Lucy Letby Case 7 Wiki

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  • Introduction

    This page contains evidence heard for child G.

    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 G

    Count 7: Attempted murder (bolus of air via NG tube & excessive milk)
    Count 8: Attempted murder (bolus of air via NG tube & excessive milk)
    Count 9: Attempted murder (bolus of air via NG tube & excessive milk)


    Prosecution opening statement

    Background


    Child G, born in May 2015 at Arrowe Park Hospital, was a baby girl and born very premature, weighing 1lb and 2oz.
    Child G suffered bleeding on her lungs and had nine blood transfusions, with a number of 'septic' or 'suspected septic' episodes requiring antibiotics, but improved and was transferred to the Countess of Chester Hospital's neonatal unit in August, and was clinically stable, being fed expressed breast milk.


    Incidents


    On the night in September, Child G was in nursery 2, with a designated nurse (not Letby). There were seven babies in the unit, with five nursing staff. Letby's assigned baby that night was in nursery 1. It was a milestone night for Child G and nurses marked the occasion with a small celebration. Child G was being fed every three hours alternately by bottle and naso-gastral tube.

    At 2am, a feed had shown minimal aspirated of partially digested milk. The nurse took her scheduled one-hour break.
    "Nothing is recorded on who was asked to keep an eye on Child G," Mr Johnson said.

    At 2.15am, the shift leader said she was sat with Lucy Letby when she heard Child G vomiting, along with Child G's monitor alarm going off. They ran into her nursery. Child G had vomited violently and suffered a collapse. The prosecution said medical records suggest the shift leader nurse's memory of being with Lucy Letby for a period of time before this event cannot be accurate.

    The prosecution say despite Child G's stomach being 'pretty much empty' prior to her feed, 45mls of milk was aspirated from her NGT. But, the prosecution say, 45mls of milk had been administered for her feed, which then did not explain what accounted for the vomit. Subsequent x-rays showed air in the abdomen and intestines.

    Child G suffered further deteriorations. During intubation, a doctor noticed bloodstained fluid from the trachea - something the prosecution say was consistent with that seen in other collapses in the case so far.

    At 6.05am, following a further desaturation, 100mls of air was aspirated from the NG tube. When the tube was removed, the registrar noted thick secretions in her mouth "and a blood clot at the end of her breathing tube". There were also signs of infection.

    Child G was transferred to Arrowe Park, before returning to the Countess neonatal unit just over a week later.
    During that time, Child G "recovered remarkably".

    Five days after her return to the Countess, Child G was due to receive her immunisations, such was her improved condition.
    A team of nurses came on the day shift that day, Lucy Letby being among them. Letby was Child G's designated nurse that day.

    Child G was fed with 40ml via a NG tube by Letby at 9.15am. At about 10.20am, Child G had projectile vomited twice and went apnoeic for several seconds, the court is told. Child G's blood saturations fell to 30%. The same problem she had faced two weeks prior. A nurse took over the care from Letby at 11.30am, as Letby was looking after two other children in room 4.
    The nurse took all the observations and noted Child G was connected to a 'Masimo monitor' - which measures oxygen saturations and heart rate levels. It is a device which stays on and cannot be turned off by a baby.

    At 3.30pm a consultant doctor was called to cannulate Child G. Privacy screens were erected and Child G was on a trolley, with the monitor still attached. The nurse went to care for another baby.
    The consultant doctor said he "could not recall" if Child G's monitoring equipment was switched off during the cannula fitting, but "it is his practice to transfer the sensor from one limb to another or if temporary detachment is required to reattach the monitor as soon as possible." He added if Child G was not stable he would not have left her.

    After the doctors had gone, the nurse responded to Lucy Letby's shout for help. When she attended, Child G's monitor had been switched off (power was off). Child G was struggling to breathe. Letby was giving ventilation breaths. Child G responded to treatment.

    In a text sent by Letby to a colleague, she wrote Child G: "...looked rubbish when I took over this morning then she vomited at 9 and I got her screened … mum said she hasn’t been herself for a couple of days”.

    But the prosecution said Child G had been due to have her immunisations, something which would not have been contemplated if Child G had not been well.

    The prosecution say Child G had vomited because she had been given excessive milk and air.

    A subsequent MRI scan revealed neurological changes and, in August 2016, it was revealed Child G had suffered "irreversible brain damage".

    The overfeeding "doesn't happen by accident," Mr Johnson told the court.

    He added similar cases will be heard with other babies.
    Mr Johnson: "Someone had switched off the monitor when Child G collapsed, and she was 'discovered' by Lucy Letby".


    Police interview


    In police interview, Letby said she remembered the nurse had been on her break when the incident happened with Child G in nursery 2. She could not remember who had been assigned to look after her. Letby suggested the excess air in Child G after the vomiting was the result of some sort of infection, or as a consequence of the vomiting. She said she had withdrawn the 45mls of milk after that episode, and air had come with it, and she had seen Child G vomiting. She said she did not know why she had gone into the room, but it was possible it was as a result of hearing Child G vomiting. Letby 'vaguely' recalled the day Child G vomited after her return to the hospital, accepting she had been the designated nurse. She had no recollection of Child G vomiting.

    In a subsequent interview, Letby accepted there were only two alternatives to the first vomiting incident - that Child G had been fed far more than should have been, or she had not digested her earlier feed. She accepted that the clear inference to be drawn was that Child G had been given excess milk and air via the NGT. She denied responsibility for either of those eventualities.

    For the second incident, Letby denied either over-feeding or injecting air into Child G's stomach.

    In Novemver 2020, Letby denied to police that she had switched off the Masimo monitor.


    Facebook


    She was asked about Facebook searches carried done on the day of the second vomiting incident that Letby looked up the parents of Child G. She said "she had no recollection of them". The prosecution say that, within a minute or two of looking at the mother of Child G on Facebook, she then looked at the mums of two other babies listed in the charges. One was the mum who, the prosecution said, "interrupted the attack" by Letby on Child E.

    Mr Johnson: "The practice of the nurses on the NNU was to use the NGT to check whether an infant had an empty stomach before feeding. That was done in Child G’s case – nothing came up which means there was nothing in her stomach.
    "She was then fed and her designated nurse went on a break. 15 minutes later Child G produced projectile vomits of such force that they left the cot and landed on the floor and nearby chair.
    "Child G collapsed and stopped breathing. An amount of feed was aspirated from her NGT equal to what she had been given about 15 minutes earlier together with lots of air.

    "There was a similar episode a few weeks later.

    "These were not naturally occurring, or random events; they were deliberate attempts to kill using a slightly different method by whilst Lucy Letby sought to give the appearance of chance events in the neonatal unit at the Countess of Chester Hospital."


    Defence opening statement

    For Child G, the defence say the child was extremely premature, "on the margins of viability" - "there will be problems," Mr Myers said.

    Child G was a "high risk baby", "irrespective of anything to do with Lucy Letby".

    Child G also displayed "signs of infection".


    Agreed Facts

    Sequence of events from records


    The court is first shown Lucy Letby's shift patterns for June 2015.

    Mr Johnson says, for the indictment, the charges of murder and attempted murder for Childs A-F, Letby was on night shifts.

    Letby was also on a night shift for September 6-7, the night Child G suffered a collapse. The prosecution say this was one of three murder attempts by Letby on Child G; the defence deny this.

    31 May 2015
    Child G was born on May 31, 2015, at Liverpool's Arrowe Park Hospital, at a gestational age of 23 weeks and six days. She weighed 535g - 1lb 2oz.

    Previously, the court heard this baby was the most premature birth of all the babies in the trial.

    She was in a poor condition at birth, requiring ventilation.She was cared for at Arrowe Park, a tertiary centre, until being transferred to the Countess of Chester Hospital on the night of August 13. At this stage she would have been a gestational age of 34 weeks plus 3 days.

    14 August 2015
    Nursing notes for Child G on Friday, August 14, recorded by Caroline Bennion, note: 'Currently [Child G] is on CPAP Peep of 4 in 29-40% of oxygen...has been since 17/7/15 and has occasional desaturations. [Child G] is trialling off CPAP in ambient oxygen and manages 1 hour in 2 episodes daily. May be eligible to trial Optiflow.

    'Fluids are all enteral feed.'

    A further note: 'Mum intends to breast feed and is expressing well...first immunisations have been given on August 1.

    '[Child G] has had metabolic bone disease but is not currently treated. Mum and dad have been shown around the unit and have been given contact numbers'.

    The court hears, from August 14 to September 6, Child G was treated at the Countess of Chester Hospital neonatal unit.

    6 September 2015
    The next evidence presented to the jury will be from September 6 onwards.

    At 2am on that day - when Child G was 99 days old - a feeding chart shows she was being fed with expressed breast milk, Gaviscon and a fortifier.

    The court is also shown a range of medications which were administered by Lucy Letby and another nurse, during that night, to Child G, before the handover at 7.30am.

    7.30am: For the day shift, the designated nurse for Child G was Vicky Blamire, who recorded hourly observations and was a co-signer for some of Child G's medication.

    11am: Consultant Dr Stephen Brearey records observations in an 11am clinical note.

    It was noted that Child G's weight had increased, by this point, to 1.985kg (4lb 6oz).

    3.37pm: Vicky Blamire's note at 3.37pm records 'all safety equipment present and correct', and Child G continued to receive regular feeds.

    Further prescribed medication is administered to Child G throughout the day.

    6.44pm: Her note at 6.44pm records, for Child G, 'Another bottle completed this evening. Bowels now open'.

    7.30pm: The handover takes place for the night shift team at 7.30pm.

    A different nurse to Lucy Letby - who cannot be named due to reporting restrictions - was the designated nurse for Child G this night.

    Letby was the designated nurse for one baby in room 1.

    The other nurse was the designated nurse for Child G in room 2, and another baby in a room whose location is unconfirmed on the chart.

    There were a total of seven babies in the neonatal unit that night, being looked after by a total of five nurses.

    Lucy Letby was the co-signer for medication administrations for Child G, along with the designated nurse.

    An observation chart for August 6 [think this is a typo and meant to be September 6 - Tofino] shows Child G's observations are made every three hours, with a heart rate in the 'normal' range at that stage.

    8.30pm: Letby had messaged colleague Kate Bissell at about 8.30pm enquiring about expressed breast milk for the baby she was the designated nurse for that night. The matter is clarified in the text conversation.

    7 September 2015
    1.46am:
    Further medication is administered to Child G at 1.46am, signed by the designated nurse and Alisa Simpson.

    2am: At 2am, the designated nurse records observations for Child G and a neonatal feeding chart records this is Child G's 100th day since birth.

    She received 45mls of milk via the nasogastric tube, with 'ph4' aspirates recorded. Child G was noted to be 'asleep' at this stage.

    The milk was expressed breast milk, plus fortifier and Gaviscon.

    Lucy Letby writes a note, written in retrospect at 8.57am, where care of Child G was transferred to her following an 'event'.

    The note says "written in retrospect for care given from 2am to present. [Child G] had large projectile milky vomit at 2.15am. Continued to vomit++. 45mls of milk obtained from NG tube with air++. Abdoment noted to be distended and discoloured. Colour improved few minutes after aspirating tube, remained distended but soft. Reg[istrar] Ventress asked to review. To go nil by mouth with IV fluids. Dr called to theatre."

    The designated nurse from the start of the shift records a note: 'nurse L Letby taken over care [of Child G] following vomit/apnoeic episode after 2am feed'.

