to the Royal Liverpool Teaching Hospital for analysis.
The prosecution say the blood sample had a very high insulin level recorded, and a low level of C-peptide.
3.35pm: Child L was also given a bolus of dextrose, prescribed at 3.35pm and administered at 3.40pm.
A note from the hospital's pathology department records the blood specimen sample for Child L.
The blood was "taken for lab but due to emergency not poded at once", nurse Mary Griffith records.
That one emergency identified in the neonatal unit, the prosecution tells the court, was for the twin brother, Child M's "dramatic collapse".
4pm: Child L's blood sugar reading at 4pm is 1.5.
Child M's collapse is recorded at this time. A crash call is put out.
Friends message Lucy Letby around this time, saying they can have "an unpacking party".
For Child L, the dextrose administration is increased to 12.5%, from 10%.
5pm: Child L's blood sugar reading at 5pm is 1.7, which was "still very low", gthe prosecution say.
5.28pm: Letby's mother messages Letby at 5.28pm telling her: "You've won rule the world :-D xxx"
6pm: Child L's blood sugar reading at 6pm is 1.9.
Text Messages (4) (child L)
6.01pm: Letby responds to a colleague at 6.01pm: "Haha why not!! Work has been s***e but...I have just won £135 on Grand National!!"
She also sent a group message: "Unpacking party sounds good to me with the flavoured vodka...Just won the Grand National!"
Blood test results
The pathology records the lab specimen of a blood sample for Child L. Among the blood test results sought for the sample are insulin and C-peptide.
The insulin level is recorded as 1,099, and the C-peptide is recorded as 264. These readings are entered into the system on
April 14, having obtained the results from Liverpool.
The C-peptide "should be 5-10 times the level of insulin", but the ratio is recorded as 0.2
Child L is recorded to have hypoglacaemia [low blood sugar].
Doctors record the hypoglacaemia continued despite the regular infusions of dextrose throughout the day.
8pm: Child L has a blood sugar reading of 2.0.
9pm: Child L's blood sugar is 2.4.
9.22pm: Letby records notes for Child M.
10pm: Child L's blood sugar reading is 2.3.
Text Messages (5) (child L)
10.11pm: A colleague of Letby, Belinda Simcock, messages her: "Thanks for listening, I'm ok x"
Letby: "Don't need to thank me, glad you felt able to tell me..."
10th April 2016
Midnight: Child L's blood sugar reading is 2.1, and remains "low" at 2.1 at
2am.
A long line is inserted, with an x-ray taken, and medication administered.
4am: The blood sugar reading is 2.3, and 2.2 at
6am.
7am: The glucose is further increased, but the blood sugar reading "remains stubbornly low" at 2.2.
It remains at 2.2
at 9am.
Text Messages (6) (child L)
Letby receives a message from Yvonne Farmer asking if she wanted to do more overtime shifts on Sunday night, Monday day or Monday night, appreciating she may be tired, with Letby responding: "Sorry but need some days off now."
She adds she could be on call for nights, and would be free for Thursday day/night shifts.
2pm: Child L's blood sugar reading at 2pm on Sunday had "normalised" at 3.0.
Letby refers to her previous shifts as "not nice" in a message to Jennifer Jones-Key.
Jennifer Jones-Key says Letby 'hasn't got many nights' coming up on the rota, adding she likely won't see Letby as she works mainly nights herself.
"We never see each other if we do work together as always mad shifts".
Child L was still receiving 15% dextrose through the afternoon of Sunday.
A nursing note made by Laura Eagles that afternoon records: "Blood sugars maintained...remains on 15% dextrose via long line...very unsettled at times."
The family had been kept updated of the situation, according to a family communication note.
5pm: Child L's blood sugar levels were "normal" at 2.8.
Samantha O'Brien becomes the designated nurse that night for Child L, and the 15% dextrose administration continues through the night.
The blood sugar levels are 2.7 at
9pm, 2.9 at
11pm, 2.7 at
2am.
11th April 2016
Samantha O'Brien, in her nursing note, records: "...1% glucose infusing via long line in left leg,. 3 hourly blood sugars, all have been above 2.6 so far this shift. Plan to continue [current medication administration]...
"Baby unsettled at times, settles with comfort measures."
5am: The blood sugar level is 2.9 at 5am on Monday, April 11.
Text Messages (7) (child L)
8.45am: Letby messages a colleague, saying: "The unit is in dire way with staff," highlighting which trained staff were on duty and who else was on in the last shift, and who was off at that time.
A colleague replies, in her message: "that's terrible"
Letby replies the overall situation was "not good", "mad and poor skill mix".
11am: Child L's blood sugar readings are 2.8.
Dr Huw Mayberry, in a clinical note, records the feeds/fluids for Child L, which were increased due to low blood sugar and falling sodium levels.
Child L's blood sugar
at 3pm is 3.5, remaining at 3.5
at 5pm.
Nurse Belinda Simcock said registar Mayberry was aware of the 3.5 readings, and if they continued to remain above three, then feeds would be increased.
7pm: The blood sugar increases to 4.7.
Child L continued to be cared for at the hospital's neonatal unit until May 3, and was then discharged.
Sequence of events from records (child M)
Limited reporting - From Dan O’Donohue Twitter (20/02/2023)
Ms Tyndall is continuing to take the court through sequencing evidence. The evidence contains door swipe data (showing staff movements on the ward), medical charts and any social media messages incoming/outgoing from Ms Letby on April 9
Notes show that at 16:02 on April 9 2016 Child M collapsed and required full resuscitation - medics administered four doses of adrenaline in just over ten minutes in a bid to stabilise the infant
In all, Child M required nine doses of adrenaline and CPR for 29minutes before he stabilised on a ventilator shortly after 16:30
Witness Statements Agreed[B] (Child L & M)[/B]
Family - Mother[B] (Child L & M)[/B]
The court is now hearing a statement from the mother of Child L and Child M, who had had a "routine
Pregnancy" until a stage when she was "not well".
She recalls being "surprised and shocked" at being told she had to be admitted to hospital.
She stayed there for 15-17 days and was asked if she was going to deliver naturally or via a C-section. Staff had looked through her file and were "worried", so the decision was made for the birth to take place, via c-section, on April 8.
The babies, weighing 3lb each, looked "very nice".
The family were taken to the neonatal unit to see them in room 1 the following day and the family were "happy", and at that time it was not known what they were going to be called - deciding on the names a week later.
Later, the mother was asked by a nurse named Yvonne to come down as soon as possible. She came down and saw Child M had collapsed and chest compressions were under way.
She was praying to see her, asking God to see them. Child L was ok on the other side of the room, and Lucy Letby was present.
She said her mind was "totally blank" and she just prayed.
After what felt like "hours", Child M had stabilised.
Each day, the mother would come down daily to see the twins, who had stabilised.
Three weeks later, the mother was discharged, and she continued to visit daily until the twin boys were discharged. They hadn't put much weight on and were small, but otherwise healthy.
Child M had "no after effects for what happened to him".
Family - Father[B] (Child L & M)[/B]
A statement from the father is now being read out. He said he was "shocked" at the news his wife needed to go to hospital due to concerns over the pregnancy, and she stayed there for "over two weeks" before the C-section birth took place.
The doctor said the babies looked "very healthy" before being taken to the neonatal unit by Lucy Letby and another nurse.
He saw the twins a couple of hours later and they were "both still fine".
The following day, the family visited - "we were both proud parents, and very happy".
Within 10 minutes of being on the ward, the father "rushed" back to the neonatal unit, where he saw a doctor doing chest compressions on Child M.
He said: "It was a very distressing image, and one that still is in my mind."
The staff said they didn't know what had happened to Child M, and Child M had had a heart attack.
Child M later stabilised after about half an hour, and there were no further issues with the twins in subsequent care.
Child M had a brain scan, with 'no damage' recorded.
The twins were "only on the unit because they didn't weigh enough", and it was "a relief to get the boys home".
Midwife[B] (Child L & M)[/B]
A statement from the midwife is now being read out to the court.
She said there was concern one of the twins was not growing as he should have in the womb, so an elective surgery took place so there were no further complications with the lack of growth.
Both babies "were in good condition" and there was time for "a quick cuddle" with the parents before the twins were taken to the neonatal unit "without any problems".
Both twins began crying after birth, one of them requiring a little extra help to do so.
The 'Apgar score', which records the conditions of the babies shortly after birth, recorded 10/10 scores for both twins at 10 minutes after birth.
Child M has a low oxygen saturation rate, but he had that rectified with breathing support.
Pharmacy Technician - unnamed
From Dan O’Donohue Twitter (20/02/2023)
Court has just been read a statement from a pharmacy technician who has worked at the Countess of Chester since 1991. A review of her records show that in 2014, three vials of insulin were ordered to the neonatal unit, six in 2015 and two in 2016
Nurse Ashleigh Hudson[B] (Child L & M)[/B]
Taken from Dan O’Donohue Twitter (22/02/2023)
Nurse Ashleigh Hudson said she recalls Letby shouting ‘can I have some help please'
She said there was 'no panic in her voice, which is normal to avoid alarming patients who may be on the unit'
Dr Arjamand Shauq (child m)
Taken from Dan O’Donohue Twitter (23/02/2023)
Court has just been read a statement from consultant paediatric cardiologist Dr Arjamand Shauq - he reviewed an ultrasound of Child M's heart on a request from medics at the Countess of Chester. They believed he could have had a thrombosis
Dr Shaq said having reviewed the images the structure 'is not a thombos' but a eustachian valve, which is 'perfectly normal in infants'
Witness Evidence (child L)
Dr Sudeshna Bhowmik (child L)
Dr Sudeshna Bhowmik, who was working as a paediatric trainee at the time in April 2016 at the Countess of Chester Hospital, has been called to give evidence.
She says, outside of the clinical notes, she has no memory of the twins, Child L and Child M.
She confirms, from the notes, she was present at the birth of the twins, citing an IV line for Child L on April 8 at 11.15am, which was "quite a routine procedure to be done on the neonatal unit".
