Andy Gill

I’m in #Manchester for the continuing trial of nurse Lucy #Letby. She’s accused of murdering 7 babies and attempting to murder 10 others at the Countess of #Chester Hospital in 2015 and 2016. She denies all the allegations she faces. Updates here and @BBCNWT. 

The court is hearing from a consultant paediatrician who was on duty when Babies E and F were on the neonatal unit. Court orders mean we can’t name the alleged victims or this doctor.Nurse Letby allegedly murdered Child E and allegedly attempted to murder his twin F. @BBCNWT

The doctor was on call in hospital accommodation on the night Baby E became ill. She’s recalling telephone discussions with a junior colleague who was treating E. The junior doctor’s notes concern 2 incidents when E had blood loss from his mouth and had a fall in blood oxygen.

The consultant says the notes show on the 2nd occasion Baby E’s blood oxygen level stayed at 60-70% despite being given 100% oxygen. “This suggests something dramatic has changed in their clinical condition.” @BBCNWT 1/2

“It suggests there’s not a problem with his breathing effort that’s making his oxygen saturation low.” @BBCNWT 2/2

It’s alleged that Nurse #Letby murdered Baby E by injecting air into his blood. She denies this, as she denies all the charges she faces. @BBCNWT

When the consultant got to the neonatal unit E’s blood oxygen level was 80% in 100% oxygen. “They’ve improved since ventilation but they’re still not as good as we would like them to be.” @BBCNWT

An x ray showed E’s heart size was normal and his lungs were clear. “There’s no indication  from the X ray why E’s saturation was low” says the consultant. @BBCNWT

11 minutes after the consultant arrived at the neonatal unit her notes say E’s blood oxygen had fallen to 50-60% in 100% oxygen and he had “no detectable [heart rate]”, so CPR was started. @BBCNWT

The consultant was the team leader for resuscitation efforts for Baby E. She says she wouldn’t get involved in the physical tasks because you “lose awareness of the overall situation.” @BBCNWT

The consultant says her notes “[don’t] tell me anything about what caused the collapse, just that [E] is extremely poorly.” @BBCNWT

Resuscitation efforts for E were not successful and CPR was stopped. The notes say he was “transferred to Mum and Dad for cuddles”. @BBCNWT

The doctor says at the time she thought E’s cause of death was necrotising enterocolitis (NEC), where part of the bowel becomes inflamed and may die. It occurs in newborns who are premature or otherwise unwell.

She thought this because E was an at risk baby, he had gastro-intestinal bleeding and he had skin discolouration. She agreed with the coroner that that she be put as his cause of death. But she now says she doubts he had NEC because …

…”[E’s] observations were stable right up to the point of collapse” and that’s not what happens with NEC, where deterioration is normally slower. There was also no sign of NEC on the X ray….

“I don’t think I gave that enough weight at the time, that the X ray was normal.” The doctor say she didn’t push the idea of E having a post mortem because his parents were so upset, “which is now something I regret.” @BBCNWT

The doctor is now being cross examined by Ben Myers KC who’s defending Nurse #Letby. She agrees with him that as a premature baby E faced specific problems. @BBCNWT 

She also agrees with Mr Myers  that a condition E and his twin F had where they shared a placenta can increase risks for them. Those risks can include NEC. Dr agrees E was at high risk for a number of conditions. @BBCNWT

In a police statement in Nov 2018 the doctor said she discussed with a colleague that E had “an unusual deterioration but in a high risk baby that was not entirely unexpected.” @BBCNWT

Mr Myers says E’s blood glucose levels were high during his time in hospital were high and this can mean baby is labouring under stress. The doctor agrees but says they’re not unusual in babies like E.

When Mr Myers suggest again suggests that Baby E was at risk because he was less robust physically, the doctor says “His deterioration was well outside what we would expect.” @BBCNWT

Mr Myers suggests that the notes show that although E lost blood and fluid there was no discussion, as there should have been, of replacing fluid or transfusing blood. The doctor says though it’s not in the notes, blood transfusion was discussed. @BBCNWT

Mr Myers suggests the consultant (who was on call) should have gone to the neonatal unit sooner than she did to treat E. “With hindsight I should  have attended but I don’t think I would have made any different decisions [from the doctors who were at the unit]”.

Mr Myers: “You should have been there.” 
Consultant  “Yes.” @BBCNWT

The consultant disagrees with Mr Myers when he suggests the Countess of Chester neonatal unit was “too slow” to intubate* E. (* where a tube is inserted into the windpipe to aid breathing).

Mr Myers suggests the consultant is “minimising the impact of a late blood transfusion” for E. Consultant: “I am minimising it as I don’t think a late blood transfusion led to [E’s] collapse and death.” @BBCNWT

Mr Myers says the consultant should have ensured that Baby E had a post mortem. She says “I apologise to them [E’s parents] that I didn’t push for that.” @BBCNWT

Court now hearing from a nurse who worked on the neonatal unit at the Countess of Chester in 2015. She’s telling the jury about how nurses administered various drugs and treatments to the babies on the unit.