    2.35am: Dr Alison Ventress writes clinical notes, timed at 2.35am and written retrospectively at 4.40am.

    They record: 'Called to r/v [Child G] urgently at 2.35am.

    'Had very large projectile vomit (reaching chair next to cot + canopy). Abdo appeared discoloured purple and distended. [Child G] distressed and uncomfortable. Red in face and purple all over. [Oxygen] to 1L via nasal cannula...'

    3am: Letby's note at 3am for Child G - 'bowels opened large green watery stool at 0300'.

    3.15am: Letby's note adds: 'Approx 0315 [Child G] had profound desaturation to 20%, marked colour loss with apnoea. Brady to 50s. Neopuffed in 100% oxygen, observations improved but [Child G] remained apnoeic. Drs arrived. Intermittenly breathing/apnoea.

    'Decision made to intubate. Moved to nursery 1...'

    Dr Ventress also noted Child G was planned to cannulate, with plan to administer fluids, but this was delayed due to the need to deliver another baby in the delivery room.

    Later, she noted: 'called out of theatre to say [Child G] had gone apnoeic and dusky. Dr called in...

    'On arrival sats 50% in oxygen. Receiving IPPV from nurse. Heart rate ok.

    'Pink and well perfused with mask CPAP....[Child G] then had another profound apnoea and heart rate down to 70, sats 40%.'

    The doctor adds Child G was then intubated, and 'IV vitamin K given due to blood from trachea'.

    Mr Johnson says this is another case where a baby is cleeding at the mouth.

    3.30am: Dr Stephen Brearey noted: 'Called in at 0330...large vomit and loose watery stool earlier followed by desat and brady. Intubated by Dr Ventress on my arrival. A small amount of blood visible on intubation. Blood samples taken and sent...'good gas post intubation'.

    At 3.45am:, Child G's parents were notified by the former designated nurse.

    3.59am: The blood sample for Child G is taken at 3.59am.

    4am: Lucy Letby records observations, a fluid balance and an intensive care chart for Child G at 4am.

    The observations have gone, the the court hears, from every three hours, to every one hour.

    A blood gas record is shown for Child G, from August 14 to September 7. Lucy Letby has signed for the last of those records.

    4.49am: An x-ray of Child G is taken at 4.49am. Consultant radiologist Dr Amer Rehman records, for the abdomen, 'generally slightly distended bowel loops, but gas noted in rectum, no transition point, mural or free gas detected on balance'.
    5.15amLucy Letby and Alisa Simpson are co-signers for medications for Child G at 5.15am,
    5.30am: and for a neonatal infusion prescription at 5.30am.

    5.30am: Dr Alison Ventress notes, for 5.30am, 'approx 0530 had another profound desat, hr down ton 60 and sats to 40%. Taken off vent and IPPV neopuff via ETT.

    'Recovered slowly but desat when back on vent ? ventilator problem so flow sensor changed + then whole ventilator changed'.

    Dr Brearey also records Dr Ventress changed the ETT with 'less leak'.

    Child G had 'one further brady and poor perfusion.'

    Child G was sedated and 'will need discussion with Arrowe Park Hospital/Liverpool Women's Hospital'.

    The parents were kept informed, the note adds.
    6.05am: Dr Ventress notes, from 6.05am - 'profound desat to 40% + HR down to 80. Decision to reintubate. IPPV given via ETT initiall. Heart rate 120 but sats remained 50% [despite increase in oxygen]

    6.10am: 'ETT removed at 6.10am. Thick secretions ++ in mouth. Blood clot at end of ETT. IPPV via facemask given

    'NG aspirated as abdo appeared v large ~100mls aspirated.

    6.15am: 'Reintubated 0615 ETT with intubation drugs. Blood-stained fluid in oropharynx.

    'Capnograph positive.'

    The plan was to continue a series of medication, plus morphine, and keep parents updated.
    Lucy Letby noted: 'Reintubated at 0615 with intubation drugs...clear air entry and bilateral chest movement. Blood gases as charted...10% glucose commenced. Morphine running...[Child G] agitated and fighting ventilator. [Medication given]. Now synchronising well.'
    Medication is administered, with Lucy Letby being a co-signer along with Alisa Simpson.

    6.36am: Dr Rehman has a further x-ray report at 6.36am, comparing observations with the previous x-ray. Among his observations, he notes: 'Lungs with slightly improved appearances, probably reflecting improved inspiration.'
    7.49am: The former designated nurse are written retrospectively at 7.49am.

    For the night '[Child G] was being nursed in a Kanbed with moniroting...

    'Feeds 180ml/kg 3x8 ebm with fortifier and Gaviscon via alternate bottle/NGT. Abdomen full but soft with no discolouration. Aspirates minimal, partial digested milk. Passed urine and bowels open++. Short period of straining/uncomfortable at start of night when having cuddles with dad. Dr Ventress aware.'

    The note adds care was transferred to Lucy Letby following Child G's large milky vomit just after 2am.

    The nurse adds, for family communication 'dad present for early part of night shift, had cuddles with [Child G]. Parents called by me approx 3.45am...arrived shortly after'.
    The care of Child G was then handed over to another designated nurse for the day shift on September 7.

    8.57am: Letby had written a note, retrospectively at 8.57am, recording what happened during the night shift: 'Abdomen appears less distended and soft. Bowels opened large green watery stool at 0300. Urine output...NG tube on free drainage...

    'Blood noted beyoned vocal cords during intubation.

    '[Child G] having frequent profound desaturations on ventilator, requiring neopuff with high pressures and 100% oxygen, takes several minutes to recover.'
    9am: Dr David Harkness, in a clinical note at 9am, records Child G was 'paralysed and sedated, well perfused. [Abdomen] soft...

    'Plan...discuss with tertiary centre [ie Arrowe Park/Liverpool Women's]'

    9.15am: Letby, at 9.15am: 'Parents attended the unit and have been fully updated...by myself, Reg Ventress and consultant Brearer. Anxious but understand need for ventilation.'

    10am: At 10am, Dr Harkness noted Child G's colour had 'improved'.
    Lucy Letby sends a text message to a colleague in relation to the care of a different child on the neonatal unit from the previous night at 10.46am.
    3pm: A longline is inserted into Child G at 3pm.
    3.30pm: Dr Ravi Jayaram's clinical note at 3.30pm - 'spoke with consultant neonatalogist at Arrowe. Agrees current managemnt plan.'

    Child G's observations are noted, with 'cool hands and feet', 'abdomen - distended but soft'.

    The blood gases had raised metabolic acidosis.

    4.30pm: A doctor's note at 4.30pm says Child G required a 2nd longline, and Child G 'remained unwell'.

    8.13pm: The day-shift designated nurse's notes include 'during [morning] handover required x2 eposdes of neopuff. Ventilation increased...

    'BP deteriorated and cannula site became white. Moved to another cannula. BP again imrpoved. Drs trying to otain longline for better access...

    'Chest clear and [blood gases] continue to be metabolic acidosis...

    'Minimal urine output all day.'

    8.51pm: The family communication says 'Parents on unit throughout day and updated. Aware that BP is too low and IV access difficult. Understandable very upset and struggling to see her this poorly again.

    'Have looked at 100-day cake, are trying to remain positive at this time...'

    Medication for Child G continues into the night of September 7.

    9.45pm: A consultant paediatrician said at 9.45pm, '[Arrowe Park Hospital consultant says] they are happy to accept [Child G there] - he will discuss with transport team.'

    10.08pm: The call to the Arrowe Park transport team is made at 10.08pm.
    10.43pm: The ambulance is booked at 10.43pm.

    At 11pm:, further observations are made for Child G.

    11.35pm: Nurse Belinda Simcock records, at 11.35pm, a series of observations for child G, which include longlines, morphine administered and antibiotics.

    The note adds 'infant to be transferred to Arrowe awaiting transport team'.

    8th September 2015
    12am:
    The transfer team arrived at the Countess of Chester Hospital at midnight.

    A consultant paediatrician's clinical notes record Child G was still 'very sick', the court hears, despite the series of medications throughout the day.

    1am: More observations are made for Child G at 1am.

    At 1.05am on September 8, the transfer team noted Child G's abdomen was 'full and veiny'.

    Text messages (1)


    During the course of September 7, a number of text messages were exchanged between Lucy Letby and her colleagues.

    One conversation began at 1.33pm from Jennifer Jones-Key, who messaged Letby: "How you doing x"

    Letby replied: "Had rubbish nights. x"

    Jones-Key: "Yeah gathered. x"

    Letby: "Thought someone would have told you x

    "Nothing else to say really, just hope they are both ok"

    Jones-Key: "Don't know ins and outs as tried to avoid it, needed a break. Found Thursday horrendous, not really slept since then. Hope you're ok"

    Letby: "That is understandable, won't tell you anything."

    The conversation then turned to Letby asking which of the team had informed Jennifer Jones-Key about the events of the night-shift for September 6-7. After a few guesses, the name 'Ali', in the messages, is said to be correct.

    Jones-Key: "Ali. She not having a good time x"

    Letby: "No, I know. It's been awful for her but she's coped with it brilliantly and got back-up when needed etc x"

    Jones-Key: "Yeah I don't know how she's done it. She was fab on Thursday..."

    The daytime designated nurse for Child G is in a text cnversation with Lucy Letby for much of the afternoon on September 7, the court is told.

    Much of the conversation relates to the condition of Child G, although messages are also exchanged in which the designated nurse is 'venting' about a number of colleagues, adding she was going to buy some sweets and eat them all to herself. Letby responded: "Absolutely, don't share", followed by an emoji of a face with its tongue sticking out.

    The nurse added Child G's parents were "devastated but determined...thought that if she got to 100 [days] they could feel confident she would be fine."

    Letby responded that, at the start of that night shift, the team had been sat at a desk "preparing a banner [for Child G's 100-day milestone]."

    The nurse responded: "Yep. [Colleague] brought her cake in."

    Later in the afternoon, the nurse messaged Letby that Child G's condition was still very poor.

    Letby responds: "any idea what's caused in [sic]?"

    The nurse responds, at 6.06pm, "Nope. Just seems to be a circulation collapse. Chest sounds clear."

    Letby: "Hmm, what can cause that.

    "Is it that she is an extreme premature who had long-term inotrope and vent dependency and now she is older and doing more for herself...it just takes a little...something to tip her over."

    The nurse responds: "We are going with sepsis..."

    Child G was noted to be looking "grim".

    Letby had seen Child G that night on September 7, messaging the nurse at 10.56pm to say the baby girl "looks awful, doesn't she".

    The nurse responds: "Yeah, going to APH [Arrowe Park Hospital]. On triple antibiotics."

    Letby relays a blood gas reading for Child G to the nurse.

    The nurse responds: "So no better. Damn" adding: "I have a bad feeling."

    Letby messaged: "But at least going to where she is known."

    "Just hope they get her there."

    The nurse replies: "Hmmmmm not sure they will."

    Letby: "On today of all days."

    Letby added Child G was "declining bit by bit".

    1.30am: Belinda Simcock records nursing notes for 1.30am and 1.40am on September 8, written in retrospect at 5.19am.

    The 1.40am note reads - 'Suctioned-nil from ETT, moderate amount thick white secretions obtained orally.'

    An increase in the dose of adrenaline is made for Child G.

    2.35am: The transport team handover is formally made at 2.35am.