The baby was "generally well", although the breathing rate was "a little elevated".
The court hears that was not a concern as that would usually be the case for babies born via C-section.
The weight of 1.465kg [3lb 3oz] was "quite low", and the blood sugar of 1.9 was "a little bit low", which can be found in premature babies who are quite small.
With glucose feeds, that would "stabilise".
The plan was to commence dextrose via IV fluids and feeds via expressed breast milk, to see if the latter would be tolerated 'in small amounts'.
She added at that time, there was no need to administer antibiotics. Dr Bhowmik tells the court with Child M showing signs of jaundice, however, that plan may need to have been revisited.
The plan was also to repeat the blood sugars in half an hour.
She says most pre-term babies will have IV fluids, and this was altered for Child L because of the baby boy's weight and glucose levels.
Cross Examination
Benjamin Myers KC, for Letby's defence, asks Dr Bhowmik to clarify the blood sugar readings for a healthy baby. 2.6 and above is healthy.
Mr Myers says Child L was recorded as having a 1.9 reading a couple of hours after birth.
He asks Dr Bhowmik questions about a 'hypoglycaemic pathway'. Dr Bhowmik says the correct course at the time would have been to start treating hypoglycaemia at the neonatal unit via IV fluids.
She tells the court she does not recall when the bag of IV fluids was put up, or who administered that bag.
An infusion chart is shown three records of the first 10% dextrose infusion. The first two are crossed out, with the third being the dose which was administered.
The judge asks to clarify that the only difference between the three records is the rate of infusion for the 10% dextrose bag. Dr Bhowmik confirms that is correct.
That concludes Dr Bhowmik's evidence.
Neonatal Practitioner Amy Davies (child L)
The court is now hearing evidence from Amy Davies, a neonatal practitioner who was employed in the neonatal unit at the Countess of Chester Hospital in April 2016. At the time, she was in Band 6.
She says she does not have any independent recollection of Child L.
From her notes, she was on the day shift on April 8, 2016, as shift leader. Lucy Letby was the designated nurse for Child L on the 8th, and Ms Davies confirms she assisted in the care.
She is asked if there was a specific pathway for babies with low blood sugar. Ms Davies confirms there was, and would involve giving milk before giving IV fluids with glucose, but each case differed.
In this case, a discussion would have taken place with the doctor, Ms Davies confirms. She said it was a decision which would not put the baby at risk, but was an alternative pathway.
Asked if she had any concerns about that pathway, Ms Davies replies: "No, no concerns."
The blood gas records show glucose levels for Child L on April 8 at 1.9 (10.58am) and 2.5 (12.14pm). The readings go above 2.5 in subsequent blood gas records for April 8, which only test for glucose levels.
She confirms she would have checked the infusion bag containing 10% dextrose with Lucy Letby, making sure it was in date, going to the right baby, and signing it. The infusion is noted as starting at noon on April 8.
Ms Davies says the pre-made dextrose concentrations available for infusion bags are 5% and 10%.
Ms Davies says the bags would be changed, regardless, every 48 hours.
Ms Davies is asked if she, at any point, administered Child L with insulin. She replies she did not, and is not aware of anyone doing so.
She says the circumstances for doing so would be two consecutive blood sugar readings of 12 or above, if a baby was hyperglycaemic.
Cross Examination
Mr Myers, for Letby's defence, asks if Ms Davies was one of the nurses who transferred Child L and Child M to the neonatal unit.
Ms Davies confirms she would have been the designated nurse for Child M at that time.
Ms Davies is asked about the hypoglycaemic pathway. She says she is familiar with it, but keeps checking as policies regularly update. She confirms one was in place at the time.
Mr Myers says the policy was milk first, then IV fluids, in normal circumstances. He says circumstances mean a doctor might change that and go to IV fluids.
Ms Davies agrees.
Mr Myers says there are three types of nutrition bag available - start-up bags for the baby's first couple of bags, maintenance bags, and specifically prescribed TPN bags which would have a baby's name on it. Ms Davies agrees.
She tells the court the bag for Child L wouldn't have been referred to as a start-up bag, but would have been a standard 10% dextrose bag, as prescribed, to be infused.
That completes Ms Davies's evidence.
Dr Anthony Ukoh (child L)
Dr Anthony Ukoh is called to give evidence.
He says his recollection was that Child L and Child M were born premature, not extremely so, and for Child L, he did not have any 'red flags' as a baby who would become unwell.
Dr Ukoh's notes for Child L from April 9, 2016, at 10.20am, are shown to the court.
He noted the baby was breathing well, and Child L was on an extra 10% dextrose dose as the blood sugars were running at a "relatively low level for his age", but was "not unusual" for premature babies.
There were no 'red flags' from the observations.
The plan was 'as per hypoglycaemic protocol', to increase the infusion of 10% dextrose administration, "to make up for the low blood sugars", and to repeat blood sugar checks.
Dr Ukoh confirms a hypo screen test result, taken at noon on April 9, which is handwritten, is in his writing.
He says it is not a complete hypo screen results sheet, and said that would have been done in response, and at the time of, a low blood sugar reading.
Some of the results would have required sending away for analysis.
He says the test results would have been received by the lab at 6.26pm.
Cross Examination
Mr Myers, for Letby's defence, asks to clarify Dr Ukoh's explanations for the way some of the results are presented.
The judge asks for the hypoglycaemic blood test, if there was just one blood sample taken from Child L for the various tests carried out.
Dr Ukoh agrees that was the case, and that some of the results would not come back straight away.
Dr A (child L)
Taken from Daily Mail as more detailed
A nurse accused of murdering seven babies and attempting to kill a further ten broke down in tears today as a paediatric consultant gave evidence.
Lucy Letby, 33, was visibly upset and even appeared to try to leave the courtroom as she stood in the dock and walked swiftly to the door leading to the cells.
A female security officer approached her for a hushed conversation.
Letby took a few moments to compose herself before returning to the seat she has occupied throughout her 16-week trial at Manchester Crown Court.
The outburst was triggered by the paediatrician, who cannot be named for legal reasons, beginning to give evidence from behind a privacy screen, blocking his view of the dock.
It prompted the trial judge, Mr Justice Goss, to ask a defence solicitor to 'just see what the problem is'.
A lawyer walked the few feet to the dock and spoke briefly to Letby through the glass screen, and moments later the defendant's barrister, Ben Myers KC, had his own conversation with her.
Letby was still wiping tears from her eyes, this time with tissues from a box beside her, as the proceedings resumed.
The consultant was asked for a second time to confirm his name and occupation. His evidence lasted only a few minutes as he took Philip Astbury, prosecuting, through some medical notes relating to Baby L, one of a set of twins whom Letby is alleged to have injected with insulin.
The consultant told the court the child's blood sugar levels were decreasing during the night shift and were 'lower than what I would have wanted'.
When asked why it was necessary to stop the levels falling, he said: 'Because low blood glucose levels in a baby can cause seizures.
'It's damaging to a baby. If it falls to a much lower level, then it can cause liver damage and brain injury.'
Mr Myers rose to say that he had no questions to ask in cross-examination.
Dr John Gibbs (child L)
Taken from Daily Mail as more detailed
Later Dr John Gibbs, the lead paediatrician on the unit at the time, told the court blood tests carried out on Baby L confirmed he had been 'given insulin that he should not have received'.
He added: 'I was not thinking at the time that someone might have administered insulin. The results showed that, but unfortunately the junior doctors who read them didn't realise the significance'.
Dr Anna Milan (child L)
From Dan O’Donohue Twitter (20/02/2023)
Anna Milan, a clinical biochemist, is giving evidence about a blood sample analysis that was carried out for Child L. The analysis was to test for insulin
Court is being shown blood analysis results for
Child L (they were collected on 9 April 2016). Ms Milan said the 'only way you get a pattern like that is if insulin has been given to a patient'
Cross Examination
Ben Myers KC, defending, is now questing Dr Milan on the process for analysing blood - from ward to lab. She says 'ideally' blood will be taken and cooled within 30minutes to preserve it. Mr Myers asks if blood is left for hours, will it cause issues - 'it can do yes'
Mr Myers asks if a sample hasn't been handled correctly, will it effect the relatability of the findings - and specifically in this case. Dr Milan says it can effect findings, but it 'wouldn't create insulin in this sample'
Dr Milan repeats, that the only explanation for the readings in this sample is external administration
Dr Gwen Wark (child L)
From Dan O’Donohue Twitter (20/02/2023)
Dr Gwen Wark is now in the witness box. She is the director of the Guildford RSCH Peptide Hormone Laboratory. Her evidence again focuses on the blood analysis of Child L
Dr Wark's evidence relates to the veracity of the blood test results. She confirms Child L's reports met all required standards
Witness Evidence (child m)
Nurse Mary Griffith (child m)
Taken from Dan O’Donohue Twitter (21/02/2023)
Mary Griffith, who was Child M's designated nurse in April 2016, is first in the witness box. She is taking the court through her nursing notes from that period
Court is being shown Child M's heart rate/respiration/temperature charts from April 8 in April 9. At around 16:00 on April 9 Child M suffered a 'dramatic' and unexpected collapse, that would require 25mins of CPR and six doses of adrenaline
Her notes from that afternoon state Child M was 'settled'. But at 16:00, her notes state: 'Baby went apnoeic and had a profound bradycardia and desaturation. Full resus commenced at 16:02'
Asked about the crash, she recalls: '(Child M's)alarm went off, I looked over my shoulder, the lights were flashing. Lucy went over to see and said yes it's an event, it needs to be sorted. At that point I stuck my head out round the door and asked for a resus call to be put out'
Paper towel & blood gas report
Court is being shown a photograph of a paper towel which was used by Ms Griffith and other medics on the afternoon of April 9 to note the medicines given to Child M between 16:02 and 16:31. The nurse says 'everything on it would have had to have been recorded' afterwards
The towel is now being passed around the court for the jury to look at
Jury have just been shown a photograph of a blood gas report for Child M - this document was recovered from Lucy Letby's house in Chester when she was arrested in 2018.