The nurse agrees with Ben Myers KC, defending, that neonates can sometimes deteriorate rapidly, and that sometimes they can deteriorate when they’d appeared quite stable. When asked if it follows that such babies can die she says “sometimes”.

Nurse agrees with Mr Myers that at the time some aspects of the neonatal unit at Chester were “quite old”. “Plumbing and drainage would not function as you would have expected.” The nurse says “correct”. Also agrees “at times” it was difficult to get hold of doctors when needed.

Court has ended for the day and will resume tomorrow. I don’t think I’ll be here, but my colleague @Tom_Mullen will keep you up to date. I’ll have a report on today’s proceedings in @bbcmerseyside at 1720 and on @BBCNWT at 1830. #Letby #Chester

I’m at #Manchester Crown Court for the continuing trial of the nurse Lucy #Letby. She denies murdering 7 babies at the Countess of #Chester Hospital in 2015/16. She also denies the attempted murder of 10 other babies. Updates here, @BBCNWT and BBC on line. 

Consultant paediatrician Dr Elizabeth Newby is describing how she treated an alleged victim, Child D. She says D as born in good condition but needed help with breathing shortly afterwards. By the evening she needed to have a tube in her windpipe to help….

…but by  the next morning D was well enough for the breathing tube to be removed. D was able to breathe on her own in air. Dr Newby “felt it was likely that there was an element of infection” as D’s mothers waters broke early and there was a delay in her having a C section birth

Dr Newby was called in to see D at 2am the following day as D had had a “profound desaturation”. [very sudden loss of oxygen levels in blood]. She was called in because D had been so stable and then had deteriorated. @BBCNWT

Dr Newby describes unusual discolourations (“bruised areas”) on D’s abdomen. “We didn’t know what to make of them, to be honest. It was quite unusual. We felt it must be related to infection.” @BBCNWT

She says the discolouration might be related to meningococcal disease in older children, but “I know that couldn’t apply to neonates because you don’t se meningococcal disease babies.” @BBCNWT

Cross examined by Ben Myers KC, defending Ms Letby, Dr Newby agrees that after birth D’s “condition was consistent with an infection of some sort.” @BBCNWT

Mr Myers asks Dr Newby about notes relating to D the night before she collapsed showing that efforts to take her off CPAP (continuous positive airway pressure) were unsuccessful because D deteriorated when this happened.

Dr Newby agrees with Mr Myers that “ a baby who is unwell can have resistance to infection - to keep running at a certain level and then deteriorate very rapidly.” @BBCNWT

Court now hearing from Dr Dewi Evans, a paediatric expert instructed by the prosecution. Nicholas Johnson KC is asking him what he says about his review of the medical notes relating to Child D. @BBCNWT

Asked about “mottling” seen on Child D’s body the first time she collapsed, Dr Evans says “its very significant and extraordinarily unusual. This is not something that happens out of the blue.” @BBCNWT

Asked about D’s condition immediately before her collapse, Dr Evans says “Her condition could not have been better. Her condition was entirely consistent with a baby recovering from early onset pneumonia. She was doing exceptionally well and was clinically very satisfactory.”

But Dr Evans says D was “recovering” from early onset pneumonia, not that she had “recovered” from it.

Dr Evans asked what would have happened if pneumonia had caused D’s death. “You find increased amounts of clinical input would not lead to improvement.. in D’s case none of this happened. She got better.” @BBCNWT

Dr Evans says his conclusion in Child D’s case is that death was caused by an injection of air into her bloodstream. @BBCNWT

Ben Myers KC, defending, asks Dr Evans why he thinks this. Dr Evans gives 5 reasons. 1. D’s collapse was rapid and v striking. 2. The presence of discolouration on D’s body “a pattern experienced [nurses and doctors] had never seen before and never since and it came and went..

3. Attempts to resuscitate D were unsuccessful. 4. The presence [at post mortem] of air in D’s blood vessels and 5. None of the other issues, eg  pneumonia were relevant. @BBCNWT

“What we have in [D’s] case is a full house of clinical characteristics consistent with her having suffered an air embolism, ie air has been injected into her.” says Dr Evans. @BBCNWT

Dr Evans agrees with the defence that D was in a state of very poor health when she went to the neonatal unit. @BBCNWT

Mr Myers refers to Dr Evans saying D was “recovering” from pneumonia, and suggests that she still had  the “potential to become quite unwell.” Dr Evans says “She was in a neonatal unit , the best place on the planet for her.”

When asked by Mr Myers again about her potential to become unwell, Dr Evans says “The potential is there, which is why she was on a neonatal unit.” @BBCNWT

Mr Myers suggests Dr Evans doesn’t want to accept problems with [D’s] respiration because that would “undermine” his conclusion that D died from an air embolus. Dr Evans says “No.”