    3am: Child G leaves the Countess of Chester Hospital in an ambulance at 3am, to be transferred to Arrowe Park Hospital.

    Belinda Simcock's note records that the parents were kept informed of the developments.

    Text messages (2)


    Alisa Simpson later messages Lucy Letby to say: "Hi Lucy. Just to let you know that [Child G] has successfully been transferred out at 3am athis morning to APH. She is stable and latest CBG [capilliary blood gas] has improved! Fingers crossed for her!"

    Letby responds: "That is good news. Thanks for letting me know"

    8th-16th September
    Child G was then treated at Arrowe Park Hospital between September 8 and September 16, 2015, before returning to the Countess of Chester Hospital.

    After Child G fell ill, she was transferred to Arrowe Park Hospital where she recovered over a number of days. On 16 September she was transferred back to the Countess of Chester.

    21st September 2015
    9am:
    Five days later – when Child G was originally due to be born – Letby recorded that she gave her a feed of breast milk through the NGT. The infant was asleep at the time at about 9am and was due to receive immunisations later that day, jurors at Manchester Crown Court were told.

    10.15am: She went on to note at 10.15am there were “two large projectile milky vomits” before Child G stopped breathing, her oxygen levels plummeted and she lost colour.

    Child G’s mother had arrived at the unit shortly after 10am and was later updated about her daughter’s deterioration and recovery.

    Text messages (3)


    PM:
    Following completion of her shift Letby messaged a colleague in the evening to say: “(Child G) poorly again.

    “Due date today!”

    Her colleague, who cannot be identified for legal reasons, responded: “Oh she likes to ‘celebrate’ the big ones in style (sadface).”

    Letby replied: Due imms (immunisations) today too. I got her screened this morning after she vomited.”

    Her colleague said: “Was she still in (nursery) 4 then?”

    Letby said: “Yup and had NN (nursery nurse) all weekend … looked rubbish when I took over this morning, then she vomited at 9 and I got her screened.”

    The colleague said “See. It really worries me. I wasn’t on when she was moved but wouldn’t have done it myself.”

    Letby replied: “I personally felt it was a big jump considering how sick she was just a week ago. Being in 4 is bad enough and then having NN that just doesn’t always know what to look for/act on. Mum said she hasn’t been herself for a couple of days.”

    The colleague said: “F***. I wish she’d told a registered nurse.”

    Letby said: “It’s hard isn’t it. When mum came in today she was like oh I’m so pleased you’ve got her which I thought was a little strange as I don’t know her that well but wonder if she just felt reassured to have a nurse.”

    Staffing charts


    The court is now shown a chart illustrating the neonatal unit's staff duties and who recorded/administrated what for September 6-7, 2015.

    At a point between 2am and 3.30am, a different nurse takes over the care for what had been Lucy Letby's designated baby for that night shift.

    The final chart shows Child G was moved from nursery room 2 to room 1 at 3.15am. One other baby was moved from room 1 to room 2 at 3.30am.




    Witness Statements Agreed

    Family - Mother


    Philip Astbury is now reading the relevant parts of Child G's parents. The court hears this agreed evidence, and is not contested.

    The first statement is Child G's mother.

    "Things went ok" with the Pregnancy until week 22, when she started bleeding. She was taken to hospital for checks.

    At week 23, she was taken to Arrowe Park, as her waters had broken and she was having stomach aches.

    She said she was struggling to sleep and went to the bathroom - she then gave birth to Child G.

    She said she rang for the emergency, but it wasn't working. Someone in the next door heard, and went for help.

    She said to medical staff: "Save [Child G]."

    "She was only 1lb 2oz, a tiny little fighter.

    "During our time at Arrowe Park, she showed doctors she was a fighter. She made good progress."

    After a change of several cots, and at seven weeks, Child G was moved to the high-dependency unit and available for skin-to-skin contact.

    By 12 weeks old - she was 'so well' she could go to Chester.

    Child G turned 100 days old and Lucy Letby was looking after her that day.

    "When we got to the hospital, she was in intensive care...it was such a shock and it looked like she was going to die."

    Child G was taken back to Arrowe Park for nine days, before returning to Chester in the HDU.

    Child G got sick again, and had to return to the intensive care unit.

    She "looked different" - and after brain scans, it was said she would just be 'a little clumsy'.

    The mum adds she had gone to get a coffee and when she went back to the high-dependency unit, Child G was "freaking out". Lucy Letby was there with another nurse.

    She said she told them she wanted to hold Child G as that would calm her down, and did so.

    Child G went to the intensive treatment unit that day.

    There were three times, she aid, Child G was transferred to the ITU.

    She said she would always ring the hospital twice a day - once at 6am and one at 7-8pm; the latter to find out who would be looking after the baby girl that night.

    During the day, she would stay with Child G at the hospital.

    When Child G came home in November 2015, at 156 days old, she had been left with quadraplegic cerebral palsy and was visually impaired, and was being fed by stomach, and nil by mouth.

    In a second statement, she said she was asked about the feeding of Child G, and how she had been taught to feed her baby daughter via a syringe, in a way she did not receive too much milk too quickly.

    She said sometimes she would be allowed to feed via the syringe, but Lucy Letby "always held the syringe" during feeding time.


    Family - Father


    A statement from Child G's father is read out to the court.

    He said there had been concerns at week 9 of the pregnancy when the mother began bleeding, and they feared there might be a miscarriage. The mother was taken to the Countess of Chester Hospital where the baby was seen to be doing fine in a scan, and the mother stayed there until the bleeding stopped.

    The mother began bleeding again later in the pregnancy and was transferred to Arrowe Park Hospital by ambulance. The father drove himself to the hospital.

    He left the mother at the hospital at 8-9pm, and later received a phone call to say the mother had gone into labour and given birth.

    He said he jumped into the car and drove to the hospital. Child G was 'stable' and the parents went to see her in the ITU. The mother had to be wheeled in.

    The father says Child G was not due to give birth until September 21 and had "only a 5% chance of survival".

    The father said Child G was "no bigger than your hand..[she] looked like a tiny person."

    Child G was kept in for 11 weeks at Arrowe Park and although "they thought she was going to die", with her having "ups and downs" and underdeveloped lungs, she was "much more stable after a couple of weeks".

    He said he only picked her up for the first time when she weighed 2lb, "as she was so small".

    Child G had 'regular ultrasounds' to check for brain development, which showed no brain bleeds, and all scans showed "she was normal".

    She was "stable enough" to be transferred to the Countess of Chester Hospital, in the HDU.

    When there, the mother would ring twice a day, and stay at the neonatal unit during the day. The father said he would collect the mother at 5.30pm, they would go home for tea, then he would go back to the hospital until about 10-11pm.

    He says he never saw anything in that time where a doctor or nurse was acting unprofessionally, nor did he have any concerns. There were "no problems" until Child G was 100 days old.

    The father said on day 99, Child G required a low amount of oxygen for breathing assistance, had been fed and was "settled; she was fine when I left".

    The parents got a phone call in the early hours of September 7 from a nurse to say Child G had vomited and aspirated. The nurse said there was "no need to rush", but the parents went to hospital "immediately".

    When the parents arrived, they found a banner to celebrate Child G's 100 days had been made, and Child G was onto a ventilator in the ITU.

    Child G was "just about stable", and they were told she had "projectile vomited".

    This, the father said, Child G had "never done before", although she has done since, "several times". Child G was transferred to Arrowe Park Hospital in the early hours of September 8, and due to the time of admission, the parents stayed in the parents room.

    After a couple of days at Arrowe Park Hospital, Child G was weaned off oxygen completely, which exceeded the expectations of the parents.

    However, the father said, he "noticed something had changed about [Child G]."

    He said while, prior to Child G's projectile vomiting incident, he would speak to her and she would smile in response. After the incident, he would speak to her, but she would not smile in response.

    Child G was transferred back to the Countess of Chester Hospital and the father asked if there was a virus at the hospital, as another baby in the unit [Child I] was also poorly.

    He said a consultant assured him "there was no virus" and "nothing wrong with the ward".

    On a few occasions, Child G had to go back to the HDU, having appeared as if she was almost ready to leave when placed in nursery room 4.

    On one occasion, he recalled the nursing staff were trying to recannulate Child G to give antibiotics, and the mum said to them "Let me hold her", and after she did, Child g calmed down.

    "It seemed that every time she moved [to nursery room 4], something happened and she would be moved back to the HDU."

    When Child G came home in November 2015, she weighed 5lb.

    She remained stable at 18 months and 24 months, but "missed milestones".

    At the age of two-and-a-half, she had an MRI, and it was only then that the parents "realised the true extent of her brain damage".

    Child G required treatment at Alder hey Hospital and required numerous ventilations throughout 2018.

    She was, at the time of the father's statement to police, 'nil by mouth', but was less prone to chest infections.

    The Countess of Chester Hospital continued to treat Child G, who had quadraplegic cerebral palsy, Level 5 cerebral palsy which meant she would go "really stiff" and stop breathing.

    The first time it happened, the parents believed she was having a tantrum, until they realised the lack of breathing was involuntary.

    Child G was visually impaired and also being treated for microcephaly, where the head is smaller than it should usually be.

    "We don't know what her life expectancy is," the father added.

    Nurse - unnamed (2)


    On Tuesday, jurors at Manchester Crown Court were read a statement from a nurse who took over Child G’s care at the end of Letby’s night shift.

    The nurse, who cannot be identified for legal reasons, stated: “I remember (Child G) being very poorly that day which surprised me and the staff because prior to September 7 (Child G) was very stable.”

    She said Child G had been “feeding and growing” in the outside nursery rooms of the unit following her transfer from Wirral’s Arrowe Park Hospital.

    The nurse said she remembered September 7 because Child G was 100 days old and that was a regular milestone marked in which a staff member would bake a cake for a child, with balloons placed around the bedside.

    She went on: “Lucy told me (Child G) had vomited while under the care of (another nurse) and then became unwell.

    “She told me she had taken over as designated nurse because (the other nurse) did not have her intensive care course qualification.”

    Referring to her medical notes, she said Child G had “blood pressure issues” throughout the day and required several infusions plus more antibiotics.

    Her observations showed a raised heart rate, the court heard, and the nurse also noted Child G was pale and cold.

    The nurse described Child G’s parents as a “loving, caring couple” who were “committed” to the wellbeing of their daughter.

    Noting both had been on the unit all day, she wrote: “Understandable very upset and struggling to see her this poorly again. Have looked at 100 day cake and trying to remain positive at this stage.”

    Engineer Stuart Eccles


    Taken from Dan O’Donohue live Twitter reporting

    Court has just been read a statement from Countess of Chester medical engineer Stuart Eccles. This was on the ventilation equipment at the hospital. Yesterday we heard doctors believed there could have been a problem with a machine as Child G was struggling to breath

    Service records show that there was no such issues reported on 7 September 2015. He said the machines on the unit were 'very reliable'

    Witness evidence

    Dr Alison Ventress


    Dr Alison Ventress is now recalled to give evidence.

    She said she recalls "very little" from the night shift at September 6-7.

    She says she did not see Child G vomiting that night.

    She tells the court Child G 'looked better' and appeared more stable, so did not refer the matter to consultants, and was called away for the delivery of another pre-term baby.

    She says she did not believe she would have been away from the neonatal unit for too long. If she believed so, she would have notified a consultant.

    The court believes she was away from the room for about half an hour.

    Dr Ventress was then called back to the neonatal unit, and observed the saturation levels were 50%, which were 'low - they should be above 90%'.

