UK - Lucy Letby Trial - Media, Maps & Timeline *NO DISCUSSION*

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Lucy Letby is on trial in the UK, charged with the murders of 7 infants and the attempted murder of 15 other infants.

Media, Maps & Timelines can be posted here.

*NO DISCUSSION* in this thread or your post will be removed.
 
Hey everyone.

I was struggling to piece together timeline of cases presented so far as I feel even this early on there's already been so much information. Hopefully this can serve as some sort of timeline that can be edited by others and reposted as needed to keep everyone orientated to the prosecution case:

My understanding so far.

Child A- Dies 8th June

Child B- Becomes unwell and recovers 9th June

Child C- Dies 14th June

Child D- ‘June 2015’- Collapsed 3 times and dies

Child E- August 3rd becomes unwell. Dies early hours of August 4th

Child F- August 5th, TPN bag started, multiple episodes of low blood sugar needing treatment

Child G- September 2015- Suffered irreversible brain damage


It goes without saying, but whatever the cause of these events, my heart goes out to families of these children.
 
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Reproduced from the info graphic in this article - Mother of a newborn interrupted Lucy Letby 'while she was killing him'



Full Indictment against Lucy Letby

Lucy Letby is charged as follows:

Count 1

Charged with murder of baby A on June 8 2015

Count 2

Charged with attempted murder of baby B between June 8 2015 and June 11 2015

Count 3

Charged with murder of baby C on June 14 2015

Count 4

Charged with murder of baby D on June 22 2015

Count 5

Charged with murder of baby E on August 4 2015

Count 6

Charged with attempted murder of baby F on August 5 2015

Count 7

Charged with attempted murder of baby G on September 7 2015

Count 8

Charged with attempted murder of baby G on September 21 2015

Count 9

Charged with attempted murder of baby G on September 21 2015

Count 10

Charged with attempted murder of baby H on September 26 2015

Count 11

Charged with attempted murder of baby H on September 27 2015

Count 12

Charged with murder of baby I on October 23 2015

Count 13

Charged with attempted murder of baby J on November 27 2015

Count 14

Charged with attempted murder of baby K on February 17 2016

Count 15

Charged with attempted murder of baby L on April 9 2016

Count 16

Charged with attempted murder of baby M on April 9 2016

Count 17

Charged with attempted murder of baby N on June 3 2016

Count 18

Charged with attempted murder of baby N on June 15 2016

Count 19

Charged with attempted murder of baby N on June 15 2016

Count 20

Charged with murder of baby O on June 23 2016

Count 21

Charged with murder of baby P on June 24 2016

Count 22

Charged with attempted murder of baby Q on June 25 2016

This timeline provided by @Tortoise is more comprehensive. Please use this as above.
 
Who are the children alleged to have been murdered by Lucy Letby? | ITV News


"A court order prohibits reporting of the identities of surviving and deceased children allegedly attacked by Letby, and prohibits identifying the parents or witnesses connected with the children.

Instead, each child has been given a letter which they will be referred to.

Nick Johnson, KC, prosecuting told Manchester Crown Court, each of the individual cases of the children involved in the trial, while Ben Myers KC, defending Letby, said his client denies all the allegations against her.

So who are the babies involved and what is alleged to have happened?" [....]
 
(Copying over reports from the trial in relation to each child.)

(NOTE THIS IS PROSECUTION OPENING SPEECH, NOT EVIDENCE)

From Chester standard;

Count 1: Child A murder allegation
Child A, a boy, was born premature in June 2015, the younger of a twin child (Child B).


3:11pm

Medical records for Child A's birth are shown to the jury, including the names of which medical staff were present at the birth, and the condition of Child A, plus medical observations.
Child A was in "good condition" at birth, and taken to the neonatal unit ICU. 13 hours later, he was breathing "in air" without the requirement of extra, medically administered, oxygen.

3:18pm

A medical chart records the fluids going in and out of Child A.
Child A was given 1ml of milk via a nasogastric tube at 4pm and 6pm.
A nurse had looked after Child A that day. She handed over care to Letby at 8pm before she had been able to administer intravaneous fluids. The fluids were started at the time of the handover - the nurse assisting Letby. Child A was stable at the time of the handover.

3:23pm

The connection of the fluids, Mr Johnson said, would have been after 8.10pm, and it was recorded on the infusion prescription chart at 8.05pm.
At 8.20pm, Child A was reported to have white feet and hands, and Letby called a doctor to the incubator at 8.26pm, as child A was deteriorating.
Resuscitation procedures began, with adrenaline administered to stimulate the heart.
Doctors observed "an odd discolouration on Child A's abdominal skin - flitting patches of pink over blue skin that seemed to appear and disappear".
Mr Johnson said: "This proved to be the first of a series of similar presentations on the skin of babies suddenly and catastrophically collapsing at the CoCH NNU over the succeeding months.
"It is a hallmark of some of the cases in which Lucy Letby injected air into the blood streams of some of these small babies."