Court has previously been told that, when questioned, Ms Letby denied the notes were taken as a souvenir and denied deliberately trying to harm Child M
From Chester Standard Round Up (21/02/2023)
Giving evidence on Tuesday, nurse Mary Griffith said she was responsible for drawing up and checking the resuscitation drugs for Child M.
She told the court the paper towel would have been on the resuscitation trolley and provided a record for doctors of what drugs had been given and when as events unfolded.
Mrs Griffith said she recognised two of the entries for adrenaline administration were in her handwriting.
Simon Driver, prosecuting, told the court the paper towel – along with a blood gas measurement report for Child M – was discovered in a Morrisons shopping bag beneath a bed in a bedroom at the defendant’s former address in Westbourne Road, Chester, on July 4 2018.
Mr Driver asked Mrs Griffith: “Have you ever taken a blood gas record home with you?”
Mrs Griffith said: “No.”
Mr Driver went on: “Have you ever taken home with you the contemporaneous notes for medications given during a resuscitation?”
“No,” repeated the witness.
Ben Myers KC, defending, suggested to Mrs Griffith that some of the notes on the paper towel were also written by Letby.
Mrs Griffith replied: “I can’t say. I’m not going to guess.”
Nurse - unnamed (child m)
Taken from Dan O’Donohue Twitter (21/02/2023)
A nurse, who cannot be named for legal reasons, is now in the witness box. She is recalling the events of Child M's collapse, she said 'Lucy and I walked over, she said he wasn't breathing, she asked for a crash call to go out'
She added: 'Lucy administered recuse breaths...I was beside Lucy'
Dr Anthony Ukoh (child m)
Taken from Dan O’Donohue Twitter (21/02/2023)
Dr Anthony Ukoh is now in the witness box, Dr Ukoh was working a day shift at the Countess of Chester on 9 April 2016
Dr Ukoh is reading over his notes from the morning of 9 April. He says Child M 'looked well, he was settled. There wasn't any major concerns, no red flags. There wasn't any signs he was in any pain'
Dr Ukoh is recalling the 'frantic' resus call he and other medics received shortly after 16:00. He says it took just under 30mins to stabilise the boy
Dr Ukoh tells the court that when he arrived on the neonatal unit Child M 'appeared lifeless'
Nurse Belinda Williamson (child m)
Taken from Dan O’Donohue Twitter (21/02/2023)
Ms Williamson is recalling Child M's sudden collapse at 16:00 on 9 April. She says he looked 'pale and mottled. not quite right'...soon after a crash resus call went out and the infant needed 25mins of CPR and six doses of adrenaline
The nurse did not take part in the resus directly, but she did send word to get Child M's parents who were still at the hospital. She recalls that there was 'talk of discontinuing' before Child M stabilised
Dr Ravi Jayaram (child m)
On Wednesday, consultant Dr Jayaram told Manchester Crown Court how he saw “bright pink” patches that “flittered around” the abdomen of one infant he treated in April 2016.
Jurors were told how he responded to an emergency call from nurses to attend Child M, a twin baby boy, who had stopped breathing as his heart rate and oxygen levels plummeted.
He said it was a prolonged resuscitation that lasted “close to 30 minutes” and at one point he thought of stopping the efforts to revive him.
However, Child M “suddenly recovered” as his heart rate rose and he started breathing again, he said.
Dr Jayaram said: “I was very pleased but I couldn’t really explain what had caused it and why he had suddenly got better.”
He later stated to police he witnessed Child M’s “unusual” skin discolouration when he arrived during the resuscitation.
Dr Jayaram told the court: “They were patches of very bright pink on his torso that flittered around. They would appear and disappear.
“Once circulation was restored and his heart rate came up above 100 (beats per minute) they vanished.”
He said the discolouration was “very similar” to what he had seen in his treatment of Child A, the first alleged murder victim.
Other colleagues had spoken of seeing skin discolouration in other babies who had also collapsed on the unit, he said.
A meeting of a consultants was held on June 29, 2016, the court heard.
Dr Jayaram said: “After a number of further unusual, unexplained and inexplicable events on the neo-natal unit the whole consultant body sat down and said ‘we really need to work out what is going on here’.
He said that “one thing that came up in our discussion” was air embolism – when gas bubbles enter a vein or artery and can block blood supply.
Dr Jayaram said it prompted him that evening to conduct a literature search in which he found a research paper which described the effects of air embolism.
He said: “I remember sitting on my sofa at home with the iPad and reading that description, and the physical chill that went down my spine because it fitted with what we were seeing.”
Dr Jayaram emailed colleagues a link to the research paper the next day.
Letby, originally from Hereford, is said to have attacked several of her victims by injecting air into their bloodstream.
Jurors have heard Dr Jayaram did not refer to skin discolouration in his clinical notes concerning Child M.
Cross Examination
Dr Jayaram disagreed with Ben Myers KC, defending, that that was because he had not seen such an appearance.
He said: “There were far more important things. The important thing was dealing with his cardiac arrest.”
Mr Myers said: “I am going to suggest it would be incompetent to leave that out of the clinical note if you saw it.”
The consultant replied: “I disagree. In many ways I wish I had written it down.
“At that time I had no knowledge or suspicion that the discolouration could have been related to something else that could have caused cardio-respiratory arrest, which is probably why I didn’t specifically put it in the notes.”
Mr Myers said given his previous similar observations about Child A then there was “all the more reason” to note changes in skin colour.
Dr Jayaram replied: “At the time it was not the priority. I wish I had and we would not be sitting here years later having this rather academic discussion.”
In a sharp retort, and pointing to the defendant in the dock, Mr Myers said: “It’s not academic. She is on trial here for multiple murders and attempted murders.”
He agreed with Mr Myers he had also failed to mention skin discolouration in his clinical notes on Child A, or in his subsequent statement to a coroner.
The court went on to hear that Dr Stephen Brearey, head of the neo-natal unit, reviewed the circumstances surrounding the case of Child D shortly after her death in June 2015.
Dr Jayaram said it was not a formal review and he discussed the findings with Dr Brearey who had looked at case papers and files.
Mr Myers said: “He identified Lucy Letby as a person of interest.”
Dr Jayaram replied: “I think he noticed that Lucy Letby was the nurse looking after these babies and that was it.”
Mr Myers went on: “He raised with you the fact that Lucy Letby was present on these occasions?”
“Yes,” said Dr Jayaram.
Mr Myers said: “With that in mind, she became the focus of interest as events unfolded. She had been flagged up as somehow linked in some way.”
Dr Jayaram said: “There was an association with her being present. Nothing more.”
Mr Myers said: “You and Stephen Brearey were already talking about Lucy Letby in June 2015, weren’t you?”
The consultant replied: “In terms of association but as clinicians we have to think about all possibilities … we don’t generally consider unnatural causes or deliberate things.
“Nothing like that was being contemplated at that stage.
“It was simply an association.”
Mr Myers said: “Miss Letby had been a person identified as a potential link by June 2015.”
Mr Jayaram said: “Yes and other colleagues had noticed the association as well.”
Mr Myers said: “So all eyes on Ms Letby then?”
The consultant replied: “Well clearly yes because there is an association.”
Jurors heard the defendant continued to work in the unit for the following 11 months.
Medical Expert Evidence[B] (Child L & M)[/B]
Dr Dewi Evans (child m)
Expert witness Dr Dewi Evans said he believes air “trickled” into the infant’s circulation via a connecting port on his intravenous drip.
He told Manchester Crown Court on Thursday, February 23 it could have taken “several minutes” for it to take effect before the youngster, Child M, rapidly deteriorated and almost died as staff battled for nearly 30 minutes to revive him.
Letby, 33, is accused of trying to kill Child M on the afternoon of April 9, 2016 while he was being treated in nursery room one on the Countess of Chester Hospital’s neonatal unit.
The defendant co-signed for an antibiotic given via a port on the drip at 3.45pm – 15 minutes before Child M stopped breathing followed by a dip in his heart rate and oxygen levels.
Letby was near the doorway of room one, helping a colleague prepare medication for Child M’s twin brother, when the alarm sounded at 4pm, the court heard on Thursday.
Consultant paediatrician Dr Evans said using a syringe to inject air via a port would be slower than a direct injection into the bloodstream.
Prosecutor Nick Johnson KC asked: “Would it follow, if someone chose to do it that way, they would not necessarily be standing over the baby at the time of the collapse?”
Dr Evans replied: “Yes, because you would not necessarily get an instant collapse. It could have occurred over several minutes.
Ben Myers KC, defending, said: “If there was air in his system sufficient to cause cardiac arrest, there is not going to be a recovery as rapid as this within 30 minutes.”
Dr Evans said: “I disagree with that. The resuscitation was absolutely incredible. This was a very, very robust period of resuscitation that was required. This is something that is fairly consistent with a baby having air into the circulation. I can’t think of any other cause.
“The volume required is pretty small. No nurse or doctor would allow a bubble of air into the circulation.”
Dr Evans said any bubbles would disappear if cardiac massage was carried out.
Mr Myers put it to Dr Evans that he no had empirical research to support his opinion that air could vanish within 30 minutes.
Dr Evans said he relied on his knowledge of “basic anatomy and physiology”.
Mr Myers went on: “You don’t know as a matter of fact how much air is required to cause a collapse?”
Dr Evans replied: “No. ‘Very little’ is all I can say.”
Dr Sandie Bohin (child m)
Taken from Dan O’Donohue Twitter (23/02/2023)
Dr Bohin says 'there are very few things that can cause a baby to collapse in this way', she says it doesn't fit with infection or issues with feeds (as he was nil by mouth at the time). She also says there was no issues with his heart, 'this was completely unexpected'
Nick Johnson KC asks Dr Bohin if she believes air was administered with 'malevolent intention' - she says 'yes'
Cross Examination
Mr Myers is now questioning Dr Bohin, he puts it to her that there is 'not much' to support her conclusions. She says that the infant suffered a cardiac arrest, 'something caused that, the baby almost died...for me air embolus fitted with that'
Professor Peter Hindmarsh (child L)
A medical expert told Manchester Crown Court that the youngster, Child L, suffered a hypoglycaemic episode which lasted from the morning of April 9, 2016 to the middle of the afternoon on April 11.
