(NOTE THIS IS PROSECUTION OPENING SPEECH, NOT EVIDENCE)
CHILD N
Chester Standard:
2:46pm
Child N - attempted murder (three allegations)
Child N, a boy, was born in June 2016. He was a couple of weeks premature and he was admitted to the neonatal unit. His clinical condition was "excellent".
The prosecution say there are three separate occasions on which Lucy Letby tried to kill him.
2:48pm
Child N had haemophilia. Subseuqent investigation found him to have a mild version of the disease, and children of his age do not bleed for no reason, particularly in the throat, the prosecution say.
The prosecution said Lucy Letby used Child N's haemophilia as a "cover" to attack him.
2:50pm
On the night of June 2, Letby was on the shift and not the designated nurse for Child N.
She had earlier texted friends and sent a message to a colleague saying “we’ve got a baby with haemophilia”. She sent a further text saying, “everyone bit panicked by seems of things although baby appears fine”.
At 8.04pm she sent a text saying that she was going to “Google” haemophilia. 7 minutes later Letby texted her coleague: “complex condition, yeah 50:50 chance antenatally”.
2:54pm
The designated nurse said Child N was stable and left for a break at about 1am. He would have asked a colleague to look after Child N, but he could not recall whch one.
Letby had two babies to care for, in room 4.
At 1.05am, Child N's oxygen saturation levels fell from 99% to 40%.
"Unusually", for a baby, he was described as crying and "screaming".
Child N recovered quickly, while the doctor was then called to another emergency.
Medical expert Dr Dewi Evans said he believed the deterioration of Child N "was consistent with some kind of inflicted injury which caused severe pain".
Dr Sandie Bohin said such a profound desaturation followed by a rapid recovery, in the absence of any painful or uncomfortable procedure, suggested an inflicted painful stimulus.
She said – “this is life threatening. He was also noted to be … ‘screaming’ and apparently cried for 30 minutes. This is most unusual. I have never observed a premature neonate to scream.”
2:57pm
12 days later, there were two separate incidents on June 15 for Child N.
Letby had been the designated nurse for the previous day.
Overnight he was in nursery 3. At the beginning of the night shift, Child N was 'very unsettled'.
Letby was to be the desigated nurse for June 15. The use of her phone appeared to show she was awake by 5.10am and in for her shift at 7.12am. She had texted a colleague that she had “escaped [room] 1 [and was] back in 3”.
2:59pm
A colleague said Lucy Letby same into the room to say hello, but when the nurse's back was turned, Letby told her Child N had desaturated before assiting with the breathing. There was no evidence of an alarm sounding or if Letby waited to see if he self-corrected.
Doctors were called and an attempt was made to intubate Child N.
He was “surprised by his anatomy more than anything else … I could not visualise parts of the back of his throat because of swelling”.
3:01pm
The doctor saw "fresh blood" in Child N's throat, which the prosecution say was the same seen in Childs C, E and G.
The doctor was unable to get the breathing tube down the throat of Child N as he was unable to visualise the child's tracheal inlet.
He attempted to intubate Child N on three occasions.
3:07pm
An intensive care chart is presented to the court, which records the amount of dextrose going into Child N.
The bleeding record, of 10am '1ml fresh blood', recording aspirates from the NG tube.
Said bleeding, the prosecution say, is not recorded anywhere in the medical notes. It was more than 2 hours after the attempts to intubate.
At 11.29am Letby sent a Facebook message to the doctor telling him “small amounts of blood from mouth and 1ml from ng. Looks like pulmonary bleed on x ray [i.e. a bleed from the lungs]. Given factor 8 – wait and see”. Other than that phone message, there is no evidence that Lucy Letby brought the bleeding to the attention of any of the medical staff.
The prosecution said this is surprising given the problems Child N had suffered.
In an update recorded on the computer notes by Lucy Letby at 1.53pm she wrote that Child N was “stiff” on handling and extending upper limbs, back arching … settled in between episodes.
The prosecution say this is similar to that found in other cases heard so far.
At 3pm there is a further entry in Letby's writing of '3ml blood', initialled not by Letby and coincides with a second collapse that day.
3:10pm
Child N collapsed just before 3pm and a consultant was called at 2.59pm. While awaiting a consultant, a junior doctor looked into the airway of Child N and saw a “large swelling at the end of his epiglottis” he could only just see the bottom of the vocal cords. He had never seen anything like this before in a newborn baby.
The junior doctor's notes made at 4.30pm recorded: "desaturated this afternoon at 2:50pm with blood in the oropharynx + blood in the NG tube. Improved with bagging. Elective intubation planned following ??? unsuccessful attempts with 2 registrars and 2 consultants cords difficult to visualise …”
Letby recorded at 6.30pm: "approx. 14:50 infant became apnoeic, with desaturation to 44%, heart rate 90 bpm. Fresh blood noted from mouth and 3mls blood aspirated from NG tube. … Drs crash called”.
The prosecution said Child N was "so unwell" that attempts were made to reintubate him, but the doctor could not see down Child N's throat as the view was obscured by fresh blood. A more specialist team was called to carry out the intubation.
3:11pm
Child N continued to be unwell on June 15 and difficulties with ventilation persisted. Eventually he was transferred to Alder Hey, where the prosecution say he recovered quickly.