3:26pm

"All resuscitation techniques which would be expected to bring a baby back to life failed."
Child A was pronounced dead at 8.58pm. He had died, Mr Johnson said, within 90 minutes of Lucy Letby coming on duty.
She was recorded as being the only witness associated with Child A's collapse.
The doctor noted, at 8.26pm, that Lety was showing an oxygen mask to Child A's face.
The monitors showed Child A had a normal heart rate and good oxygen saturations, and a normal ECG, but was not breathing.
The doctor noted: "an unusual blotchy pattern of well perfused pink skin over the whole of [Child A]'s body coupled with patches of white and blue skin … all over his body."

3:26pm

The case was referred to the coroner and the cause of Child A's death was 'unascertained' at the time.

3:30pm

Medical expert Dr Dewi Evans suggested Child A's collapse was "consistent with a deliberate injection of air or something else into [Child A]'s circulation a minute or two prior to deterioration," Mr Johnson told the court. Only Letby was present.
Another medical expert said the cause was "not some natural disease process, but a dose of air "deliberately administered".
An independent pathologist described the cause of death was 'unascertained', in that there was nothing in the autopsy that pointed to why Child A had died, but the cause was most likely 'exogenous air administration through the longline or UVC'.

3:31pm

Said explanations are also backed up, the prosecution say, by an independent radiologist.

3:36pm

When interviewed by police regarding the circumstances over Child A's death, Letby said she had given fluids to Child A at the time of the change of shifts.
She said within "maybe" five minutes, Child A developed 'almost a rash appearance, like a blotchy red marks on the skin'.
She said she had wondered whether the bag of fluid "was not what we thought it was".
In an interview in June 2019, Letby said she had asked for all fluids to be kept from the bag at the end to be checked, but the prosecution said there was was no record of her having made such a request.
It was suggested by police that Letby had administered an air emolus. She replied it would have been very hard to push air through the line.

3:38pm

In a November 2020 police interview, police put to her that Letby had tracked the family of Child A on Facebook. She said she had no memory of doing so but accepted it if there was evidence on her computer doing so.
The prosecution said there was evidence.

Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders

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From Sky News;

Child A died less than 90 minutes after being handed into Letby's care​

The prosecution is now outlining details about Child A. None of the children harmed, or killed, are being named for legal reasons.
Child A was allegedly murdered on 8 June 2015, shortly after his birth.
Despite being premature, he was born in "good condition" and on 8 June he was described in his medical notes as breathing "in air" - meaning he didn't need extra oxygen.
But, by 8.26pm that same day he was "deteriorating rapidly".
He had been handed over to Letby's care less than half an hour earlier.
By 9pm, he had been pronounced dead - within 90 minutes of Letby coming onto shift.


Child A 'most likely' died after being injected with air​

Multiple medical experts concluded the cause of Child A's collapse was "not some natural disease process".
One said his collapse was "consistent" with a "deliberate injection" a minute or two prior to his deterioration - at a time when only Lucy Letby was present.
Two doctors concluded his death was most likely caused by an injection of air into either his umbilical venous catheter (UVC) or his long line.
A radiologist concluded that "even allowing for post-mortem gases to develop, the gas pattern seen in the x-rays was unusual and in keeping with air being injected into Child A's bloodstream".

Lucy Letby trial - latest: Nurse 'adamant' she's done nothing to harm any of the babies in the case as defence begins
 
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(NOTE THIS IS PROSECUTION OPENING SPEECH, NOT EVIDENCE)

Chester Standard:

3:40pm

Count 2: Child B attempted murder

Child B is the elder twin sister of Child A, born in June 2015. She required breathing support via a ventilator at birth.
Attempts to fit an umbilical vein catheter (UVC) twice failed, so a long line (IV) was inserted for fluids to be administered successfully.
Breathing support gradually lessened and Child B was stable.

3:44pm

A designated night-shift nurse was responsible for Child B. Shortly before midnight, the blood/oxygen levels had fallen to 75% and the Cpap nasal prongs were dislodged from Child B's nostrils. The nurse repositioned the prongs and the levels recovered.
Just after midnight, Letby started a bag of liquid feed with Child B, with the nurse, through an IV line.
At 12.16am Letby - while not Child B's designated nurse - took her blood gases.
About 28 hours after her twin brother had died, at about 12.30am, Child B's alarm sounded and Letby had called the nurse to the child's incubator. Child B was not breathing.