Peter Hindmarsh, professor of paediatric endocrinology at University College London, said the results of a blood sample taken some time on the afternoon of April 9 meant he was “quite certain” that non-natural insulin was present in his system.
Nick Johnson KC, prosecuting, said: “So somebody gave insulin to (Child L)?”
Prof Hindmarsh replied: “Yes, I agree with that statement and I think we should add that it was not prescribed insulin.”
Giving evidence on Friday, he considered the most likely method of administration was intravenously into a bag of dextrose, a sugar supplement, which was connected to Child L’s drip.
Prof Hindmarsh said the volume of insulin required would be “quite small” and would not be noticeable in the bag or from a routine stock check.
He added: “Once in the bag it’s – in a sense – sealed off from you being able to detect it by smell.”
Jurors heard the dextrose concentration was increased as medics tried to bring Child L’s blood sugar levels up – which necessitated a change of bag – and the rate of infusion was also stepped up.
Prof Hindmarsh said despite that there was “not really much change in the glucose measurements which would imply there was ongoing insulin present and ongoing insulin action”.
He told the court that insulin could “potentially” have been added to at least three dextrose bags if the giving sets were also changed.
Prof Hindmarsh also raised the possibility that if the giving set remained the same then insulin could stick to its plastic, come off and then release into the bag.
Cross Examination
He agreed with Ben Myers KC, defending, that “sticky insulin” would eventually run out.
Mr Myers asked: “It is the case that sticky insulin could be operative over a similar period?”
Prof Hindmarsh replied: “I don’t think anyone has done this sort of study to be honest. I think the answer is I don’t know.”
He told Mr Myers the “relatively steady” blood sugar levels did not seem to be influenced by the increased infusion rates.
Mr Myers asked: “Would that be more consistent with it being added to the bag as you go on, rather than the sticky insulin?”
Prof Hindmarsh replied: “Yes.”
Police Interviews Summary (child L)
When later interviewed by Cheshire Police following her arrest Letby denied deliberately administering insulin to Child L, who cannot be identified for legal reasons.
She said to her knowledge neither she nor a nursing colleague had accidentally administered the substance, which had not been prescribed.
Letby added she could not believe such a mistake would have been made.
When suggested by detectives it was a deliberate act of sabotage, the defendant replied: “That was not done by me.”
Asked if she had any explanation for the presence of insulin in Child L’s circulation she said it “must have been in one of the bags or fluids he was receiving”.
Police Interviews Summary (child m)
Taken from Dan O’Donohue Twitter (23/02/2023)
Prosecutor Nick Johnson KC has just read a summary of Ms Letby's police interview in relation to Child M. Earlier this week the court heard how after Ms Letby was arrested in 2018, police recovered a blood gas report of Child M under a bed at her home
She told police that there was 'no reason why she had kept it' and that it was an 'error on her part' perhaps not emptying pockets before she left work. She denied taking it to 'remind her of an attack' on Child M
Child N
Child N - attempted murder (three allegations)
Prosecution Opening Statement (child n)
Background (child n)
Child N, a boy, was born in June 2016. He was a couple of weeks premature and he was admitted to the neonatal unit. His clinical condition was "excellent".
The prosecution say there are three separate occasions on which Lucy Letby tried to kill him.
Child N had haemophilia. Subseuqent investigation found him to have a mild version of the disease, and children of his age do not bleed for no reason, particularly in the throat, the prosecution say.
The prosecution said Lucy Letby used Child N's haemophilia as a "cover" to attack him.
Incident (child n)
On the night of June 2, Letby was on the shift and not the designated nurse for Child N.
She had earlier texted friends and sent a message to a colleague saying “we’ve got a baby with haemophilia”. She sent a further text saying, “everyone bit panicked by seems of things although baby appears fine”.
At 8.04pm she sent a text saying that she was going to “Google” haemophilia. 7 minutes later Letby texted her coleague: “complex condition, yeah 50:50 chance antenatally”.
The designated nurse said Child N was stable and left for a break at about 1am. He would have asked a colleague to look after Child N, but he could not recall which one.
Letby had two babies to care for, in room 4.
At 1.05am, Child N's oxygen saturation levels fell from 99% to 40%.
"Unusually", for a baby, he was described as crying and "screaming".
Child N recovered quickly, while the doctor was then called to another emergency.
12 days later, there were two separate incidents on June 15 for Child N.
Letby had been the designated nurse for the previous day.
Overnight he was in nursery 3. At the beginning of the night shift, Child N was 'very unsettled'.
Letby was to be the desigated nurse for June 15. The use of her phone appeared to show she was awake by 5.10am and in for her shift at 7.12am. She had texted a colleague that she had “escaped [room] 1 [and was] back in 3”.
A colleague said Lucy Letby same into the room to say hello, but when the nurse's back was turned, Letby told her Child N had desaturated before assiting with the breathing. There was no evidence of an alarm sounding or if Letby waited to see if he self-corrected.
Doctors were called and an attempt was made to intubate Child N.
He was “surprised by his anatomy more than anything else … I could not visualise parts of the back of his throat because of swelling”.
The doctor saw "fresh blood" in Child N's throat, which the prosecution say was the same seen in Childs C, E and G.
The doctor was unable to get the breathing tube down the throat of Child N as he was unable to visualise the child's tracheal inlet.
He attempted to intubate Child N on three occasions.
An intensive care chart is presented to the court, which records the amount of dextrose going into Child N.
The bleeding record, of 10am '1ml fresh blood', recording aspirates from the NG tube.
Said bleeding, the prosecution say, is not recorded anywhere in the medical notes. It was more than 2 hours after the attempts to intubate.
At 11.29am Letby sent a Facebook message to the doctor telling him “small amounts of blood from mouth and 1ml from ng. Looks like pulmonary bleed on x ray [i.e. a bleed from the lungs]. Given factor 8 – wait and see”. Other than that phone message, there is no evidence that Lucy Letby brought the bleeding to the attention of any of the medical staff.
The prosecution said this is surprising given the problems Child N had suffered.
In an update recorded on the computer notes by Lucy Letby at 1.53pm she wrote that Child N was “stiff” on handling and extending upper limbs, back arching … settled in between episodes.
The prosecution say this is similar to that found in other cases heard so far.
At 3pm there is a further entry in Letby's writing of '3ml blood', initialled not by Letby and coincides with a second collapse that day.
Child N collapsed just before 3pm and a consultant was called at 2.59pm. While awaiting a consultant, a junior doctor looked into the airway of Child N and saw a “large swelling at the end of his epiglottis” he could only just see the bottom of the vocal cords. He had never seen anything like this before in a newborn baby.
The junior doctor's notes made at 4.30pm recorded: "desaturated this afternoon at 2:50pm with blood in the oropharynx + blood in the NG tube. Improved with bagging. Elective intubation planned following ??? unsuccessful attempts with 2 registrars and 2 consultants cords difficult to visualise …”
Letby recorded at 6.30pm: "approx. 14:50 infant became apnoeic, with desaturation to 44%, heart rate 90 bpm. Fresh blood noted from mouth and 3mls blood aspirated from NG tube. … Drs crash called”.
The prosecution said Child N was "so unwell" that attempts were made to reintubate him, but the doctor could not see down Child N's throat as the view was obscured by fresh blood. A more specialist team was called to carry out the intubation.
Child N continued to be unwell on June 15 and difficulties with ventilation persisted. Eventually he was transferred to Alder Hey, where the prosecution say he recovered quickly.
Medical experts (child n)
Medical expert Dr Dewi Evans said he believed the deterioration of Child N "was consistent with some kind of inflicted injury which caused severe pain".
Dr Sandie Bohin said such a profound desaturation followed by a rapid recovery, in the absence of any painful or uncomfortable procedure, suggested an inflicted painful stimulus.
She said – “this is life threatening. He was also noted to be … ‘screaming’ and apparently cried for 30 minutes. This is most unusual. I have never observed a premature neonate to scream.”
Medical expert Dr Dewi Evans said the blood seen in Child N's stomach had originated there, caused not from intubation attempts but "instead some preceding trauma".
He suggested that “thrusting” a NG tube into the back of the throat might be the mechanism used to inflict the injury.
Dr Sandie Bohin suggested only two possible explanations; either inflicted trauma or a spontaneous bleed. She considers the latter less likely as the haemophilia was 'only moderate'.
Dr Bohin’s view was that the likely cause of the bleeding was trauma to the mouth, to the throat or to the oropharynx, most likely from a NGT or suction catheter.
Professor Sally Kinsey describes the collapse on June 3 as dramatic with no recognised medical cause. She excluded the possibility of a pulmonary haemorrhage - in other words, bleeding in the lungs, causing the collapse on June 15. In her opinion such bleeding would not have occurred spontaneously in a child with Child N's degree of haemophilia.
It follows, the prosecution say, the bleeding was caused by trauma.
Professor Kinsey also ruled out heavy-handed intubation as a cause.
Police interviews (child n)
In police interview, Letby had difficulty remembering Child N.
She did recall an occasion when doctors had difficulty intubating him. She agreed that she had seen blood but denied being responsible for causing him harm.
She could not explain the entry in her notes timed at 10am on June 15 in which she recorded aspirating more fresh blood which she had not apparently brought to the attention of anyone else.
Defence Opening Statement (child n)
For Child N, the defence say there are "many reasons" why a baby would shout or scream.
"It was far more likely to be hunger" - "you certainly won't find evidence of anything else".
Regarding the allegation Letby did something to cause Child N to bleed, the prosecution say the intubating doctor already saw blood, because Letby harmed him.
The defence disagree and say blood was "not identified until intubation had already happened, or was in the process of happening".
There were three attempts to intubate him.
The defence say, again, there was "sub-optimal care" for Child N.
Agreed Facts (child n)
Sequence of events from records (child n)
Cheshire Police intelligence analyst Claire Hocknell is now talking the court through the first of two sequences of events for Child N.
