I'm back at Manchester Crown Court for the trial of nurse Lucy Letby. We'll be continuing to hear evidence in relation to Child H. The prosecution allege Ms Letby tried to murder the infant on two occasions in September 2015.
There'll be a slight delay to proceedings this morning as judges/lawyers are attending a eulogy at 10.30am for a former Manchester Crown barrister who recently died.
Prosecutor Nick Johnson is reading a statement (which is agreed evidence) from Countess of Chester Hospital midwife Deborah Moore. She took Child H's mother to theatre for her emergency C-section
Ms Moore says from reviewing her notes it was an 'uneventful birth and the mother did not require any additional treatment'
Mr Johnson, prosecuting, is continuing to read statements of agreed evidence from medics working on the evening of Child H's first collapse
A member of nursing staff, who can't be named for legal reasons, recalls apologising to the parents of Child H for not informing theme sooner of their daughter's condition.
Child H's mother said yesterday, in a statement, that she and the child's father were "quite annoyed" they had not been informed their daughter's first collapse and said it was a "shock" to see their daughter on a ventilator
The nurse's statement, read to court, said: "We always try to inform the parents as soon as possible, but not if this is going to comprise health of the baby, if we felt the baby was going to die, parents would be informed right away – never felt the case with (Child H)'
Dr Alison Ventress is now in the witness box. She tells the court she will always remember Child H as she was the first baby she performed a pneumothorax aspiration on (needle in the chest to remove air)
Dr Ventress is taking the court back over her notes from the morning September 24 2015. Child H had poor blood gas and had a profound desaturation down to 'the 50%s and needed bagging with neopuff'
The baby girl slowly recovered and was placed on Bipap (a small machine that pushes air through a mask and into child's airway and lungs), the court is told
Her notes from that morning state that Child H's breathing 'remained gasping pattern'. Dr Ventress says this is 'more serious than grunting' and agrees that it was 'indicative of a serious respiratory problem'
Notes from the early hours of 25 September show another desaturation. At 1:14am Dr Ventress was 'bleeped urgently' as Child H had 'poor chest movement and poor colour'. She was placed on neopuff
The medic noted that Child H's chest drain, which had been fitted as she had a collapsed lung, was 'no longer functioning….blood stained fluid leaking from drain'
Dr Ventress says that is 'not uncommon' with chest drains. She says fluid was not indicative of any infection
Her notes show that at 1.25am Child H had another profound desaturation. Oxygen levels down to 30s. Dr Ventress performed an emergency pneumothorax aspiration, 70ml of air was aspirated which was 'quite a lot for a baby that size' she tells the court
Child H's sats improved after the procedure, but there was a further desaturation at 1.45am. Second aspiration was then needed and another butterfly needle inserted into lower chest, this again worked and drained a further 60mls of air - again sats improved
The baby girl's sats remained in the stable range until 3am when she had another profound desaturation, her blood oxygen fell to 26%. 85mls of air aspirated and her sats again improved. A plan was drawn up to insert a further chest drain
We're now looking at Dr Ventress' notes from her next shift on 25 September (going into 26 September). She records at 23.50 that there had been 'several episodes of desaturation in the previous two hours'
At around 1am on 26 September Child H's ventilation had to be increased, Dr Ventress again suspected a pneumothorax. She called a consultant for further advice
We're now looking at Dr Ventress notes from 03:22 when Child H suffered a profound collapse which needed a full resuscitation. CPR was commenced at 03.26 and three doses of adrenaline were administered between 03.30 and 03.39
At 03.46 chest compressions were stopped as Child H's heart rate had improved and her colour started improving - treatment was successful
Ben Myers KC, defending, is now questioning Dr Ventress. The medic agrees that desaturations in babies like Child H are not 'uncommon'. She agrees that Child H was 'clearly unwell'
Mr Myers sets out that Child H had had three chest drains inserted and numerous desaturations in the run up to 26 September, Dr Ventress agrees. He asks whether those medical procedures are 'likely to put strain on a little body like hers', she agrees
Mr Myers asks if it is possible the cumulative impact of those procedures could have resulted in a collapse like the one observed on 26 September, she agrees
A former nursing colleague of Ms Letby, who cannot be named for legal reasons, is now in the witness box. She is taking the court through her notes on Child H from 25 September 2015
Another former nursing colleague of Ms Letby, who cannot be named for legal reasons, is now in the witness box. She is taking the court through her notes on Child H from 23/24/25 September 2015
Asked for her recollections of the events of 26 September, the nurse said she remembers Child H 'became unwell that night and needed some resuscitation'
The nurse is asked about 'a difference of opinion' that occurred that night over whether a baptism should be offered for Child H after her collapse. The baptism was offered to the parents, which was accepted
The nurse and a senior manager disagreed over whether it was the appropriate time for it to be offered
This disagreement arose mainly due to the fact it was early hours of the morning and the unit was busy. The nurse said it shouldn't be 'blown out of proportion'
