Three unexplained collapses in 3 days.
14 days of NO unexplained collapses---
then LL returns from vacation, and , Baby O, previously deemed healthy, has his first collapse.
Prosecution evidence, March 8th 2023, Day 69 - Tweets https://twitter.com/MrDanDonoghue Triplets O and P Electronic Evidence cont. We're back after a short break for lunch. Court continuing to be shown sequencing evidence for the case of Child O (these included prescriptions, door swipe...
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A nursing note [on Baby O] by Samantha O'Brien at 6.29pm on Wednesday records: 'No signs of increased work of breathing...CBG carried out this AM at 1045, good result....respiratory rate remains stable. Baby nursed in incubator...temp within normal limits.'
'Fluid requirements checked and correct...10% dextrose infusing via cannula in left hand, site became puffy throughout day....feeds of donor EBM also commenced at 1300hr, currently having 4mls 2 hr...'
A note at 6.41am recorded a TPN nutrition bag was stopped as Child O had reached full feeds of donor expressed breast milk, and was 'tolerating well'.
At 7.32am 'abdo loos full slightly loopy. Appeared uncomfortable after feed.'
Child O was checked and settled.
The day shift , for LL, begins at 7.30am. During this shift, Child O died.
Lucy Letby is the designated nurse for Child O and Child P and one other baby in room 2.
7:30 am--Letby records, for Child O:...'Observations within normal range...nil increased work of breathing. Donor EBM via NH [NG] tube. Minimal milk aspirates obtained...'
Letby messages a colleague after 8.30am to say she had a student nurse in but 'no time to do anything'.
Letby adds: 'She's nice enough but bit hard going to start from scratch with everything when got 3 babies I don't know and 2 hourly. Ah well...'
The Whatsapp conversation continues over the following hour.
Dr Katarzyna Cooke records for Child O: 'No nursing concerns observations normal'.
The plan was to continue weaning Optiflow, establishing feeds and prescribing vitamins for Child O.
The doctor records a brain scan for Child O at 12.10pm, noting normal observations.
Letby records a fluid chart at 12.30pm with 'trace aspirates'. A similar reading was recorded earlier that morning.
A doctor's clinical notes record at 1.15pm, Child O 'vomits and has distended abdomen. 'Trace aspirate...no bile 1x vomit post feed No blood'
'Unlikely NEC, most likely distention secondary to PMec.'
Letby records, for 1.15pm: '[Child O] had vomitted [undigested milk], tachycardiac and abdomen distended. NG tube placed on free drainage...blood gas poor as charted...saline bolus given as prescribed with antibiotics. Placed nil by mouth and abdominal x-ray performed. Observations returned to normal'
[by 2:40 pm the collapse begins:]
A doctor notes: 'Called to see [Child O] at [about] 1440. Desaturation, bradycardia and mottled. Bagged up and transferred to Nursery 1. Neopuff requirement in 100% oxygen...'
Letby records: 'Approx 1440 [Child O] had a profound desaturation to 30s followed by bradycardia. Mottled++ and abdomen red and distended...'
Shift leader Melanie Taylor is recorded as entering the neonatal unit at 2.46pm.
The doctor records Child O was intubated '1503-1508' 'at first attempt'.
Dr Stephen Brearey records for Child O at this time: 'small discoloured ? purpuric rash on right wall'
Child O suffered another event at 3.44pm, the court hears.
Bleep data for a crash call is made at 3.49pm.
A consultant writes a retrospective note '[Child O] had been intubated about 3pm when [doctor colleague's] fast bleep went off. Arrived to find [Child O] was being bagged. Desat to 35...'
Lucy Letby's note 'Drs crash called 15:51 due to desaturation to 30s with bradycardia, minimal chest movement and air entry observed. Reintubated...'
Morphine is administered to Child O.
A doctor records a further collapse for Child O at 4.15pm, and chest compressions commence.
Lucy Letby records, in notes written retrospectively at 8.35pm for 4.19pm: 'CPR commenced 16:19 and medications/fluids given as documented...IV fluids 10% glucose...morphine...'
Kate Tyndall continues to talk through the sequence of events for Child O.
Adrenaline is given to Child O at 4.26pm, as well as a pres
cription for sodium bicarbonate.
A consultant records adrenaline and compressions given to Child O.
Dr Stephen Brearey records being called back at 4.30pm.
Lucy Letby records, at about 5pm: 'Placed back on to ventilator. Dopamine commenced....Flecks of blood from NG tube. Discolouration to abdomen. Unable to obtain heel prick...due to poor perfusion.'
The records show attempts to resuscitate and stabilise Child O were unsuccessful. Child O was baptised.
Child O passed away at 5.47pm on June 23, 2016.
Dr Stephen Brearey records: 'After 30 mins of resus, futility of resus explained to parents. Parents and team agreed to stop CPR. [Child O] passed to mum.'
A post-mortem blood test revealed 'nothing untoward', the court hears.
Child P suffers an event at 6pm, the court hears.
OK, I POSTED ALL OF THE ABOVE TO SHOW THAT LL WAS A MAJOR FACTOR IN THIS COLLAPSE. SHE WAS NOT A BYSTANDER.
AND ALSO TO SHOW THAT BOTH TRIPLETS WERE COLLAPSING AT THE SAME TIME. THERE ISSUES OVERLAPPED. WITHIN 30 MINUTES OF BABY O'S DEATH, HIS BROTHER WAS SUFFERING HIS 1ST EVENT.