2nd June 2016
The first is a Facebook message from a Countess of Chester Hospital doctor at 11.56am on June 2, asking Lucy Letby for an 'opinion on something'.
Lucy Letby replies: "Hope I can help!"
1.42pm: Child N is born via C-section at 1.42pm, weighing 1.67kg, at 34 weeks plus 4 days gestation. His 'APGAR' scores, recording how well Child N was doing immediately after birth, are 9/10 at 1 minute and 9/10 at 5 minutes.
2pm: Nurse Caroline Oakley records Child N was admitted to the neonatal unit at 2pm, and Child N had 'prematurity and clotting disorder'.
2.30pm: A blood sample was taken at 2.30pm.
A clinical note by Dr Anthony Ukoh reports: '34+4 baby boy cried immediately, required no active resus'.
'Not for IM Vit K for now until haemophilia status known'.
'Observations: ...intermittently grunting++'
3.10pm: A desaturation down to 67% oxygen saturation, lasting one minute, is recorded by nurse Caroline Oakley at 3.10pm.
The nurse adds, in a nursing note: '[Child N] Allowed to rest. Sounds very mucousy. Grunting intermittently...dropped saturations to 67% when upset; temp being recorded and required 60% O2 to recover...awaiting blood results before being given Vit K.'
The note adds: 'Decision made to screen and [nil by mouth], IV fluids/Vit K IV as prescribed as still grunting'
6pm: An x-ray result before 6pm recorded that Child N likely had an infection.
6.47pm: Nurse Caroline Oakley recorded at 6.47pm that Child N's temperature, which had been low, was recovering.
A family communication is recorded: 'Dad has visited baby on unit and updated by [Belinda] Simcock. She has also visited mum... and updated...'
A haemophilia diagnosis is confirmed for Child N.
7.30pm: Lucy Letby is recorded as starting her night shift on June 2 at 7.30pm, in time for the 7.30pm-8pm staff handover.
Letby is a designated nurse, with shift leader being Melanie Taylor and other designated nurses being Christoper Booth and Sophie Ellis.
Booth has two babies in room 1, including Child N,
Ellis had one in room 2 and two in room 3, and Letby had two in room 4. Two babies were in transitional care, and another baby was 'rooming in with her parents' - that baby's designated nurse was Letby.
Messages re Dr A (1) (child n)
A few minutes after entering the neonatal unit, Letby Whatsapps a colleague and says she had a 'paper handover' as colleague Caroline had gone home.
Nurse Christopher Booth records 'care taken over approx 2000...oxygen saturations predominantly in mid 90s-100%'. He also records the usual handover checks.
Letby messages 'We have got a baby with haemophilia'
Reply: 'How many weeks?'
LL: '34'
R: 'oh'
LL: 'Everyone bit panicked by seems of things but baby appears fine'
R: 'male?
LL: 'yeah'
LL: 'Oh and had weird FB message from [doctor] earlier...'
Letby adds she does not know much about haemophilia. Her colleague replies to be careful with cannula and blood samples.
The conversation continues about discussion of other babies, and Letby messages her colleague: 'Had strange message from [doctor] earlier...'
Reply: 'Did u? Saying what?'
'Go commando?
Letby:
Letby: 'Asking when I was working next week as wants to talk to me about something, has a favour to ask..?'
R: 'Think he likes you too...'
R: 'Hmm did u not ask what it was?'
LL: 'No just said when I was working and he said wants my opinion on something'
LL: Hmm...
R: 'Hmm'
LL: 'Do you think he's being odd?
R: 'Thought as flirty as u'
LL: 'Shut up!'
R: 'What?!'
LL: 'I don't flirt with him!'
R: 'Ok'
LL: 'Certainly don't fancy him haha just nice guy'
R: 'Ok'
The conversation continues back on work, asking why there was a staff shortage on the unit. One of the staff members is speculated to be off with stress.
10pm: The conversation on Whatsapp, now continuing after 10pm, discusses another baby's condition.
3rd June 2016
1am: Further observations are recorded regularly for Child N up to 1am.
1.05am: Child N then suffered a desaturation at 1.05am.
Nurse Christopher Booth: 'One episode whilst I was on my break, whereby infant was crying++ and not settling.
He became dusky in colour, desaturating to 40s. Responded to facial oxygen within 1-2 minutes, crying [subsided] after 30 minutes'. The note adds Child N's colour returned to pink perfusion.
2.04am: Nurse Booth added, up to 2.04am: 'No further episodes observed. Oxygen saturations have been consistently mid 90s-100%...in view of earlier episode, infant remains nil by mouth...'.
Nurse Ashleigh Hudson takes over care of Child N for the day shift on June 3.
'Tachypnoeic on handover, unsettled'
Messages (2) (child n)
Letby messages the same colleague: 'been busy...' adding what had happened to a number of babies during the night shift, and what staff on duty had been doing.
She adds: 'Glad to be off, survived my nights tho' folowed by a smiley face emoji.
Dr Sudeshna Bhowmik records a list of 'problems' for Child N, including prematurity, jaundice and respiratory distress.
A plan was to discuss with Alder Hey Children's Hospital haemotology, and that discussion was carried out.
A dose of vitamin K is prescribed for Child N during the day shift.
6pm: Nurse Ashleigh Hudson records a 'slightly mucky aspirate' for Child N towards the end of the day shift, at about 6pm.
The note of a summary of care between 8am-6pm records Child N was 'settled for the rest of the day', with 'minimal aspirates obtained. Aspirates clear with tiny old blood specks'.
'Paeds have liased with AHCH'
8pm: Nurse Christopher Booth, at the time of the night shift handover for June 3-4, records at 8pm Child N was settled.
A family communication note by nurse Hudson: 'Both parents updated on current condition and plan of care. Mum very anxious, worried about baby being in the incubator. Explained need for it, to keep baby warm and make observation easier...'
4th June 2016
3am: The sequence of events goes up to June 4 at 3am, where Christopher Booth records 'No significant desaturations, bradycardias or apnoeic episodes observed overnight...'
The sequence says Child N continued to be cared for at the Countess of Chester Hospital's neonatal unit between June 3 and June 14. The rest of the sequence of events, presented electronically to the jury, begins from June 14, 2016.
14th June 2016
7.40am: Lucy Letby is the designated nurse for Child N on the day shift of June 14. At 7.40am, Child N takes on a feed of expressed breast milk.
8am: Letby records notes at the handover at 8am.
Messages (3) (child n)
Letby messages a colleague to complain about having to finish up a previous shift' nurse's work, and had left a bottle 'dirty'.
Lucy Letby records regular temperature readings for Child N which are all recorded in a 'normal range'.
The court had previously been told readings in the 'yellow area' (too high, or too low) would be considered abnormal, but none of the temperature readings recorded as being too high or too low.
Letby notes: 'Demand feeding EBM via own bottle, completing more than required volumes....repeat SBR this morning on downward trend but not yet >50...otherwise ready for home'.
In a family communication note: 'Mummy visiting this morning, carried out cares and feed. Put infant to breast. Discussed feeding at home'
The notes show Child N was ready to go home, apart from further treatment required for jaundice, and was on phototherapy.
Other family members visited Child N at the neonatal unit that day.
For the night shift of June 14, Child N was in nursery room 3.
8pm: Nurse Jennifer Jones-Key, in a note written retrospectively, records Child N was 'nursed in incubator with eye protection insitu. Baby demand bottle feeding' at the start of the shift at 8pm.
Messages (4) (child n)
Letby is involved in a Whatsapp message conversation with a nurse, and a Facebook messanger conversation with a doctor at this time.
The nurse colleague complains about work colleagues on that night shift.
Letby says she has had a "lovely run of shifts in 3".
"Nice babies and parents"
Letby messages the doctor to say she was planning to go to Torquay with her parents in July 2016, and discusses about her having had hypothyroidism since she was 11, and had 'blips over the past 12 months'.
15th June 2016
1am: A nursing note by Jennifer Jones-Key just after 1am on June 15 records Child N had become 'very unsettled' and was 'pale, mottled and veiny' with slight abdominal distension.
A blood test was taken for analysis.
Further observations are taken.
Messages (5) (child n)
Letby messages her colleague at 5.10am: 'Awake already'
Her colleague replies: "I wouldn't come in!"
Letby: "Oh...why"
The colleague replies: "5 admissions, 1 vent"
LL: "OMG"
Colleague: "Baby [N] screened, looks like s**t"
6am: Jennifer Jones-Key's note before 6am: 'baby looked worst this morning and cap refil after 3 secs. Reviewed again by paeds...'
Letby messages a doctor colleague saying she might be back in '1' again for her next day shift, in nursery room 1.
7.10am: Lucy Letby is recorded as entering the neonatal unit at 7.10am. She messages the doctor: "No repeat today. I've escaped being in 1, back in 3".
7.15am: The sequence of events shows Child N had a desaturation at 7.15am.
Jennifer Jones-Key records: 'at 0715 baby crying and dropped saturations - as seen by NNU nurse Lucy [Letby].'
The nurse adds Child N had to be given 100% oxygen support by a doctor.
8am: Child N was transferred to nursery room 1 at 8am.
A note is made on the resiting of the NG Tube - 'NG resited in right nostril with acide reaction. At handover baby dropped saturations and required Neopuff. Care handed over to NNU nurse Lucy Letby'.
Lucy Letby is recorded as being the designated nurse for the day shift on June 15, and records, in a noe written retrospectively: 'Infant transferred to nursery 1 on handover. Mottled, desaturating requiring Neopuff and oxygen...cold to touch.'
9am: Lucy Letby records, in a note written at 1.53pm for care at about 9am: 'Unable to intubate - fresh blood noted in mouth and yielded via suction ++.'
10am: Letby messages her colleague on Whatsapp before 10am: 'Thanks for staying to help. Much appreciated.'
Letby records '1ml fresh blood aspirated' from Child N at 10am.
11am: A doctor colleague messages Lucy Letby before 11am to ask: "Is he ok?"