3:47pm

A crash call was put out at 12.33am, and resuscitation began. The nurse noted purple blotches and white patches all over Child B's body, and the heart rate had dropped.
In a witness statement three years later, Letby's colleague, the designated nurse for Child B, said she and Letby had been preparing antibiotics at the time of the collapse.
After efforts to resuscitate Child B, Child B "recovered very quickly".
A doctor subsequently found "loops of gas filled bowel".
The prosecution say this was a finding replicated many times in the upcoming cases.
Child B improved until being discharged the following month.

3:47pm

Dr Dewi Evans concluded Child B was "subjected to form of sabotage" that night, the court hears.

3:49pm

Another medical expert said an airway obstruction would cause a "sudden desaturation and reduction in heart-rate", but would not account for the "florid change in skin colour and perfusion noted at the time".
The medical expert said a "relatively quick recovery" would "only be explained by a dose of air...deliberately administered in the bloodstream".

3:51pm

A blood expert added "no blood disorder would account for the sudden deterioration suffered by [Child B]."


3:53pm

In police interview, Letby was asked about the circumstances regarding the connection of a liquid feed bag at 12.05am. She said she had looked at paperwork for the lipid syringe (an addition to the liquid feed bag to children not being given milk), and said the prescription was "not her writing" but "she had signed for it" and "ideally it should have been co-signed by somebody".
The rules are that two nurses have to sign for things administered to a baby.

3:55pm

Letby told police she had conducted observations on Child B, but the other nurse was the allocated nurse.
Letby also said it was the other nurse who had alerted her to the problem with Child B.
In a June 2019 police interview, Letby said it was her signature on the blood gas record at 12.15am, just before Child B collapsed.
The prosecution say this is an example of Lucy Letby signing the charts for a baby who was not her designated patient at a time just before the child collapsed.

3:59pm

In November 2020, Letby was asked by police about a handover sheet relating to Child B found at her home address in a search.
The sheet showed she had been the designated nurse for two babies in a different room that night.
Mr Johnson said: "Here you can see that we have twins who were born prematurely but in pretty good condition.
"No one expected them to face grave problems, yet both suffered unusual symptoms within a short time of each other which in interview Lucy Letby said were similar.
"The prosecution’s expert paediatricians say that the collapses and skin mottling were the result of air being injected into their bloodstream.
"The first injection caused the death of [Child A], the second the dangerous collapse of his sister.
"We say that there is no plausible alternative to an air injection [air embolus]. The fact that it happened in 2 cases just over 24 hours apart shows that these were no accidents.
"Lucy Letby was the only person present [with Child A] at the time he collapsed...and was in the room when the same happened to [Child B].
"We also say that you are entitled to look at the evidence of what happened to [Child A and B] in the context of one, what Lucy Letby did to other children and two, most starkly, her having poisoned [two other children] with insulin."

Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders

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Sky News:

15:49

Child B the victim of 'sabotage'​

About 28 hours after Child A had been killed, shortly before midnight, Child B's oxygen levels began to fall. Another nurse adjusted Child B's head and nasal prongs and her levels began to recover.
At 00.05am, Letby began a bag of liquid feed on Child B and - even though she was not Child B's designated nurse - took her blood gases.
At around half past midnight Child B's alarm sounded as she was not breathing.
Her oxygen saturation levels had fallen to 50%.
"She was blue, she wasn't breathing and she was limp," says Nick Johnson KC. Child B also had purple blotches and white patches all over her body.
Child B "recovered quickly" once resuscitated, her heart rate increased, her breathing resumed, "she became very lively" and required minimal respiratory support thereafter. She survived the incident - without suffering any further consequences.
Subsequent tests found "loops of gas-filled bowel".
A doctor concluded she was "subjected to some for of sabotage before or after midnight on the night of the 9 / 10 June 2015".
A second doctor observed the sudden discolouration, profound collapse and "relatively quick recovery is rare and only explained by a dose of air administered into the bloodstream".

16:00

The 'obvious conclusion'​

Nick Johnson KC reiterates that Letby was always on shift at the time of these, sometimes fatal, incidents, telling the jury: "You might be tempted to draw what, we suggest, is the obvious conclusion."
A handover sheet relating to Child B was also later found during a search of Letby's home address.
At the time of Child B's death, Letby was the "designated nurse" for two babies in other rooms of the neonatal unit, indicating she should have had no involvement in Child B's care.
Yet it was her signature found on the blood gas record shortly before Child B began to deteriorate.
"Taking a step back, it's easy to get sucked in by the detail in this case but important always to keep a sense of perspective," he says.
But, Mr Johnson says both Child A and B were born "prematurely but in pretty good condition".
"No one expected them to face grave problems yet both suffered unusual symptoms within a short time of each other which, in an interview, Lucy Letby said were similar," he says.