3:13pm
Medical expert Dr Dewi Evans said the blood seen in Child N's stomach had originated there, caused not from intubation attempts but "instead some preceding trauma".
He suggested that “thrusting” a NG tube into the back of the throat might be the mechanism used to inflict the injury.
Dr Sandie Bohin suggested only two possible explanations; either inflicted trauma or a spontaneous bleed. She considers the latter less likely as the haemophilia was 'only moderate'.
Dr Bohin’s view was that the likely cause of the bleeding was trauma to the mouth, to the throat or to the oropharynx, most likely from a NGT or suction catheter.
3:14pm
Professor Sally Kinsey describes the collapse on June 3 as dramatic with no recognised medical cause. She excluded the possibility of a pulmonary haemorrhage - in other words, bleeding in the lungs, causing the collapse on June 15. In her opinion such bleeding would not have occurred spontaneously in a child with Child N's degree of haemophilia.
It follows, the prosecution say, the bleeding was caused by trauma.
Professor Kinsey also ruled out heavy-handed intubation as a cause.
3:15pm
In police interview, Letby had difficulty remembering Child N.
She did recall an occasion when doctors had difficulty intubating him. She agreed that she had seen blood but denied being responsible for causing him harm.
She could not explain the entry in her notes timed at 10am on June 15 in which she recorded aspirating more fresh blood which she had not apparently brought to the attention of anyone else.
Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders
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Sky News:
Letby used Child N's haemophilia as a 'cover to attack' him
The prosecution opening has now moved on to Child N, who was born premature, but his clinical condition was described as "excellent".
The prosecution allege Letby tried to kill him on three occasions.
He was born with haemophilia, a disease which can cause bleeding for no reason, or a trivial reason. Staff at the hospital attributed many of the episodes to this.
However, Nick Johnson KC says: "Subsequent investigation has shown Child N has a mild version of the disease.
"Children with a mild level of haemophilia rarely bleed for no reason."
This, Mr Johnson says, "gave her cover to attack Child N".
He continues: "Because if she caused a bleed she thought it would be put down as haemophilia.
"She was right."
Letby later texted a friend saying she was going to Google haemophilia, saying it was a "complex condition, yeah 50:50 chance antenatally".
Mr Johnson tells the court: "No doubt this is what her Google research had told her.
"It appears therefore that Lucy Letby thought Child N was lucky to be alive."
14:57
Pre-term baby 'screamed' for 30 minutes after injury 'inflicted by Letby'
The child's designated nurse said he was stable until he went for a break at around 1am.
At 1.05am Child N experienced a "sudden deterioration" which was consistent with some kind of "inflicted injury which caused sever pain, distress and destabilised him", the prosecution says.
Unusually for a pre-term baby, he was described as "crying and screaming".
Independent medical experts said this was "consistent with inflicted injury or having received an injection of air", jurors were told.
His recovery was prompt - which would not be consistent with an infection.
One of the medical experts wrote: "This is life threatening. He was also noted to be... 'screaming' and apparently cried for 30 minutes.
"This is most unusual.
"I have never observed a premature neonate to scream."
15:09
Incident one: Child N had swollen throat with 'fresh blood'
Twelve days later, on 15 June 2016, there were two more incidents, the prosecution tells jurors.
At 8am, Child N's oxygen levels had fallen to 48%. A decision was made to intubate him.
The doctor doing so said "he was surprised by his anatomy more than anything else. I couldm't visualise the back of his throat because of swelling".
There was "fresh blood" in Child N's throat - something, the prosecution says, that had been seen before in previous children.
He attempted to intubate Child N on three occasions but was "unable to get the breathing tube down his throat".
Medical notes shown to the jury show that Letby later recorded that Child N had vomited 1ml blood.
The prosecution says that apart from one Facebook message to a doctor, there is "no evidence she brought the bleeding to the attention of any of the medical staff on the ward, which is surprising", given that Child N had collapsed in the first three hours of the shift.
15:16
'Something - somebody - had caused Child N's throat to bleed again'
We are hearing about Child N as the prosecution opening continues.
At 2.56pm on 15 June 2016, medical staff were crash bleeped because Child N was suffering a "life threatening" collapse.
While waiting for another doctor to arrive, one doctor on the ward looked into Child N's airway and found a "large swelling" and could only just see the bottom of the baby's vocal chords.
"He had never seen anything like this before in a newborn baby," prosecutor Nick Johnson KC tells the court.
There were more attempts made to reintubate Child N, as he was so unwell, but doctors were "unable to see down Child N's throat because the view was obscured by fresh blood".
"Something - somebody, we say - had caused Child N to bleed again," the court is told.
A more specialist team was called in to carry out the intubation.
15:20
Swelling in throat was 'evidence' of trauma
Child N was a "stable baby" who did not suffer any other "spontaneous bleeds" at any time as a result of his condition.
An independent medical expert said there are only two possible explanations, "either inflicted trauma or spontaneous bleeds", the prosecution says.
The doctor said the swelling to the baby's throat was "further evidence" that trauma had taken place that day.
When interviewed by police, Letby said she had difficulty remembering Child N.
She agreed she had seen blood but denied being responsible for causing him harm.
Lucy Letby trial - latest: Nurse 'adamant' she's done nothing to harm any of the babies in the case as defence begins