Letby notes, at 11am: 'Small amount of fresh blood orally and 1ml from NG tube'
Letby messages the doctor in response: 'Small amounts of blood from mouth & 1ml from NG. Looks like pulmonary bleed on xray...
"Sorry if I was off during intubation...I like things to be tidy & calm (Well, as much as possible!)"
The doctor responds: "No, you were perfectly fine with me...I thought you were wanting to just get on with in case there was another desat."
Letby replies: 'Well I have got my hair in a bun today, it's only fitting that I was 'serious Lucy' !!'
Letby adds 'no more bleeding thankfully', in relation to Child N.
The rest is taken from Dan O’Donohue Twitter (03/03/2023)
15th June Cont..
Ms Letby's nursing notes from June 15 record that Child N was 'pale/mottled' and required oxygen support
Ms Letby's notes state that Child N's parents had been informed and that they were 'understandably upset'
At 14:50 on June 15, Ms Lebty recorded that Child N had a profound desaturation. Notes state: 'Infant became apnoeic with desat to 44%. heart rate 90bpm. Fresh blood noted from mouth'...minutes later a number of senior medics were crash bleeped to attend the child
Nursing notes record that there was difficulty trying to insert an ET tube. With two doctors failing to 'obtain a secure airway'
Two consultants from the anaesthetic team were called to help, but they also had difficulty fitting an ET tube, the nursing notes show.
Messages (6) (child n)
Court now being shown messages between Ms Letby and colleagues that evening. A doctor, who cannot be named for legal reasons, asked her if she was okay and told her to cry if she needed to.
Messages shown in more detail from HERE
On June 15 – when she is alleged to have made two more bids to murder Child N – she swapped Facebook messages with the same doctor, who cannot be identified for legal reasons, the court heard.
Manchester Crown Court heard that the registrar, who was working nights, messaged Letby: “Only a few hours to go and it’s holiday time – do you think you’ll manage to hand over quickly?
At about 5.25pm Letby replied: “I’ll still be here. He’s (Child N) poorly, bled again and became apnoeic.
“Sat having a quiet moment and want to cry. Just mad with so many people and lack of space etc.”
The doctor said: “Oh Lucy, poor little thing and you.
“Are you OK? Have a cry, you’ll feel better for it I’m sure. You’re welcome to take my car home if you’re too tired to walk. I sort out picking it up in the morning.
“So sorry you’ve had a rubbish day at the end of your long run – holiday well and truly deserved.”
Letby responded: “ I’m OK just feel like I’ve been running around all day and not really achieved anything positive for him.
“Don’t want to cry in front of people here, maybe when I’m home! That’s very kind re the (car) but should be OK. Have you managed to switch off at all and sleep?”
The doctor messaged: “No not really. Your day sounds as though as it’s been horrible. Poor you. Are you going to be OK?
“I’m sure he’s had the best care possible today and that you will have done everything you can for him.
“Are you doing anything nice before you go on holiday? You’re not having to do a long run of shifts to get the time off for that are you?”
Letby said: “No off for nearly 2 weeks!”
The doctor replied: “Oh what an end to a rubbish day. I haven’t been back to Torbay for a few years .. I’m always surprised how little it changes when I go back. Happy memories.
“I used to love Cockington in the summer – it always looked so pretty when the flowers were out. Have you handed over yet?” He added: “Look on the top shelf. Right hand side. For the walk home. Your still welcome to the car.”
Letby replied: “Cockington is gorgeous!! We always go there for afternoon tea. Dad was offered a job in Paignton many moons ago, could have been a very different childhood growing up by the sea. Looking forward to going back.
“Hope little man is OK and your night isn’t too stressful. On the home straight now at least.
“You are a sweetie (name of doctor), thank you.”
The doctor messaged: “Chocolate makes bad days a little better. Hope you liked it.”
Letby said: “That’s true. Just a shame I don’t usually eat chocolate … but on this occasion …”
The doctor replied: “It was well deserved today. Are you OK?
Letby said: “Yes thank you . Just glad he’s (Child N) OK.
“Hopefully I’ll sleep well tonight and can enjoy getting ready for hols. Are you OK?”
The doctor said: “He’s just left the building. I’d be surprised if you didnt sleep well after so many long days zzz.”
Letby said: “Glad he got off safely.”
The doctor replied: “My night is complete! Just been handed a 3-week-old for a cuddle, who am I to refuse!!”
Letby messaged: “Aww baby cuddles make everything seem better.”
Back to Dan O’Donohue Twitter
7.40pm: Notes from 19:40 on June 15 show that there was a further 'profound desaturation'. Child N had 'colour loss' and required neopuff breathing support
7.48pm: At 19:48 the baby boy required resuscitation and a number of doses of adrenaline
He eventually stabilised. Ms Letby said in a message to a colleague, who can't be named for legal reasons, that Child N's parents were present and had had the boy christened.
Messages (7) (child n)
Court has been shown numerous messages between Ms Letby and a doctor, who cannot be named for legal reasons. In one of those messages she asks 'What do you think caused his (Child N's) bleed?'
The doctor responds: 'I think there will be a haemangioma or collection. If it was epiglottitis his crp should have been higher because he was starting to become unwell'
Doctor says he's 'optimistic he'll be okay' Ms Letby responds: 'That's brilliant news, thanks for letting me know' - soon after the boy was discharged from Alder Hey hospital
Witness Statements Agreed (child n)
Family - Mother (child n)
The court is now hearing a statement from the mother of Child N, who was born on June 2, 2016 at 1.42pm, via C-section.
The mother first visited the neonatal unit, where Child N was, at 10pm that night. Child N was kept there due to prematurity, and for the first 13 days there were no problems reported to the parents.
Child N had haemophilia and on June 15, the parents were informed the baby boy had had a bleed. The parents were informed to attend hospital as soon as possible.
Child N was in intensive care, and on arrival Lucy Letby was there with other people.
They were told they had tried to intubate Child N between 4-8am.
Child N had two collapses that day - the parents were told to go out and get some fresh air in between the two collapses. While they were out, Child N had his second collapse.
A 'spur of the moment' baptism took place. Lucy Letby stayed beyond the end of her shift, and Child N was transferred to Alder Hey, where he recovered quickly over the following couple of days.
Family - Father (child n)
A statement is now being read from Child N's father, who says Child N's mother was a haemophia carrier.
He said he could not go to all the scans, but at one of them there was a concern Child N appeared to stop growing, so steroids were prescribed.
A C-section was planned, several weeks early.
When Child N was born, he weighed 3lb 11oz.
It was "a little scary" when he was first born, as Child N needed a little oxygen, but he was then ok.
For the first 13 days, the only issue reported to the parents was an issue with Child N's liver, which he was being treated for with light therapy.
The parents visited daily.
On the day Child N was due to come home, on June 15, the father was at work. He received a call from Lucy LEtby saying Child N was 'a bit unwell' during the night, but was fine now. He did not get the impression that Child N was still unwell.
He then received a call from child N's mother to come to the hospital as soon as possible.
When he arrived, Lucy Letby was in the room with Child N, giving cares. There was "no urgency". Lucy said: "Hi. He's been a bit unwell during the night."
He said he was "shocked" when he saw Child N, as he had dried reddy-brown blood around the mouth.
"I remember being confused and thinking, 'what's wrong with him?'"
"No-one told us what happened, or why."
After going outside for a bite to eat, they returned to the neonatal unit and found the blinds were down.
A staff member on reception said Child N was "really unwell" and if they would like a priest.
Someone came into the maternity room, where Child N's mother was staying with the father. The staff member said: "You'd better come - he's really ill this time."
Upon their arrival to the intensive treatment unit, resuscitation efforts were being administered to Child N.
The father said he could not watch what was going on. Staff from Alder Hey Children's Hospital were among the staff members in the room.
After a breathing tube was fitted, Child N stabilised and 'calmed down'.
The parents spoke to a haemophiliac specialist nurse who had come from Alder Hey via taxi.
Child N was taken to the transport team, in a process "which seemed like forever", by 11pm.
Lucy Letby came to the parents and said she had stated beyond the end of her shift and hoped that
Child N was going to be alright.
Child N was taken to Alder Hey, where he stayed for a couple of weeks before going home.
When home, the parents noticed Child N had 'twitches', then later 'spasms', and at one point was not breathing.
He was taken to the Countess of Chester Hospital, and transferred to Alder Hey, where he stayed for 1-2 weeks.
Dr Sudeshna Bhowmik (child n)
Firstly, a statement from Dr Sudeshna Bhowmik is read out to the court.
Dr Bhowmik says tests were carried out on Child N for haemophilia.
It was discussed with the parents that Child N would be taken to the neonatal unit due to his prematurity, and would need an incubator for temperature control.
Child N had intermittent grunting at one hour of age, which was not unusual for babies born via C-section as there would be increased fluid in the lungs. The usual practice was to oberserve for four hours to see if the baby would settle down. Vitamin K was withheld on the risk of increased bruising/bleeding for Child N, until test results came back.
Child N was later screened for sepsis as he had continued grunting beyond the four-hour observation period. He was breathing without any support required.
He had had 'an episode' where he desaturated to 40%, with colour change noted, but had "settled thereafter" and did not need "supplementary oxygen for very long".
The rest of the examination by Dr Bhowmik on June 3 was "normal", and Child N was seen to be pink and well perfused, and doing "well from a respiratory point of view"
Nurse Caroline Oakley (child n)
A statement from Caroline Oakley is read out to the court, in which the nurse describes Child N being born, transferred to the neonatal unit, and describes being aware the mother was a haemophilia carrier.
Child N was dressed and placed in a 'hot cot'. He was 'grunting intermittently', which was not unusual. At 3pm, his temperature dropped to 36.4 degrees, and the temperature of the cot was increased to 39 degrees.
Child N had a desaturation to 67% and was given 60% oxygen support, and was screened.
Child N was presenting "quite typically" for a baby of his gestational age, and there were no overriding concerns at the time of the handover.
