I'll be bringing live updates from Manchester Crown Court this morning where the murder trial of nurse Lucy Letby continues. We'll be hearing evidence in relation to Child N, who the Crown say Ms Letby tried to kill on 3 occasions in June 2016. She denies all charges.
Dr Huw Mayberry is first to give evidence today - via live link from Australia. Dr Mayberry currently works as a registrar in Melbourne, back in 2016 he was at the Countess of Chester Hospital
Dr Mayberry is being asked about the events of June 15, 2016. Child N crashed several times throughout that day - at one point requiring full resuscitation and six doses of adrenaline
Dr Mayberry was crash bleeped to attend the neonatal unite at around 15:00 due to a 'sudden desaturation following 3ml aspirate of blood from NG (tube)'
The doctor tells the court he tried to intubate Child N, but he 'was unable to get a very clear view because there was substantial swelling within the airway'. He said that this swelling was 'unlike anything I had encountered previously'
He said the infant's epiglottis (flap of tissue at the back of the throat) was 'quite swollen, it looked quite large and reddy pink in colour'. He adds 'I had not seen this in my practice before, only in textbooks'
He tells the court that his initial thought was that this could be epiglottitis - this often caused by an infection, but can also sometimes happen as a result of a throat injury
Dr Mayberry tells the court that he does not recall seeing any blood in Child N's throat. Asked if he could he could give a cause for the swelling, he says 'no it’s not something I've had much experience of'
Ben Myers KC, defending, is now questioning Dr Mayberry. He asks in his professional opinion what can be the cause of blood - he says he told Cheshire Police it could have been a result of gastric irritation or Necrotising enterocolitis (NEC)
He says it could also have been a result of Child N's blood disorder, which resulted in a deficiency of an essential blood-clotting protein
We're now hearing from another doctor, who cannot be named for legal reasons, about the events of June 15.
The medic tells the court that he recalls Child N as he had trouble trying to intubate him, he says 'which for me is not a frequent occurrence'
Notes from the early hours of June 15 show that the doctor ordered a blood test as Child N was mottled in appearance and he wasn't sure why
The mottling eventually resolved, but over the next few hours Child N suffered five desaturations. The doctor said this made him think the baby boy had an infection. A septic screen of his bloods was then ordered
He tells the court that results ruled out infection as a cause. He said there was some concern about blood 'not being delivered to the skin in way that is normal'. By 8am on 15 June, Child N's mottling had returned. The doctor took the decision to move him to Nursery 1
Nursery 1 allows for more intensive care and treatment
The doctor tells the court that on that morning he took the decision to intubate Child N and put him onto a ventilator. He recalls seeing 'unusual' swelling and blood in the back of the baby boy's throat
After three unsuccessful attempts to intubate, the doctor abandoned the procedure. His note from that morning states: 'intubation abandoned due to blood present at oropharynx and likelihood of trauma due to repeated attempts'
Child N was then placed on non-invasive respiratory support
Ms Letby's defence lawyer Ben Myers KC is now questioning the doctor.
Myers is asking the doctor when he saw the blood in Child N's throat. He said 'I believe blood was there at insertion attempt number one' Myers puts it to him that 'if you can't see, you wouldn't attempt it?' He replies:'You can do, if quite certain of position'
Mr Myers has just quoted the doctor's police statement from 2018. In this he says he was 'not sure' if the bleeding was his 'fault' due to his attempts to move the tongue with a medical implement to intubate
We're back after a short break. Retired consultant paediatrician Dr John Gibbs is now in the witness box. He was called to attend Child N at around 16:00 on June 15
Citing his notes, Dr Gibbs recalls that a specialist team had been called to help doctors with Child N's breathing (due to various problems with trying to intubate)
The team from Alder Hey Children's Hospital arrived in Chester at 19:20. They were made up of experienced intensive care consultants and an ear, nose and throat surgeon. Plan was to take Child N try to intubate, if that failed an emergency tracheostomy would take place
Dr Gibbs tells the court that Child N suffered a 'sudden deterioration' before the team could carry out the procedure however. Heart rate dropped to 60bpm, oxygen dropped to 40% - 'clear he was not being ventilated properly', Dr Gibbs said
At this point, Dr Gibbs said chest compressions were started and six doses of adrenaline were given over 30mins. A specialist doctor from Alder Hey also finally managed to intubate the baby, which allowed him to be placed on a ventilator
Asked for his conclusions about the events of June 15, Dr Gibbs says the blood could have been a result of a bleed on the lung - but adds 'why (Child N) had that swelling documented by colleagues, I really don’t know'
Dr Gibbs says that 'in the end I don’t think infection was the cause' of Child N's collapse
Dr Stephen Brearey is now in the witness box. He was on duty on the afternoon of June 15. He was called to help with Child N by a colleague as doctors were having difficulty intubating the infant
Dr Brearey made an unsuccessful attempt to intubate the baby boy. He tells the court from reviewing his notes it wasn't successful due to blood and swelling at the back of Child N's throat, which blocked vision of his airway
