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