A second statement by nurse Caroline Oakley said there was nothing to suggest the naso-gastric tube had been moved, nor any difficulties with the tube being initially inserted.
Nurse Melanie Taylor (child n)
Nurse Melanie Taylor, in her statement, says she "vaguely" remembers Child N by the name, but does not recall the shift. She confirmed she was the shift leader for the night of June 2/3, 2016.
She was aware Child N had suffered a collapse during the night, but did not remember it happening or responding to it.
Nurse Sophie Ellis (child n)
Nurse Sophie Ellis, in her statement, says for the night shift of June 2/3, 2016, she had a vague memory of Child N as had haemophilia, which was unusual. She did not remember the details of the night shift she worked.
She says she knows, from the notes, Child N had a collapse, but does not remember being involved in the efforts to stabilise Child N. She knows the collapse happened when Christopher Booth was on a break.
Nurse Christopher Booth (child n)
Christopher Booth, in his statement, is asked about the night shift he was on for June 2/3, 2016. He said he remembered Child N as it was unusual for a neonatal baby to be a haemophiliac. He adds his memory of the shift is "limited".
He says he is "almost certain" he was caring for Child N that night. He recalls Child N was stable, with oxygen saturations "almost 100%, and "no abnormalities" presented.
He says it was likely on the hour when he left for his one-hour meal break, saying he had "no concerns". He handed over care to a nurse, but does not recall who that was.
When he returned from his break, he was "surprised" to learn Child N had become 'unsettled' and 'fractious' suffered a desaturation. He adds he had not been called back from his break.
Nurse Valerie Thomas (child n)
Valerie Thomas, in her statement, says she does not recall Child N or the night shift of June 2/3, but does know she was on that night shift. She says she was likely working in nursery room 3 or 4.
She knows Child N had collapsed when nurse Booth was on a break. She said it was "very unlikely" she would have been involved in any subsequent care.
Nurse - unnamed (child n)
Taken from Dan O’Donohue Twitter
A nurse, who cannot be named for legal reasons, said in her statement that she remembers being 'shocked' at Child N's deterioration that day. She said that he was previously stable and ready to go home that day
Elizabeth Mor (child n)
Taken from Dan O’Donohue Twitter
Court being read a statement from Independent
Nursing Healthcare Advisor Elizabeth Morgan, who was asked by Cheshire Police whether Ms Letby's 'failure' to alert other medics that fresh blood had been aspirated from Child N's mouth that day fits with 'good practice'
Ms Morgan said in her professional opinion, it would be 'standard good practice' to escalate anything unusual - first verbally and then later recoded
Witness Evidence (child n)
Dr Jennifer Loughnane (child n)
Prosecutor Philip Astbury says Dr Jennifer Loughnane will next give evidence.
She confirms she is a consultant paediatrician at the Countess of Chester Hospital, and was employed as a registrar on the night shift of June 2/3, 2016.
She says she has no independent recollection of Child N or that night shift, other than that recorded in her notes.
At 10.55pm, she carried out a routine review, which included an examination of Child N.
Dr Loughnane has noted Child N's history up to that point in the first 12 hours of his life, and noting a concern of a growth restriction during pregnancy, and the weight of 1.67kg indicating Child N was "a small baby".
No risk factors for sepsis were detected.
Child N was 'screened [for infection] - due to grunting at four hours'. The grunting was, the court hears, due to Child N having extra fluid in the lungs.
Child N was 'self ventilating in air', 'respiratory rate 60', 'Sats 96% room air'
An antenatal plan had been put in place as Child N's mother was a haemophilia carrier.
At 1.10am, Dr Loughnane is informed about Child having a desaturation. She does not recall who did so.
The note at the time records: Child N 'got upset, looked mottled, dusky, sats 40%, O2 100%'.
'On my arrival, 40% O2, screaming, sternal recession, poor trace on Sats probe, pink'.
The desaturation was "significant", Dr Loughnane tells the court.
Mr Astbury asks about the significance of the word 'screaming'.
Dr Loughnane says that 'screaming' is not a word she would tend to write very often in her neonatal notes. She says that would indicate Child N was particularly upset.
Dr Loughnane said attempts were made to settle the baby, but was crash bleeped away.
On her return, Child N's saturation levels recovered to 100%, and he was "asleep". The time of Dr Loughnane's return is not recorded.
The plan was to continue to observe Child N and carry out the blood gas reading at 2am, indicating the note was made sometime before 2am.
A blood gas reading is carried out at 2.04am, and Dr Loughnane says there is a raised lactate reading for Child N.
Cross Examination
Benjamin Myers KC, for Letby's defence, is asking Dr Loughnane questions.
He says Dr Loughnane covered a lot of areas of the hospital on that night shift. She replies the arrangement was standard for most hospitals.
Mr Myers refers to notes made before the handover took place, in relation to Child N "intermittently grunting++" and an event of Child N desaturating to 67%.
He asks if it is possible for a baby to desaturate because they are upset, via a 'false desaturation' from the Sats probe not picking up the trace.
Dr Loughnane says that can be the case, but it would usually be recorded as such in the medical notes. The number on the oxygen saturation reading could be lower, or not be displayed at all.
Mr Myers asks about Child N 'screaming' and being 'pink', which he says if Child N had suffered a desaturation, he was "certainly recovering" from that. Dr Loughnane agrees.
Mr Myers asks about the relevance of the 'poor trace on Sats probe'.
Dr Loughnane says she had been told of the 40% sats reading, but on her arrival, she had seen Child N was pink.
Mr Myers says there were no signs of Child N having any fresh blood anywhere. Dr Loughnane agrees.
Dr Loughnane also agrees it is rare to be looking after a baby at the Countess of Chester Hospital - or any hospital - who has haemophilia.
Mr Myers says other than the raised lactate reading, the blood gas record at 2.04am was normal. Dr Loughnane agrees.
The prosecution rise to clarify the '40% O2 (on my arrival)' note, and ask if that is a saturation reading or the oxygen support for Child N. Dr Loughnane says she cannot be sure, but believes it would be the latter.
Mr Astbury says if the 40% oxygen saturation recorded by the nurse was inaccurate, it would have been noted as such in medical notes. Dr Loughnane agrees that would be the case.
That completes Dr Loughnane's evidence.
Dr Huw Mayberry (child n)
Taken from Dan O’Donohue Twitter
Dr Huw Mayberry is first to give evidence today - via live link from Australia. Dr Mayberry currently works as a registrar in Melbourne, back in 2016 he was at the Countess of Chester Hospital
Dr Mayberry is being asked about the events of June 15, 2016. Child N crashed several times throughout that day - at one point requiring full resuscitation and six doses of adrenaline
Dr Mayberry was crash bleeped to attend the neonatal unite at around 15:00 due to a 'sudden desaturation following 3ml aspirate of blood from NG (tube)'
The doctor tells the court he tried to intubate Child N, but he 'was unable to get a very clear view because there was substantial swelling within the airway'. He said that this swelling was 'unlike anything I had encountered previously'
He said the infant's epiglottis (flap of tissue at the back of the throat) was 'quite swollen, it looked quite large and reddy pink in colour'. He adds 'I had not seen this in my practice before, only in textbooks'
He tells the court that his initial thought was that this could be epiglottitis - this often caused by an infection, but can also sometimes happen as a result of a throat injury
Dr Mayberry tells the court that he does not recall seeing any blood in Child N's throat. Asked if he could he could give a cause for the swelling, he says 'no it’s not something I've had much experience of'
Cross Examination
Ben Myers KC, defending, is now questioning Dr Mayberry. He asks in his professional opinion what can be the cause of blood - he says he told Cheshire Police it could have been a result of gastric irritation or Necrotising enterocolitis (NEC)
He says it could also have been a result of Child N's blood disorder, which resulted in a deficiency of an essential blood-clotting protein
Nurse Jennifer Jones-Key (child n)
Taken from Dan O’Donohue Twitter 03/03/23
Nursery nurse Jennifer Jones-Key is now in the witness box. She was on a night shift on 14 June 2016 and was Child N's designated nurse along with Neonatal assistant Lisa Walker. They took over Child N's care from Ms Letby, she tells the court there was no concerns on handover
Ms Jones-Key's nursing notes, written retrospectively at 5:51am on 15 June, state that 'just after 1am baby looked very pale mottled and veiny'
She recalls that over that morning Child N 'started to have a few desaturations' and was placed on full monitoring
Ms Jones-Key tells the court that Child N 'settled down' but 'from 7am onwards he was having more desaturations'
The nurse says shortly after 7am, Ms Letby came in to 'say hello'. At that point, she said 'I think the monitor went off, so Lucy went over to see. He went quite pale, I think he’d stopped breathing, I got the neopuff'
She's asked by the prosecutor where Ms Letby was in the room, she doesn't remember. She is asked again why Ms Letby was in the room - 'just to say hello, because we were friends', she says
She doesn't remember any conversation between them. She says the decision was taken to provide respiratory support to Child N . A nursing note from that morning states: 'noted to be mottled all over body and blue in colour and cold to touch'
Ben Myers KC, defending, is now questioning the nurse. He asks if Ms Letby was 'quite a good friend', 'Yes' she responds. He asks, in her opinion, if Ms Letby was a 'capable and hard working nurse', she agrees
Mr Myers asks, in her knowledge, whether Ms Letby only gave 'the highest level of care' to the babies she cared for, she responds 'yes definitely’
Mr Myers is referring back to Child N's desaturation that morning, he says essentially Ms Letby said hello to Ms Jones-Key then responded when the baby boy's monitor went off - Ms Jones-Key agrees
Doctor A (child n)
Taken from Dan O’Donohue Twitter
We're now hearing from another doctor, who cannot be named for legal reasons, about the events of June 15.