    Child G was 'pink and well perfused' following efforts to assist her breathing, and moving her to room 1. Her saturation levels took 5 minutes to move up, but this was not seen as unusual.

    Child G then had 'another profound apnoea', which Dr Ventress said would '99% sure' have happened in her presence.

    The heart rate had dropped to 70, saturation levels to 40%, perfusion had dropped.

    Breathing assistance was administered and there was a 'gradual improvement'. Saturations increased and perfusion improved, according to Dr Ventress's notes.

    She tells the court "We can't carry on in this situation" as Child G had suffered two profound desaturations in a short period of time, so it was necessary to intervene via intubation.

    Dr Ventress noted 'blood-stained fluid noted coming up from trachea/between cords' during intubation.

    Child G had 'good air entry'.

    There was a 'large leak' on the tube, but this was "not a concern" at this stage as there was good air entry.

    Vitamin K was administered to help with blood clotting, as blood had been seen.

    Dr Ventress tells the court: "She responded well to the treatment we had given her" at that stage.

    At 5.30am Child G had another profound desaturation, with heart rate down to 60bpm and saturation levels down to 40%.

    Child G would "recover slowly" each time from the desaturations.

    After being put on the ventilator, Child G desaturated once more, so Dr Ventress said she was wondering if the problem was with the ventilation equipment. The equipment is changed, but Child G has another desaturation event at 6.05am, with the heart rate falling to 80bpm and saturations to 40%.

    Dr Ventress said, following reintubation, the heart rate went up to 120 but the saturation levels remained at 50% despite increased oxygen support.

    The doctor said she would "probably" have been cotside for most of this time.

    The ETT is removed at 6.10am, with "thick secretions++ in mouth" and a blood clot at the end of the tube.

    Dr Ventress says breathing support is given via the mask and jaw support, but the saturations fell to 17%.

    Dr Brearey was called in "urgently".

    The naso-gastric tube was aspirated as the abdomen "appeared very large", with about 100mls aspirated. The saturations gradually improved after this.

    Dr Ventress says it is "quite common" for the tummy to get bigger with breathing support administered, and it was likely it was air was removed.

    Child G was reintubated with a mild anaesthetic at 6.15am, with 'blood-stained fluid in oropharynx' noted.

    Dr Ventress says the first observation of blood was in the windpipe, whereas this was more in the throat.

    Child G "responded well" to being intubated.

    X-rays at 4.48am and 6.36am had the comment for abdomen: 'generalised gaseous distention'.

    Cross Examination
    Ben Myers KC, for Letby's defence, is now asking Dr Ventress questions.

    Dr Ventress confirms she met Child G's parents when she was first admitted to the Countess of Chester Hospital.

    Mr Myers presents a 'neonatal discharge summary' for when Child G was discharged from Arrowe Park, with a summary of Child G's condition and problems.

    The main problems, Mr Myers, include 'chronic lung disease', 'extreme prematurity', 'sepsis suspected', and active problems include 'chronic lung disease - on CPAP' and 'establishing feeds'.

    He said chronic lung disease would be a 'persistent issue' for Child G.

    Dr Ventress said it would require breathing support such as CPAP.

    Mr Myers says a baby like Child G requires constant medical care and was at risk of infection. Dr Ventress agrees.

    He says that by the time Child G went back to Arrowe Park on September 8, it was believed it was "linked to infection".

    Mr Myers shows blood gas readings for Child G for September 4-5, with pH readings that are 'normal', but the carbon dioxide and bicarbonate readings are 'elevated'.

    Dr Ventress says that is common in premature babies with chronic lung disease.

    Dr Ventress agrees.

    Mr Myers asks if this was something which did not appear out of the ordinary.

    Dr Ventress agrees.

    Dr Ventress confirms she would have been, for the night shift of September 6-7, her duties would involve patients at the children's ward and neonatal unit. She says it would be "rare" if she would have to cover A&E as well. She would also be tasked with the post-natal unit as well.

    At the time of the 'urgent review' at 2.35am on Setptember 7, she said she would have been at the children's ward.

    She said, from her statement to police, she would have gone "straight away" to review Child G.
    Mr Myers asks that upon attending the unit, and informing the plan of action for Child G, was Dr Ventress then called away before she could carry out anything herself?

    Dr Ventress agrees.

    Mr Myers says it was for delivery of another pre-term baby.
    Dr Ventress's clinical note says Dr Ventress was called out of theatre to say [Child G] had gone apnoeic and dusky.

    Mr Myers refers to the note about 'blood-stained fluid noted coming up from trachea/between cords'.

    He asks if that was noted after intubation.

    Dr Ventress said it was during intubation.

    Mr Myers asks if it would be unusual to see that.

    Dr Ventress: "It's not uncommon for the baby to [have bleeding during intubation] - it is unusual to have blood coming up from beneath the vocal cords."

    Mr Myers says would the blood-stained fluid be blood mixed with some secretion?

    Dr Ventress says she cannot quantify what the fluid was, but it was "not pure blood".

    Mr Myers says if there was any issue with blood intervening with the procedure. Dr Ventress says there was not.

    Nurse - unnamed (1)


    The colleague, who cannot be named for legal reasons, said the baby's observations were stable when she left the high dependency unit after feeding her 45ml breast milk via the NGT.

    On her return, the youngster was not in the room and had been moved to the intensive care unit as fellow staff gathered around her cot, she said.

    She told Manchester Crown Court: "If I was concerned, I wouldn't have gone on my break. For example, if she looked unwell, or her monitor was alarming, or if she hadn't tolerated her feed, or woke up upset.

    "I was told she had been unwell while I had gone on my break."

    Simon Driver, prosecuting, asked: "Was that development expected or unexpected?"

    She replied: "It was unexpected."

    Mr Driver asked: "Why?"

    The witness said: "Because she was fed and settled when I left her and there had not been any observations on her chart which caused me any concern."

    Jurors have been told Letby went on to take over the care of Child G, who deteriorated later in the shift as her oxygen levels dipped and her breathing stopped periodically.
    Cross Examination
    The witness told Ben Myers KC, defending, she was not trained in intensive care so her duties on the night would have been appropriately passed to Letby.

    Shift Leader Ailsa Simpson


    Shift leader Ailsa Simpson said she was with Letby at the nursing station - directly opposite the high dependency unit - when she heard a projectile vomit at 2.15am.

    Both rushed into the room where Miss Simpson said she was greeted by alarms sounding from the monitor connected to Child G's cot.

    She said she "sat up" the youngster and that either she or Letby then used a facemask to assist with Child G's breathing.

    She said: "It was a large, milky digested vomit. It had gone from over the cot and on to a chair next to her."
    End of reporting

    Dr Stephen Brearey


    Dr Stephen Brearey is being called to give evidence in the case of Child G.
    Dr Brearey confirms he has reviewed his clinical notes from the time of the care for Child G, from August-September 2015.

    He said by the time of the ward round, Child G was improving, having been at the Countess of Chester Hospital for a week [having been transferred from Arrowe Park Hospital], with main concerns being respiratory support.

    He recalls prescribing medication to help with Child G's bowels.

    On September 2, on the second ward round, there was a "pattern of improvement" and "everything was moving in the right direction".

    Dr Brearey's clinical note for 11am at Sunday, September 6, 2015, is presented to the court. He was the consultant for that weekend and carried out a check of Child G as part of a routine ward round.

    Child G was 97 days old at this point. she had been born at a gestational term of 23 weeks and six days.

    She was receiving feeds, including expressed breast milk, via the naso-gastric tube and bottles.

    "Clearly she was making progress with that...and her oxygen requirement was coming down."

    The court hears Child G was 'quite stable' at this point.
    Child G was 'still a little under' her target weight by this stage, at 1.985kg, but this was "normal" for pre-term babies.

    Child G was on Gaviscon medication to help with the stomach lining, and other medication to help lower oxygen support requirements.

    Child G's gut was "clearly working normal", the chest was 'clear' and the abdomen 'soft'.

    Child G was considered to be at high risk of a chronic lung condition, as would be the case with many pre-term babies, and the plan would have been for monthly check-ups and a vaccine to help treat this.
    Dr Brearey then confirms he was called in, as the on-call consultant, at about 3.30am on September 7.

    Dr Alison Ventress had called him in, and was in the process of intubating Child G upon Dr Breary's arrival.

    Dr Ventress noted Child G: "Had very laerge projectile vomit (reaching chair next to cot and canopy). Abdo[men] appeared discoloured purple and distended."

    Dr Brearey said he had not witnessed this sort of projectile vomiting before, in a pre-term baby "who has been stable for so long", without a suitable diagnosis of a condition which could cause projectile vomiting.

    Child G deteriorated and Dr Ventress intubated the baby girl.

    Dr Brearey confirms he was called in from home.
    He said Child G initially appeared she had stabilised after intubation, with 'normal' gas reading.

    He was then called to the pre-term delivery that Dr Ventress had been called away to, for a delivery at 4am.

    He said he was satisfied Dr Ventress had the situation under control, and there were satisfactory readings, so was called over to the delivery.

    The blood gas reading was, on Dr Ventress's note, 'good', 30 minutes after intubation.

    The ventilation status was also 'satisfactory'.
    At 5.30am, Child G had a profound desaturation.

    "Her heart rate dropped to 60[bpm] and her oxygen [saturation] to 40% - which is unusual" when Child G was on a ventilator.

    Dr Ventress wondered if the problem was the ventilation equipment, so moved to manual breathing support via a Neopuff device.

    Child G was then reattached to a ventilator, before the ventilator was changed.

    A 'large leak' remained, which meant the issue was unlikely to be with the ventilator.

    The 'large leak', Dr Brearey says, he cannot explain, for a pre-term baby.

    He says Dr Ventress was getting chest movement from Child G on the Neopuff device.

    "It's perplexing and I can't think of a natural cause why that would happen."
    Child G had another profound desaturation at 6.05am and the decision was made to reintubate her.

    The heart rate increased but the oxygen saturation levels remained low, despite further breathing support, with 100% oxygen ventilation and increased respiratory pressure.

    Those levels were "low" in the context of those support measures being applied, Dr Brearey says.

    'Thick secretions ++ in mouth' were noted, with a blood clot at the end of the ETT.

    The oxygen saturation levels fell to 17%, with the heart rate down to 70bpm, and 'poor chest movement'.

    Dr Brearey tells the court a heart rate under 100bpm was cause for concern.

    He was called in urgently, the clinical note adds.

    The naso-gastric tube was aspirated and 100mls was aspirated from Child G.

    "This seemed surprising" as Child G had been fed 45mls every three hours, and Child G "had already had a large vomit which covered the cot and the area around the cot".

    "It seems abnormal and I can't explain where that [aspirate] would have come from."
    The plan was to paralyse Child G, via a medication bolus, to allow for better ventilation, and to repeat a blood gas reading, and continue with morphine for sedation.

    Child G was 'nil by mouth' and IV fluids were to be given. Standard medicine to treat neonatal sepsis was also to be administered.

    The parents were 'about to be updated'.

    Dr Brearey said at the time they were not sure whether there was a problem with Child G's gut, given the large aspirate and large vomit, which was why the baby girl was 'nil by mouth'.

    An x-ray taken showed lungs of 'chronic lung disease', which was "known previously" and would not explain what had happened that night.

