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.”