The medic tells the court that he recalls Child N as he had trouble trying to intubate him, he says 'which for me is not a frequent occurrence'
Notes from the early hours of June 15 show that the doctor ordered a blood test as Child N was mottled in appearance and he wasn't sure why
The mottling eventually resolved, but over the next few hours Child N suffered five desaturations. The doctor said this made him think the baby boy had an infection. A septic screen of his bloods was then ordered
He tells the court that results ruled out infection as a cause. He said there was some concern about blood 'not being delivered to the skin in way that is normal'. By 8am on 15 June, Child N's mottling had returned. The doctor took the decision to move him to Nursery 1
Nursery 1 allows for more intensive care and treatment
The doctor tells the court that on that morning he took the decision to intubate Child N and put him onto a ventilator. He recalls seeing 'unusual' swelling and blood in the back of the baby boy's throat
After three unsuccessful attempts to intubate, the doctor abandoned the procedure. His note from that morning states: 'intubation abandoned due to blood present at oropharynx and likelihood of trauma due to repeated attempts'
Child N was then placed on non-invasive respiratory support
Cross Examination
Ms Letby's defence lawyer Ben Myers KC is now questioning the doctor.
Myers is asking the doctor when he saw the blood in Child N's throat. He said 'I believe blood was there at insertion attempt number one' Myers puts it to him that 'if you can't see, you wouldn't attempt it?' He replies:'You can do, if quite certain of position'
Mr Myers has just quoted the doctor's police statement from 2018. In this he says he was 'not sure' if the bleeding was his 'fault' due to his attempts to move the tongue with a medical implement to intubate
Dr John Gibbs (child n)
Taken from Dan O’Donohue Twitter
Retired consultant paediatrician Dr John Gibbs is now in the witness box. He was called to attend Child N at around 16:00 on June 15
Citing his notes, Dr Gibbs recalls that a specialist team had been called to help doctors with Child N's breathing (due to various problems with trying to intubate)
The team from Alder Hey Children's Hospital arrived in Chester at 19:20. They were made up of experienced intensive care consultants and an ear, nose and throat surgeon. Plan was to take Child N try to intubate, if that failed an emergency tracheostomy would take place
Dr Gibbs tells the court that Child N suffered a 'sudden deterioration' before the team could carry out the procedure however. Heart rate dropped to 60bpm, oxygen dropped to 40% - 'clear he was not being ventilated properly', Dr Gibbs said
At this point, Dr Gibbs said chest compressions were started and six doses of adrenaline were given over 30mins. A specialist doctor from Alder Hey also finally managed to intubate the baby, which allowed him to be placed on a ventilator
Asked for his conclusions about the events of June 15, Dr Gibbs says the blood could have been a result of a bleed on the lung - but adds 'why (Child N) had that swelling documented by colleagues, I really don’t know'
Dr Gibbs says that 'in the end I don’t think infection was the cause' of Child N's collapse
Dr Stephen Brearey (child n)
Taken from Dan O’Donohue Twitter
Dr Stephen Brearey is now in the witness box. He was on duty on the afternoon of June 15. He was called to help with Child N by a colleague as doctors were having difficulty intubating the infant
Dr Brearey made an unsuccessful attempt to intubate the baby boy. He tells the court from reviewing his notes it wasn't successful due to blood and swelling at the back of Child N's throat, which blocked vision of his airway
Cross Examination
Mr Myers is now questioning Dr Brearey, he's asking him about Child N's blood disorder, which increases the risk of bleeding
Mr Myers is taking the court back over notes of that day, they show that there was seven attempts to intubate Child N (before Alder Hey team succeeded). Mr Myers asks if this is something that should have been possible to do, he replies 'in normal circumstances yes'
The medic tells the court that he 'can think of no natural, normal cause for why (Child N) deteriorated multiple times' and then improved afterwards at Alder Hey
Dr Francis Potter - Alder Hey (child n)
Taken from Dan O’Donohue Twitter
Dr Francis Potter is now in the witness box. He was part of the Alder Hey team that assisted on June 15 - he said he remembers the case as it was 'quite unusual' for his team to get a call to go out and assist
He says when he arrived Child N was 'mottled and grey' in appearance - he recalls starting use of a bag and mask to ventilate the baby boy. When this didn't work, chest compressions were commenced
Dr Potter says after Child N stabilised and was transported to Alder Hey he recovered 'fairly rapidly' - within 48hrs he had left intensive care
Cross Examination
Mr Myers is now questioning the medic. He asks whether repeated attempts to intubate could cause stress to the baby, he says it would cause stress to the person trying to intubate
He said 'failure makes the second attempt more difficult and third more difficult'...he adds that rather than making repeated attempts, they should be limited and someone with more experience should be called to help quickly
Medical Experts Evidence (child n)
Professor Sally Kinsey (child n)
Taken from Dan O’Donohue
Blood expert Prof Sally Kinsey is now in the witness box. She was approached to review Child N's case
Child N has a rare blood disease, Prof Kinsey is explains to the jury that this can cause 'catastrophic' bleeding following minor injury. Child N had a 'moderate' variant of the condition, she tells the court
Prof Kinsey is asked whether the blood seen in Child N's throat that day could have been caused as a result of self injury or a spontaneous bleed due to his blood condition - she says no
Cross Examination
Ben Myers KC, defending, is now questioning the witness. He says his questioning will focus on whether a physical act can be established for causing the bleed
Prof Kinsey tells the court that Child N's blood disorder did make him "more likely to bleed", but said: "He won’t just bleed for no reason."
Dr Dewi Evans (child n)
From Dan O’Donohue twitter
Medical expert Dr Dewi Evans is now in the witness box, he was asked to review the case by Cheshire Police.
Dr Evans’ opinion is that the bleeding in Child N's throat was not caused by the attempts to intubate, but instead some preceding trauma
Dr Evans says Child N's 'progress was pretty uneventful' and was 'making satisfactory progress for a baby that was premature but otherwise well' in the weeks from birth to 15 June
Court being taken back over timeline of Child N's crashes on 15 June - which culminated in CPR and him having six doses of adrenaline, before he was eventually transferred to Alder Hey Hospital
Dr Evans is giving his analysis on Child N's first collapse on June 3. The baby suffered a profound and sudden collapse in the early hours of that day.
This was preceded by, what one doctor recalled, as 'screaming' - Dr Evans said that is 'very unusual' for a child of this age
Dr Evans says he went and reviewed scientific research papers on air embolus (injection of air) - these found that in some cases where babies had been injected accidently with air, there was a period of screaming before desaturation an death
He said what happened with Child N was 'repeated' in what we have seen in previous cases
On the 15 June incident, Dr Evans said in his opinion the bleeding 'was a result of trauma to his upper airway'
Cross Examination
Ms Letby's defence lawyer Ben Myers KC is now questioning Dr Evans
Mr Myers points out that Dr Evans wrote several reports on the collapse of Child N. In his first report written in 2018, the medic didn't mention the incident on 3 June. He tells Mr Myers he 'overlooked' it and later included in subsequent reports
Mr Myers says 'if you considered it significant you would have said so in your first report'
Mr Myers puts it to Dr Evans that there is 'nothing' in the medical notes for Child N 'to support a suggestion that there was an inflicted injury'. Dr Evans disagrees, he says that was his opinion when he authored his report in 2019 and says 'that is my opinion now'
On whether Child N had received an injection of air on 3 June, Mr Myers put it to Dr Evans that there was no evidence of an injection of air and that the medic was attempting "to work a piece of evidence in to support" his theory on air embolus.
He disagreed and said he was "applying standard clinical practice" in his review and said it was written with knowledge of previous babies in this case. "I think that we have to seriously consider that this baby was a victim of air embolus on 3 June", he said.
Mr Myers has jut been questioning Dr Evans about how he was approached to review these cases. He says he was approached. Mr Myers pulls up an email from 2017 that Dr Evans sent to the National Crime Agency telling them the death's at Chester 'sound like my kind of case'
He accuses Dr Evans of 'touting for work' and says he was using his review to 'fit the allegation not the facts'. He puts it to him that air embolus was mentioned to him by Cheshire Police before the review, he denies accusations - accuses Myers of 'going on a wild goose chase'
Further detail from Chester Standard HERE
On Tuesday, March 6, jurors were read an email sent by Dr Evans to the National Crime Agency (NCA) in May 2017, ahead of his involvement with Cheshire Police.
In his message to “Nick” at the NCA’s national injuries database, Dr Evans wrote: “Incidentally I’ve read about the high rate of babies in Chester and that the police are investigating.
“Do they have a paediatric/neonatal contact? I was involved in neonatal medicine for 30 years including leading the intensive care set-up in Swansea. I’ve also prepared numerous neonatal cases where clinical negligence was alleged.
“If the Chester police had no-one in mind I’d be interested to help. Sounds like my kind of case.
“I understand that the Royal College (of Paediatrics and Child Health) has been involved but from my experience the police are far better at investigating this sort of problem.”
Ben Myers KC, defending, said to Dr Evans: “This is you putting yourself forward. In effect, touting for this job.”
Dr Evans replied: “I was offering my professional opinion if that was in their interest.”
Mr Myers said: “It’s you ready to give them what they wanted, Dr Evans?
The witness said: “No, no. I have dealt with several police cases where I have said ‘this case doesn’t cross the threshold of suspicious death or injury’, or whatever.
“My opinions are impartial and independent.
“I also give evidence to law firms representing defendants. In the last five years I have given more reports relating to defendants than the police or the prosecution.”
Mr Myers went on: “At some point before you started writing reports you were told by the police about suspicious rashes and air embolus, weren’t you?”
Dr Evans said: “That is completely untrue. It’s totally untrue.
”The first time I heard a local doctor mention air embolus was a couple of weeks ago.
“The first person I know to raise the area of air embolus was me. I did that in case number one and I thought ‘oh my god, what is going on here?’
“I was not told anything about any suspect. I knew absolutely nothing.”
Dr Sandie Bohin (child n)
Taken from Dan O’Donohue Twitter
Dr Sandie Bohin, who also reviewed the case, is now in the witness box. She said the bleeding suffered by Child N on 15 June could have been caused by 'local trauma to the mouth'
On the incident on 3 June, Dr Bohin says she has 'never experienced' a neonatal baby crying for 30mins. She says it is an 'extraordinarily long' time and puts it down to an 'inflicted painful stimulus'