    The abdomen had 'generalised gaseous distention' - "but nothing which would indicate obstruction", and nothing which would indicate NEC, a gastro-intestinal disease.
    A note from Dr Brearey recorded, for the abdomen x-ray - 'gaseous abdomen, no perforation'.

    Dr Brearey's note adds, at 5.30am, 'compensated metabolic acidosis'.

    Dr Brearey says this is an 'error on my part', given the pH readings, from a 'long night'.

    The note concludes Child G's case 'will need discussion with Arrowe Park Hospital/Liverpool Women's Hospital' if her condition continued as it was.
    Dr Brearey tells the court Child G had an MRI scan following these events which "looked worse than previous scans". It was "still uncertain" what the long-term prognosis would have been since then, but since then Child G had developed dystonia, quadraplegic cerebral palsy, "as a result of brain damage in early life", which causes the muscles in the body to be stiff and have limited function.

    Child G required further feeding support mechanisms, so the food Child G has is less likely to aspirate [into other parts of the body] and be prone to chest infections.

    Child G was greatly dependent on the care of her parents. Dr Brearey adds: "I have great respect for everything they [the parents] have done for the last six/seven years."
    Cross Examination
    Ben Myers KC, for Letby's defence, is now asking Dr Brearey questions.

    Dr Brearey confirms he was the neonatal lead at the Countess of Chester Hospital for 2015-2016, and continued to hold that position until 2020.

    He said he would spend more time dealing with neonatal issues. Some of it would involve administration and management, but also development.

    Mr Myers says at the time of Child G's events, Dr Brearey believed infection was the most likely cause.

    Dr Brearey says his initial impression was that it was infection.
    Mr Myers says one of the problems was with oxygenation, and the ventilator was changed, but that did not resolve the problem with oxygenation. Dr Breary agrees.

    Mr Myers refers to the ETT being removed at 6.10am, which was 'the same tube' being used for both ventilators.

    When the tube was removed, the blood clot was found, and that could have had an impact on oxygen saturation levels.

    Dr Brearey said it would not block it completely. He adds the blood gas results prior to that would not show that to be the case.

    "It might have a small degree of influence," but he said it would not have a huge impact, and in his experience he had not come across such an event, given that pressures are involved in the tube.

    Mr Myers refers to the aspirates found - he asks if there is any reference to milk/fluid aspirates on the note. Dr Brearey confirms the type of aspirate is not shown.

    Mr Myers asks if Dr Brearey knew what the contents of that 100mls was.

    "The only other possibility if it is not stomach contents is if it's blood, and I certainly don't recall 100mls of blood."

    He said it would not be air, it would be recorded as fluid.

    He says the process of aspirating from the NGT, if it's just air, then that would be 'not significant and not recorded'.

    Mr Myers refers to Dr Ventress's recollection to court, that the '100mls' aspirated could have been air, although she was not 100 per cent sure, and if it was fluid, she would have recorded that.

    Dr Brearey said he wouldn't be 100 per cent, but if it was not air, that would be recorded.

    Mr Myers says the 100mls aspiration is not documented on Dr Brearey's note.

    Dr Brearey says in retrospect, he was concentrating on Child G's care, and it would have been easier, if knowing what was to come, to have recorded it on his notes.

    Prosecution
    The prosecution rise to clarify about the blood clot, saying if that blood clot had blocked the tube, would the equipment have detected that. Dr Brearey said the equipment would have given off an alarm.


    Dr David Harkness


    Dr David Harkness, who has previously given evidence during the trial, is being recalled to give evidence in the case of Child G.
    He "vaguely" recalls the care of Child G, mainly from refreshing his memory by looking at clinical notes taken at the time.

    He tells the court Child G was "quite stable" with a small amount of oxygen support, and the most amount of support was via feeding, but she was not far off going on to bottle feeds each time.

    The feeds were 'greater than normal' to help Child G gain weight, as she was, at 1.985kg, a little underweight, and it was so Child G could go home without requiring naso-gastric tube feeds.

    Dr Harkness confirms 'things were going in the right direction, generally', for Child G.
    For September 7, 2015, Dr Harkness notes the observations at the time of the event.

    He said he was on a day shift and was informed of the 'sudden desaturation' during the handover.

    He said sepsis 'was the most common' thing to think about whenever a baby has a desaturation, so Child G would have been treated for that.

    Chest x-rays were also a common test to carry out.
    The oxygen levels for Child G were "still dropping every now and then", with the heart dropping also, and she was "not doing particularly well with her breathing, despite being ventilated".

    During the daytime observation, the mean blood pressure for Child G was "low", despite being on medication to increase that, which Dr Harkness says was "worrying".

    Child G's heart rate was 200bpm, which was high, and the urine output was very low.

    The blood test taken for sepsis "was not an exact science"; the readings were "not alarming" but "difficult to take in isolation", the court hears.
    Among the 9am plan for Dr Harkness on his notes, was 'discuss with tertiary centre' - as Child G was "so unwell".

    A follow-up note from 10am showed Child G's blood pressure had risen to a normal level, a low carbon dioxide level, and the blood gas reading showed a high pH number of 7.646 and a high lactate number.

    The plan was to decrease the ventilation support and repeat the blood gas in 30 minutes.

    Dr Harkness says Child g was "incredibly sick", had stabilised by 10am, but still "incredibly sick and we were worried about her at that time".

    He says the situation had improved but Child G needed a lot of support and was "not out of the woods at that point".

    He said the blood test was inconclusive, and could not recall why aspirations was on his list, and there was nothing on his record that could 'conclusively' say it was sepsis or some other diagnosis.

    Cross Examination
    Mr Myers, for Letby's defence, asks Dr Harkness if he agrees that a sudden deterioration for Child G is 'not uncommon'.

    Dr Harkness says it is "very rare" in a stable, term baby.

    Mr Myers refers to Dr Harkness's statement to police in 2018, in which he said for September 7, 2015, at 9am: [Child G] had a deterioration - which is not uncommon'

    Dr Harkness says in his years of subsequent experience, he has seen considerably fewer sudden collapses.

    At the time of the statement in 2018, he had had seven years experience.

    He says as a point of generalisation, it was "not uncommon", but in term babies, it was 'uncommon', now he has had further years of experience and context.

    Mr Myers says in Dr Harkness's statement to police, the deterioration 'was no surprise to him' as it was relatively common, as there was a risk of infection in such babies.

    Dr Harkness says with further years, he has seen it "less and less", and would no longer hold that view.

    He says at the time, he felt it was relatively common, from his time in Chester.

    This next evidence was given on a separate day
    Dr David Harkness, who was a registrar at the Countess of Chester Hospital in 2015, is due to give evidence this morning. Will focus on the events of 21 September 2015. On that morning Child G had a second incident of projectile vomiting and that afternoon needed resuscitation

    Dr Harkness tells the court he was on a day shift on 21 September. He says he cannot remember, aside from using his notes, the events of that day

    Court is being shown notes from that day, which show there were seven attempts to cannulate Child G. Dr Harkness' colleague Dr John Gibbs told the court yesterday that in babies, such as Child G, that require a lot of intensive care there can be issues with cannulation

    Dr Harkness is recalling the cannulation of Child G at around 15:30 BST that day...he says he was assisting Dr Gibbs. He said he was there to pass equipment and keep baby still - jobs normally carried out by a nurse.

    Asked why a nurse did not assist, he said 'I expect nurses were very busy, but can't be specific why'

    Dr Harkness is now being asked if he remembers
    whether Child G was hooked up to a monitor. He says she was. He is asked if the sensor from the monitor was moved while attempting cannulation. He cannot remember

    He is asked if a sensor would ever be moved, he said it 'would occasionally be moved from one to limb to other'. He agrees it is important to keep a monitor on and attached. He says it is 'not safe' to turn such a monitor off

    Asked if he turned Child G's monitor off, he says 'I'm even sure I know how to turn off that particular monitor…at no point would I have turned it off'

    After the cannulation, Dr Harkness is asked whether he remembers having any conversations with anyone. He says he has a 'vague' recollection of speaking to a member of nursing staff
    Cross Examination
    Ben Myers KC, defending, put it to Dr Harkness that he and Dr Gibbs left Child G behind a screen, detached from the monitor, and had failed to inform nursing staff.

    Dr Harkness repeatedly says he 'can't remember'. On the monitor being switched off, he flatly says 'no'

    Ben Myers said: “You must know very well Dr Harkness that conversation took place?”

    Dr Harkness said: “I can’t remember.”

    Mr Myers said: “I suggest a detail like that is something you would not forget?”

    The doctor replied: “I disagree.”



    Nurse Christopher Booth




    Senior nurse Christopher Booth is now being called to give evidence. He was employed at the Countess of Chester Hospital in 2015, and would sometimes be employed as a shift leader in the neonatal unit.

    He confirms he recalls Child G was an "extremely premature baby" who was approaching her 100th day milestone.

    He said: "We knew her well, we knew her family well."

    He says Child G was making good progress and establishing feeds, sometimes via a naso-gastric tube and sometimes by bottle.

    Philip Astbury asks if there was anything Mr Booth can recall about the time approaching Child G's 100th day.

    He says it is a big milestone for babies on the unit.

    He tells the court: "We do make a big thing about it - it's an important event, we make banners for the family, one of the staff members brings in a cake for the family to celebrate."

    Mr Booth is shown the shift layout for the September 6-7 night shift, in which he was looking after a baby in one of the neonatal unit rooms that night.

    He recalls, from his memory and what he has read from his statement, a call being put out when Child G had a "sudden deterioration", and her "colour was poor", at 3-3.15am.

    He said he was not aware of the projectile vomiting incident earlier that night, and that was ascertained later.

    He said he was there to help in the resuscitation efforts, having been 'quite peripheral' in the incident.

    "A verbal call to seek assistance" was made at 3-3.15am. Mr Booth entered the nursery and saw Child G was being given breaths via a Neopuff device and oxygen support.

    He says Lucy Letby was there along with another nurse, and a senior house officer, and an urgent call for the consultant Alison Ventress was put out.

    'Rescue breaths' were being given to Child G. Mr Booth says he cannot recall who was administering these. He recalls after 10 minutes, it was "prudent" to move Child G into nursery room 1, which had more suitable equipment and was "more suitable" to treat "sicker babies".

    He tells the court he assisted in the transfer of Child G to room 1.

    He recalls he was aware of more apnoea episodes for Child G that night, but as he was happy with who was looking after Child G, he 'took a step back' from personal invovlement.

    He says Lucy Letby was among the dedicated nursing staff for Child G.

    Mr Myers KC, for Letby's defence, says he has no questions to ask of Christopher Booth.

    Nurse - unnamed (3)


    Taken from Dan O’Donohue live Twitter reporting.

    A former nursing colleague of Ms Letby, who cannot be named for legal reasons, is now in the witness box. She is recalling the events of 21 September

    Court told that Child G was cannulated, behind a screen, and placed on a Masimo monitor - a portable device attached to the patient by a sensor that continually measures oxygen saturations and heart rate levels.

    After the doctors had gone, but Child G was still screened, the nurse told the court that she heard Ms Letby shouting for help. She said she responded, Ms Letby was using neopuff on the infant - who 'did not look very well at all'

    She noticed that the monitor screen was black and had been switched off.

    The nurse said this was not normal procedure (for the monitor to be off)

    The nurse however has told the court that she asked to review her original statement to police last month - as she said she had seen in the prosecution opening that there was a suggestion Ms Letby had turned the monitor off - she said 'I knew that not to be the case'

    She tells the court that on 21 September two doctors came her to apologise, as they had left the screen in situ and not switched the monitor back on
    Cross Examination
    On Wednesday, she confirmed to Ben Myers KC, defending, that she spoke to detectives last month after reading the opening speeches online which suggested Letby had switched off the monitor.

    Mr Myers said: “From what happened you knew that was not the case?”

    The nurse replied: “As far as I’m aware I believe that was not the case.”

    She said two doctors, consultant Dr John Gibbs and registrar Dr David Harkness, approached her the same afternoon to apologise for leaving Child G behind the screen and for not turning the monitor back after completing the procedure.

    Mr Myers said: “I suggest Ms Letby was cross that the doctors had left her behind the screen with the monitor off?”

    The nurse said: “I don’t remember that.

    “I remember her being concerned.”

    Mr Myers said: “Do you recall she said this is something to make a formal complaint about?”

    The witness replied: “I don’t remember but I went to my manager to report it myself without anyone suggesting it.”

    Dr Peter Fielding


    Dr Peter Fielding, who was a senior house officer on the Countess of Chester neonatal unit in 2015, is now in the witness box

    The court is now being shown Dr Fielding's notes from the morning of 21 September when Child G fell ill. They start with a summary of the baby's health, notes she is premature and has chronic lung disease. Also notes medicines that she was on at the time.
    Cross Examination
    Dr Fielding, in questioning from Mr Myers, says he didn't witness the projectile vomiting incident and by the time he arrived on the unit Child G was 'recovering'

    Dr John Gibbs


    Dr John Gibbs, who was working as a consultant paediatrician at the Countess of Chester in 2015, is now in the witness box.

    Dr Gibbs tells the court he attended the neonatal unit and examined Child G after she had projectile vomited and her blood saturations fell to 30%.

    Dr Gibbs described that as a 'severe desaturation'

    Dr Gibbs said: 'It’s just unusual for a premature baby who had been feeding entirely satisfactorily since returning from Arrowe Park Hospital to be projectile vomiting'

    Dr Gibbs is recalling the difficulty of fitting a cannula on Child G on the afternoon of 21 September. He said given the level of intensive care she had had in her life, it was difficult to find a vein

    Dr Gibbs says he cannot remember what room or what type of cot Child G was in, he also cannot remember what he did after fitting the cannula (given this is seven years ago)

    Asked if she was attached to a monitor, he can't remember but says 'given her problems she should have been on monitoring yes'

    He says if a sensor from the monitor is taken off a baby's body part - in order to fit a canula - then it should be fitted to another body part. He says 'it shouldn't be left off'...he adds that there 'shouldn't be no monitoring at all'

    Asked what he did after the cannula was fitted, he says that he doesn't remember but he wouldn't have left Child G alone. He says he would have alerted a nurse on the unit. Asked if there was any subsequent conversations, he says he 'can't remember'

    Cross Examination
    Mr Myers is now questioning Dr Gibbs. He asks the medic whether gastro-oesophageal reflux, that Child G was suffering with, could cause projectile vomiting - he says 'possibly'

    Mr Myers is now asking about the monitor. He asks Dr Gibbs if the monitor is switched off during cannulation - he says 'it shouldn't be'....he adds that he can't remember what happened with Child G's monitor on 21 September

    Mr Myers said: “Later both you and Dr Harkness spoke to (the nurse) to apologise for that.

    “Now that happened, didn’t it?”

    Dr Gibbs replied: “I’m sorry but I don’t remember that.”

    Mr Myers said: “If you had left a baby unattended without the monitor on and it’s a matter you had to apologise for, you would remember that?”

    Dr Gibbs said: “I would expect so.”

    Mr Myers said: “If you had left a baby like this would it have concerned you?”

    “Yes,” said Dr Gibbs.

    Mr Myers went on: “If it was very busy and you were being overstretched across different parts of the hospital, if you had to leave in a rush for instance?”

    Dr Gibbs said: “That’s one reason I might not have had time to speak to a nurse like I should have done, but I can’t remember.”

    Mr Myers said: “You apologised that she had been left behind a screen unattended?”

    Dr Gibbs said: “If that is what (the nurse) says then that must have happened, I just don’t remember that.”

    Mr Myers said: “And left the monitor switched off?”

    Dr Gibbs said: “If that is what is she said then presumably that happened.”

    Nurse Caroline Bennion


    Senior nurse Caroline Bennion is now in the witness box.
    Ms Bennion is being cross examined by Mr Myers KC about her recollection of the events of 21 September. She is being taken back over the clinical notes from that day
    Ms Bennion says she does not have a recollection of 'who was doing what' at 15:30 that day (when Child G was cannulated)
    Ms Bennion agrees that as Child G was an extremely premature baby she 'did have the potential at any stage to deteriorate'

    Manager Eirian Powell


    Eirian Powell, who was the neonatal manager at the Countess of Chester in 2015, is now giving evidence. She is being asked about the events of 21 September. She tells the court she was due to give Child G her immunisations that day
    She says that there was 'some instability' with Child G's temperature and was told she 'wasn’t well enough at that time', so the immunisations were withheld
    Other than her immunisations, Ms Powell said she cannot remember any other issues reported to her with Child G

    Medical experts evidence

    Dr Dewi Evans


    Nicholas Johnson KC, for the prosecution, recalls medical expert Dr Dewi Evans to give evidence, for Child G.

    Mr Johnson reminds the jury this part of the case is for the first attempted murder charge on Child G (of three; the other two allegedly taking place on September 21, 2015).

    The court hears Dr Evans has written several reports in respect of this case, the most recent being in September 14, 2022.

    Mr Johnson refers to a report Dr Evans made in May 2018.

    Child G was born at Arrowe Park Hospital on May 31, 2015, and two weeks later was examined via a cranial ultrasound to identify if there was any bleeding on the brain.

    Dr Evans says this is carried out routinely, and the absence of any bleeding on the brain was a very encouraging sign.

    The court hears Child G had been born "exceptionally early".

    Dr Evans said in his report that gestational age of 23 weeks and six days was "at the limits of viability".

    Dr Evans explains the type of IV access that was given to very premature babies such as Child G.

    A follow-up ultrasound on June 30 showed no bleeding on the brain for child G, and was "very satisfactory", Dr Evans explains.

    Child G was transferred to the Countess of Chester Hospital in August 2015. At the time of her discharge, Dr Evans said she was "stable", with known chronic lung disease which required oxygen breathing support, and CPAP.

    Dr Evans: "It was the standard management of babies when they have chronic lung disease."
    For the first couple of weeks at the Countess, Child G required 28-31% oxygen.

    A follow-up ultrasound showed "nothing concerning", and Child G had normal observations, requiring medicines which were common for premature babies, such as Gaviscon and supplemental sodium and iron.

    "All was well and her oxygen saturation was 95% which was very satisfactory".

    Dr Evans says Child G's observations were "very satisfactory" at the Countess of Chester Hospital in early September 2015.

    Child G's condition was getting "even better" with oxygen breathing support being weaned off.

    The observation for the shift of September 6-7 is shown to the court.

    The respiration rate is 'normal', with readings normally marked, in the three-hourly observations up to 2am. He says he is not sure why the individual readings have a cross and circle marked for the hourly observations afterwards, but suspects that is because Child G was on ventilation support.

    The oxygen saturation readings are "very stable" up to 2am, with the baby girl's readings "as stable" as they were in previous days.

    A mixture of medications is recorded on the intensive care chart for 4am onwards.

    Dr Evans agrees that Child G was in a satisfactory condition, prior to the events of September 7, 2015.

    Dr Alison Ventress's notes from the early hours of September 7 are shown to the court, describing Child G's projectile vomit at 2.35am, purple and distended abdomen, and increased oxygen requirement. 'Red in face and purple all over'.

    Dr Ventress noted Child G had 'gone apnoeic and dusky', and upon additional breathing support, the oxygen saturation levels went up and the baby girl was taken to nursery room 1.

    A photo is shown to the court with black circles indicating where Child G's projectile vomit patches went. One patch is in the cot, another patch is on the floor, and another is on the seat of an adjacent chair.

    Mr Johnson continues to talk through the sequence of events, which Dr Evans confirms he has noted throughout his report.

    Dr Evans said in his report, for the 100mls aspirate taken from Child G, "It is not clear how much of the 100mls was milk, and how much was air".

    Mr Johnson asks about what happens if a baby's stomach is full.

    Dr Evans says if you give milk gravitationally, no more milk will go in, as the stomach is full.

    He says the baby is unlikely to absorb the final few millilitres of milk if the stomach capacity is, for example, 45ml, and the milk portion is 55ml. While the stomach could expand a little, the likelihood is the milk would drip out.

    Dr Evans describes there is a way of "forcing" more milk into the stomach via a syringe, which "you would never do" as it would forcibly distend the stomach.

    Dr Evans says he was looking for signs of an infection in the records, as it is one of the most common findings on a neonatal unit, so one is "always alert" to that possibility.

    From Child G's blood test at 3.59am on September 7, the findings were all considered "normal" and did not point to a sign of infection, the court hears.

    A subsequent blood gas reading, 10-12 hours later which contains 'CRP: 28' is "not particularly high" but is a sign of infection.

    The subsequent blood gas reading after that was indicative of infection, Dr Evans tells the court.

    Dr Evans says Child G, at birth, was "on the margins of survival", but it was the "skill of staff" at Arrowe Park which ensured her stabilisation.

    He says there were no signs Child G was unwell prior to her collapse on September 7. He says the only two considerations were the chronic lung condition, which was common and for which she was receiving treatment, and establishing feeds.

    "Considering her start in life, this was an extremely satisfactory state".

    Child G's weight of 1.985kg was a little low, but she was tolerating bottle feeds every other feed (with naso-gastric tube feeding on the other occasions).

    Dr Evans says Child G would likely have still required supplemental oxygen support once she went home.

    The photo showing where the projectile vomiting patches landed is shown to the court.

    Dr Evans says there are three black circles. The one in the cot indicates the baby was sick, which "would be worthy of note, but not unusual".

    The second one between the chair and cot, on the floor.

    "For a baby of 2kg to vomit that far is quite remarkable".

    Dr Evans says there is a condition which can cause projectile vomiting of that length, as had been mentioned earlier today by one of the doctors, but Child G showed no signs of having that condition.

    Dr Evans adds: "Even more astonishing is the vomit that ends up on the chair. That is several feet away.

    "I can't recall a baby vomiting on the floor. I can't recall a baby vomiting that distance. It was described quite correctly as extraordinary.

    "On top of that it was noted the abdomen was distended."Dr Evans said you cannot measure the volume of the vomit that had fallen.

    Lucy Letby's note for Child G - 'large projectile milky vomit at 2.15am. Continued to vomit++. 45mls milk obtained from NG tube with air++. Abdomen noted to be distended and discoloured.'

    Dr Evans said the 45mls aspirated was in addition to the vomit. 45mls of milk was administered by the feed.

    "There can only be one explanation - [Child G] had received far more milk down the NG Tube.

    "She may have also received a bolus of air from the feeding tube."

    Dr Evans says that would also cause the abdominal distention.

    He says the plunger end of the syringe was put over the end of the tube for the milk, which would have caused distention, then would have caused the baby distress, then "she would have vomited because of the gross distention".

    The condition which can cause projectile vomiting can be excluded, the court hears, as the vomiting would have continued until the baby would have been taken into theatre for surgery.

    Dr Evans says the muscles only 'go one way', and the only time this does not work is if the baby is compromised by something.

    "In this case the baby was compromised by receiving a large volume of milk to the stomach".

    In that instance, the stomach muscles contracted and that led to the vomit. He says the mechanism is similar to that seen in adults.

    He says if an adult drank a large volume of liquid too quickly, there is a chance they could vomit.

    Dr Evans says Child G's condition thereafter was "incredibly unstable", with "significant amount of oxygen deprivation" and bradycardia.

    "Getting [Child G] back to where she was before 2am was extremely challenging and difficult.

    "They managed to do so...but during that time she suffered prolonged oxygen desprivation...leading to irreversible brain damage."

    The doctor's note of 'blood at the back of the throat' is referred to.

    He said the bleeding was found at the initial resuscitation/intubation, and the significance of that was the baby did not have a bleeding disorder, so "therefore the bleeding present from the beginning from more or less the time [Child G] crashed."

    Dr Evans says this case has been seen before, "much worse", in Child E.

    The bleeding in this case was less, but still significant as it was "unexpected".

    Dr Evans stresses Child G's infection happened "after the collapse".

    Dr Evans says Child G's infection was 'CRP related', as those particular blood gas readings went from 'less than 1' to 'over 200' in the hours following her collapse.

    Dr Evans's report from 2021 is now being discussed. He was asked to consider whether an infection was the cause of the projectile vomiting.

    "With respect no, I consider the infection happened afterwards.

    "An infection would not cause a baby to vomit halfway across the nursery room."

    He also asks: "Where would the extra fluid come from?"

    He says Child G must have had "far more" than the allocated 45mls milk feed fed to her.

    Dr Evans is asked about Lucy Letby's explanation that babies can swallow a lot of air when they vomit.

    "Well, they don't." Dr Evans replies.

    He says excess air was administered to Child G, in addition to the milk.

    He adds a baby with an infection has never presented in this way.

    He also says a baby on a naso-gastric feed would not vomit. The NGT system would be set up, Dr Evans says, so the undigested milk would be aspirated prior to anotyher feed. If there is a lot of undigested milk, then caution would be taken before administering another feed.

    The pH would be measured before each feed to ensure the tip of the NGT is in the stomach, and not another orifice.

    On this occasion, a pH reading of four would indicate the presence of stomach acid, indicating the NGT was in the correct place, Dr Evans says.

    Dr Evans is asked to read out his further report, in which he says administering excess milk and/or air cannot be done "accidentally".

    The effect of the stomach being overfull, the diaphragm "cannot move up or down", meaning "the baby cannot receive air in its lungs", which leads to oxygen deprivation, loss of oxygen saturation, bradycardia, and collapse.

    Cross Examination
    Ben Myers KC, for Letby's defence, is now asking Dr Evans questions.

    He says Child G was 'born on the margins of survival', and Dr Evans agrees that is the case, having said so in his May 2018 report.

    Mr Myers says a lot of work was needed to get Child G stable. Dr Evans agrees.

    He says that, relative to where she began, she was a lot better.

    Mr Myers asks if she was still prone to infection. Dr Evans agrees.

    Mr Myers refers to Dr Evans, in his report, referring to Child G being treated "inapproporiately" at 2am on September 7, 2015.

    Mr Myers says that is worked on the basis that Child G's tummy would have been empty or almost empty at the time, as the nurse responsible would have aspirated Child G's stomach of all milk.

    Mr Myers says 'we now know' the stomach was not aspirated prior to 2am.

    Dr Evans says that was not the case, as the nurse had aspirated to get a pH reading.

    Mr Myers says the nurse had not aspirated the milk, as she would not have done so in a baby as young as Child G as a matter of procedure.

    Dr Evans: "No, this is too simple." He says milk is a neutral pH, so if the reading is '4', then that sample was indicative of acid in the stomach.

    Dr Evans says after the projectile vomiting, over three areas of a nursery, there was an aspiration of 45mls of milk.

    "There has to have been a significant amount of additional milk plus air to explain what happened to the little baby at two o'clock in the morning."

    Mr Myers refers to the report, saying a nurse empties the stomach contants through aspirates.

    Dr Evans: "The pH was 4 [in the stomach], 4 is acid."

    Mr Myers says Dr Evans is basing what he says upon having her stomach aspirated before the 2am feed.

    Dr Evans says there would have been no milk in Child G's stomach prior to the 2am feed, as the stomach was checked for pH.

    Dr Evans says he is "totally satisfied" with his opinion that Child G's stomach was empty prior to the 2am feed.

    The amount of vomit plus aspirate was "massive" and only had one explanation - "she had a huge amount of milk plus air".

    Mr Myers asks if Dr Evans is basing his opinion on Child G's stomach being emptied of milk just before the 2am feed. Dr Evans says he is.

    He says the nurse said she would not normally aspirate all the milk from a stomach [as in completely remove all trace].

    Mr Myers says, in the six reports, there is no mention of the plunger to the syringe as a method to force more milk in.

    Dr Evans agrees it is not in his reports, but he is telling him now.

    Mr Myers says 100ml of aspirate was withdrawn at 6.15am, but the quantities of liquid/air were not known. Mr Myers says Dr Alison Ventress said it was "probably air". Dr Evans agrees he heard that evidence.

    The clinical note for Child G on September 7, by Dr Ventress, is shown to the court.

    Mr Myers relays Dr Evans's note relating to excess fluid inhibiting diaphragm movement.

    Mr Myers: "In fact we know that the later collapse and desaturations came after [Child G] vomited [on the morning of September 7]."

    He says "that is distinct" as Child G had "settled" by that point.

    Dr Evans: "That is not correct, actually - she was in a very unstable condition."

    Dr Evans says there is 'hardly' an entry where Child G is stable for any significant period of time that morning.

    He says from the time of the vomiting, Child G "never fully stabilised".

    He says the medical staff would not have anticipated the oxygen deprivation being "very marked" and for a "more prolonged time than they would have realised", and that was no fault of the staff.

    He says Child G's condition was "an improvement" but she was "unstable", and had been "compromised from the point of vomiting".

    Dr Evans says it is difficult for medical staff to "provide a running commentary" when trying to save a little baby's life.

    The removal of vomit and 45ml aspirate had "got rid of the pressure" and would have led her to be "relatively better" - "and I use the words advisedly".

    He tells the court he is "very satisfied" with the explanation he has given.

    Mr Myers says the bleeding seen is "not even close" to the case seen with Child E.

    Dr Evans says it is in the same area.

    Mr Myers says to link it to Child E is to support the prosecution.

    Dr Evans says that is not the case, and if he did not have access to the other cases, he would have come to the same conclusion.

    He adds that Child G was, chronologically, was the first case he examined.

    Mr Myers says there is no evidence of trauma.

    Dr Evans says he does not know the cause, but seeing such bleeding was "incredibly concerning" and "worrying".

    Mr Myers asks if it was possible Child G had a small haemorrhage.

    Dr Evans says there would have been no reason for it. "No is the answer to that".

    He says the back of the throat is a small area, and the blood was noticed around there.

    Mr Myers says babies may vomit for many reasons. Dr Evans agrees.

    Mr Myers asks is 'forceful vomiting' can happen. Dr Evans says he is not familiar with the term in that context.

    Mr Myers says Dr Evans does not agree with Dr Ventress's evidence on projectile vomiting. Dr Evans says he only disagreed with infection being the cause of the projectile vomiting.

    Mr Myers asks if Child G projectile vomited with such force because she was unwell. Dr Evans disagrees, and asks where the extra fluid would have come from.

    Mr Myers: "We don't know [the quantity of vomit as it was not measured]."

    "No, but it's a lot of vomit."

    "We don't know how much, do we?"

    "It was...an awful lot of vomit."

    Gastro-oesophageal reflux can cause projectile vomiting, Mr Myers asks.

    Dr Evans says it can, but that was not mentioned as a diagnosis in the Arrowe Park Hospital discharge letter.

    It would not have caused the type of vomiting seen, Dr Evans tells the court.

    Mr Myers refers to the CRP readings for Child G, which had risen throughout September 7, and was "consistent with infection". Dr Evans agrees.

    Mr Myers says that could have been consistent with infection developing before the vomiting.

    "No, it cannot."

    Dr Evans says the CRP reading is raised at the time the infection presents.

    He says the majority of babies, a CRP reading is raised at the time of the infection being present.

    In this case, there were no other markers of infection prior to the vomiting.

    Mr Myers says there was a "large watery stool", to which Dr Evans says was not unusual.

    Mr Myers says there is no finding of aspiration pneumonia when Child G was taken back to Arrowe Park. Dr Evans says she does not believe she had that, but believes she had an infection which "probably kicked in" during the attempts to resuscitate her.

    Mr Myers says that does not rule out an infection being present prior to the vomiting.

    Dr Evans: "There is no clinical evidence to back up that hypothesis."

    He adds: "I don't deal with 'ifs', I deal with evidence."

    He says the charts show everything as they should be up to the point of the vomiting and desaturations.

    Prosecution
    Mr Johnson asks Dr Evans about the 'adding of a suggestion of a plunger being used' in the evidence, in the context of milk feeds.

    Dr Evans had referred to the forcible additional milk feed method, without the additional context of a plunger, in his May 2018 report. Dr Evans says the method can only be applied with the use of a plunger.

    Mr Johnson asks about the pH aspirate the nurse would have obtained, if the previous milk feed had not been digested/aspirated.

    Dr Evans said the aspirate would have looked like undigested milk and the pH reading would have been neutral - around 7.

    The feeding chart for September 5 is shown to the court, which Dr Evans says shows no vomiting, and no evidence of gastro-oesophageal reflux.

    He says gastro-oesophageal reflux does not happen out of nowhere.

    Dr Evans adds Child G was having normal bowel movements as well.

    Dr Evans says, for the feeding charts and observations prior to the vomiting, "this is as good as it gets", with "no red flags", and is "very satisfactory".

    ——

    Independent medical expert Dr Dewi Evans, who has given evidence previously, has been recalled to provide evidence in relation to Child G, for one of the two September 21, 2015 events, when Child G vomited and desaturated.

    Dr Evans is now explaining what he observed for the morning of September 21. He said the vomiting was "extremely worrying" and came with concern of the "life-threatening" desaturation levels.

    The court is shown Lucy Letby's nursing note from that morning 'At 10.15 x2 large projectile milky vomits, brief self resolving apnoea and desaturation to 35% with colour loss. NG tube aspirated'.

    Letby had given Child G a feed at 9am, the note recorded.

    The note also adds Child G's abdomen was 'soft' and 'distended'.

    A doctor's note for the incident records Child G 'was apnoeic for 6-10 seconds, went blue, sats down to 30%. Last feed 9am'.

    Dr Evans confirms he has seen these notes.

    Dr Evans said an important feature was the abdomen was larger and distended. He says that could be due to an abdomen full of milk, full of air, or a combination.

    He says that is despite the vomiting which would mean the contents of the stomach

    "This is a very significant, concerning issue", he adds, in combination with Child G's oxygen saturation levels dropping.

    Dr Evans said there was "one explanation", which was that Child G had been given "far more milk via the naso-gastric feed".

    Child G had been tolerating 40mls of milk, which would not explain "two large projectile vomits" plus "30mls of milk left in her stomach".

    Dr Evans says Child G received "lots more milk" which had resulted in the episode.

    He says it could have been milk, could have been air, or a combination of the two, but difficult to say what levels of each would have been administered.

    Cross Examination
    Ben Myers KC, for Letby's defence, is now asking Dr Evans questions about the September 21, 2015 incident.

    He says one of Dr Evans' earlier reports said there had not been evidence of a life-threatening event for September 21.

    Dr Evans said he "overlooked" it when looking through 4,000+ pages of evidence, which had included these nursing notes.

    Mr Myers is now asking about a nursing note by nurse Melanie Taylor on September 30, 2015, which Dr Evans identified.

    The note includes Child G had desaturations, with 'one profound desat/apnoea requiring position changed and oxygen this morning'.

    Dr Evans had recorded the observations required further looking at.

    Mr Myers returns to the September 21 incident, and says the 'projectile vomiting' is a cause for concern that Dr Evans identified.

    Mr Myers says the incident does not record the amount of vomit, or how far it travelled (unlike the September 7 incident).

    Dr Evans said it was not a 'self-resolving' incident, and it was significant that Child G vomited twice, and stopped breathing.

    He said it was "a serious event", but not as serious as the one on September 7, 2015.

    Mr Myers says the incident was "brief".

    The court is shown a note from Dr Peter Fielding from September 21, 2015, in which the bowels were open and the stools were 'loose and green'.

    Mr Myers asks if this is a sign of Child G's overall poor health.

    Dr Evans says loose stools would be common in babies.

    Mr Myers asks if there was a more marked history of Child G vomiting upon her return from Arrowe Park in September 16, 2015. Dr Evans said the events of September 7 left her a "significantly changed baby", and agrees vomiting was more likely.

    Child G was then receiving feeding by tube.

    Mr Myers says there are "numerous" occasions of Child G vomiting from September 16, and the incident on September 21 followed a pattern.

    Dr Evans says he agrees due to "basic arithmetic", in that Child G still had 30mls of milk in the stomach after a 40mls milk feed and "two projectile vomits".

    Mr Myers says "we don't know" how much milk came up in those vomits. Dr Evans says the nursing notes are "pretty descriptive", and "no nurse" would describe two vomits as "5ml each", as that would amount to "a teaspoon each".

    It "had to be" more than 40mls milk feed at 9am, which would "also explain" the distended abdomen.

    The judge asks if there are any other entries of "projectile vomiting" recorded for Child G in the notes. Dr Evans says there is not.

    Dr Sandie Bohin


    Medical expert Dr Sandie Bohin is now being recalled to give evidence.

    Mr Johnson takes Dr Bohin through her reports, in which she said there was "no cause for concern" in Child G's condition at the Countess of Chester Hospital prior to September 7, 2015.

    Dr Bohin confirms Child G was given a 45ml milk feed via the naso-gastric tube at 2am on September 7, 2015.

    Mr Johnson refers to the subsequent sequence of events, and that Dr Bohin had recorded what had happened from the medical staff's notes and medical charts.

    Dr Bohin said Child G was, prior to the collapse, "very stable", with decreasing oxygen support required, and she was "managing very well" on that.

    "From a respiratory point of view, all was well".

    Child G was tolerating three-hourly feeds, and she was "progressing very well" for a pre-term baby.

    The observation chart prior to the 2am feed on September 7 was "completely normal".

    The episode of 'projectile vomiting' was 'concerning' as Dr Bohin said she had not seen babies, particularly those weighing 2kg, doing that.
    She found that "extraordinary".

    Dr Bohin said the milk must have come from somewhere, and the vomit has to go over the side of a deep-sided cot, on to the floor and the nearby chair "a considerable force has to be generated inside the abdomen".

    She says there must have been "much more than 45mls of milk inside the stomach."

    Mr Johnson asks if there is an 'innocent explanation' which could have explained the projectile vomiting.

    Dr Bohin says "no", as the stomach was empty, with a pH reading of 4. If there was milk in the stomach, it would have 'neutralised' the stomach and the pH reading would have been higher.

    "I think the stomach was empty, and she was given excess milk and possibly air...which distended the stomach."

    Dr Bohin is asked by police about Lucy Letby saying babies can 'take on a lot of air when vomiting'.

    Dr Bohin was asked if that was correct or not.

    Dr Bohin tells the court: "That's not correct. Babies do not take on air when they vomit."

    remainder of Dr Bohin’s evidence taken from Dan O’Donohue Twitter as no live reporting from Chester Standard

    Medical expert Dr Sandie Bohin is continuing to give evidence today. She tells the court that it was 'extraordinary' for a baby the size of Child G - she was 2kg - to vomit as far as she did.

    She said: 'She would have had to have exerted a huge amount of force to vomit over the side of the cot and onto the floor and chair…that's surprising given she was only 2kg'

    Dr Bohin is taking the court back through Child G's medical notes and spelling out the infant's early feeding history and how that developed. The notes show that through summer 2015 she was gradually improving

    Dr Bohin makes the point that medics were considering giving Child G immunisations around the time of her collapse. She said the baby 'must have been well and stable' as medics 'wouldn’t consider giving immunisations unless a baby is absolutely stable'

    On the incident of 7 September, Dr Bohin tells the court that Child G 'must at some point have been given an excessive amount of milk to projectile vomit and have a residual 45ml in stomach'

    Cross Examination
    Ben Myers KC, defending, is now questioning Dr Bohin. He is taking the court back over Child G's medical notes from June 2015. Dr Bohin agrees at this time the premature girl was as 'sick as you could possibly be'

    Mr Myers is looking notes that she had a discoloured abdomen. Dr Bohin says that at this stage the girl would have weighed just 500g and there would be no subcutaneous fat - so could see blood vessels (hence discolouration normal) riation normal)

    We're continuing to view notes on Child G from the first few weeks after her birth. They show she was on steroids (as she was having trouble with ventilation). Bleeding noticed at one point was put down to a 'probable pulmonary haemorrhage'

    Dr Bohin notes that Child G had a low platelet count, which could explain the bleeding. She says 'certainly in a baby this fragile' a pulmonary haemorrhage could be lethal - states if it was indeed such a haemorrhage it was 'very mild'

    Mr Myers is taking the court through a note from the end of July 2105 which showed a 'significant' desaturation before Child G was due to travel from Arrowe Park to the Countess of Chester.

    Dr Bohin agrees that the infant was not well at this stage, 'she was still very young, still very vulnerable and prone to all sorts of complications due to her prematurity'

    Mr Myers is making the point that, as an expert witness, Dr Bohin is allowed to hear all the evidence as it is presented to the court. She rejects suggestion that her conclusions have 'come from a dialogue with Dr Evans' (the other medical expert in this case)

    - -

    Dr Sandie Bohin is now being recalled to give evidence, for the case of Child G.

    Dr Bohin says Child G had been "tolerating well" up to September 21, and had "two large projectile vomits" after being given a 9am feed while asleep.

    Nicholas Johnson KC says Dr Bohin refers to a 6am, 45mls bottle feed of milk, and Lucy Letby records a 40mls naso-gastric tube feed of milk at 9am.

    Following the two large projectile vomits, 30mls of milk was aspirated from Child G.

    Dr Bohin says the event "just didn't add up" from the 40mls feed.

    She says the two projectile vomits would have been "more than a mouthful of milk" of 5-10mls each, and "basic arithmetic" meant that more than 40mls of milk would have been administered at 9am.

    Cross Examination
    Mr Myers KC is now asking questions.

    He asks Dr Bohin "we don't know" how much milk there was in Child G's stomach prior to the 9am feed.

    Dr Bohin says that is the case, but Child G had been tolerating feeds well.

    Dr Bohin says there is a difference between a posit (small vomit), a medium vomit and a large vomit.

    Mr Myers says "we don't have the basic figures, do we?"

    Dr Bohin says "we don't", but there are descriptions which nurses use to outline the quantities of vomit.

    Mr Myers says the incident was not on the same level of the September 7 incident.

    Dr Bohin disagrees, saying the incident was still serious. She agrees it "was not the same scale", as the events were "almost identical", even if the "repurcussions" of what followed were not as serious as that on September 7.

    Dr Bohin agrees that "vomiting became much more of a feature" for Child G upon her return from Arrowe Park Hospital, but says there were only records of projectile vomiting on September 7 and September 21.

    Mr Myers says from October 3-8, 2015, Dr Bohin had recorded Child G had '1-2 vomits each day, vary from small to large, and some after a nappy change'.

    A nursing note from October 8, shown to the court, records 'two large vomits' for Child G, and the feeding regime was changed as a result. On October 9, another nursing note records 'tolerating 3x8 [three feeds, eight hours apart] feeds well...x2 large digested milky vomits'. That is followed by another 'large vomit' on October 9.

    Dr Bohin says the difference with these vomits is they are not projectile vomiting and did not cause Child G "to be medically compromised".

    Mr Myers refers to an incident of "projectile and quite large in size" vomiting for Child G on October 15, 2015.

    Dr Bohin says he has looked through many documents and charts in this case, and may have overlooked that one incident of projectile vomiting.

    Mr Myers refers to other 'large vomits' on October 17 and October 22, the latter 'with wind following feed'.

    He refers to Child G's father's statement in which he said since September 7, he had seen Child G projectile vomit and covered the cot.

    Dr Bohin says "with the greatest of respect", parents can refer to "projectile vomiting" when they mean "vomiting".

    Professor Arthur Owens


    Taken from Dan O’Donohue Twitter 03/02/2023

    Consultant paediatric radiologist Owen Arthurs is first up in the witness box this morning. He's giving expert evidence on CT scans, X-rays and other images in this case

    Dr Arthurs is taking the court through radiographs, taken at Arrowe Park Hospital and the Countess of Chester, of Child G.

    Dr Arthurs says 'there isn’t anything specific' to suggest Child G was suffering from sepsis/NEC or any other infection. He said 'there's nothing on the X-rays that would really provide a diagnosis' for Child G's condition

    Police Interview Summary

    Nicholas Johnson KC is now relaying Letby's interviews with police. Letby recalls Child G and could not remember why she had taken over care of her.

    She said "sometimes babies vomit, but not very often is it a projectile vomit".

    She said she was not involved in Child G's feed.

    She recalled she may have gone over to Child G when she heard vomiting.

    She was asked about the significance of the air in the NGT. She says sometimes air is taken in when babies vomit.

    She said she was not sure of the cause of the air in Child G's abdomen.

    She was asked about the "profound desaturation" on September 7, 2015. She could not clearly recall who was there at the time, or where she was at the time.

    For September 21, 2015, Letby had a "vague recollection" of the shift.

    She said it was a "busy shift" and she was "looking after other babies as well" at that time.

    She said there had been "no issue" with the 9am feed, and could not clearly recall the vomit at 10.15am.

    She was later re-interviewed. For September 7, Letby could not recall any concerns with Child G prior to the event.

    She said there were two possibilities - that Child G had received more than 45mls of milk, or there was undigested milk in the stomach. She denied force-feeding milk or administering air to Child G.

    For September 21, Letby agreed Child G's stomach would have been empty when the feed began. She denied intntionally harming the baby girl.

    In the third police interview, Letby was asked again about the September 21, 2015 incident. She said she remembered going behind the screen and seeing Child G. She did not recall seeing a monitor which had been switched off. She denied switching the monitor off.

    She agreed it was bad practice to switch the monitor off, and "someone had made a mistake" in switching the monitor off and leaving the child behind a screen unobserved.