Lucy Letby trial - latest: Nurse 'adamant' she's done nothing to harm any of the babies in the case as defence begins
 
(NOTE THIS IS PROSECUTION OPENING SPEECH, NOT EVIDENCE)

CHILD C


Chester Standard:

11:08am

We are hearing evidence on Child C's death.
Dr Dewi Evans heard that infection was a "significant factor" in Child C's collapse, but could not adequately explain it.
He had concerns about Child C's sudden deterioration.
The cause of death was ‘widespread hypoxic/ischaemic damage to the heart/myocardium’ due to lung disease, with maternal vascular under perfusion as a contributary factor.

11:12am

As was the case with Child B, the prosecution say, Lucy Letby was not the designated nurse for Child C, a baby boy. Letby was assigned to look after a baby girl, and the leading nurse had to reinforce this assignment when, the prosecution say, Letby was 'ingnoring her'.

11:13am

A medical expert concluded Child C was killed by air "deliberately put into the nasal gastric tube".
The prosecution say this was a "variant or refinement of a theme Letby had started with the twins".

11:15am

The prosecution added an independent pathlogist said the skin colour changes in Child C were likely caused by prolonged unsuccessful resuscitation.
Child C had pneumonia, but the pathologist concluded Child C died as a result of having an excessive quantity of air injected into his stomach via the nasogastric tube (NGT).

11:19am

The court has heard Child C was being looked after by a nurse less qualified than Lucy Letby and had been given the responsibility as Child C was stable.
That nurse had left to go to the nurses station in the hospital. While there, she heard Child C's monitor sound an alarm.
Upon her return, Letby was already in the room, standing next to Child C's cot.
It was the third baby to have suffered a serious deterioration in the matter of a few days, the court heard.

11:20am

Letby was the only nurse who had been on duty for all three collapse incidents for Child A, B and C.

11:22am

In police interview, Letby denied she had anything to do with Child C, other than with the resuscitation.
She could not remember why she had ended up in nursery 1.
In a second interview, asked about texts which had been found on her phone placing her in that room, Letby said that she might have been sending them from the nurses’ station and then gone into room 1 “to do something else”.
She then agreed that she had been the only person in the room when Child C had collapsed.

11:24am

After finishing her shift, Letby searched on Facebook for Child C's parents.
The prosecution say this would've been one of the first things she would have done after that night shift ended.
Mr Johnson, for the prosecution, added Letby would have been the only adult in the room when Child C collapsed, as was the case with Child A, and was one of only two in the room when Child B collapsed.

11:25am

"What we are going to see as we progress is that Lucy Letby’s method of attacking the babies in the neonatal unit was beginning to develop," Mr Johnson tells the court.

Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders

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Sky News:

Prosecution continues with the Child C - born weighing just 800g​

Child C, the prosecution claim, was murdered by Letby on 14 June.
He was, like many children in this case, born premature - prosecuting, Nick Johnson KC describes him as "significantly premature".
He weighed just 800g (less than 2lbs) when he was born, although he is described as "in good condition".
Although he initially showed signs of breathing distress, after a number of days his respiratory support was reduced and he began to manage to breath independently.
When the nurse checked Child C's stomach contents, they founded traces of bile - an early sign of necrotising enterocolitis (NEC), a serious gastrointestinal disease where a portion of the bowel becomes inflamed and may die.
As a result, the hospital temporarily stopped his feeds - but just hours later Child C was fine, and a decision was made to re-institue milk feeds.

The night shift of 13 June​

On the night shift of 13 June, beginning at 8pm, a different - less qualified - nurse was allocated responsibility for caring for Child C as he was seen to be stable.
Letby was assigned the care of another child, given the initials of JE, who was considered to be deteriorating. He was grunting, a "potential red flag for breathing problems". JE is not a child mentioned in the indictment.
The shift leader told Letby she had to keep a close eye on JE and "this was a message that [the shift leader] had to reinforce later in the shift when it became clear that Letby was ignoring her," Mr Johnson tells the court.
When Child C's assigned nurse left to go to the nursing station, she heard his alarm go off.
"When she went back into room one, there was Lucy Letby, standing next to Child C's cot," says Mr Johnson.
He says she had "no business" in that room.
At this point, Child C was desaturating - his oxygen levels were dropping - and his heart rate was going down.
He had "suffered a serious deterioration" and "there again at the bedside, or the incubator side, was Lucy Letby", the prosecution tells the court.

texted colleague she wanted to be in room with Child C - for her own wellbeing​

Staff tried to assist with Child C's breathing, using a "neopuff" device to help him breathe.
Although he quickly recovered within a short time, he had prolongued periods of low oxygen and his heart rate slowed.
Nick Johnson KC tells the court: "You might get the impression from this case that babies collapsing was a common event in the neonatal unit – after all this was the 3rd in a few days - but this was the first time Child C's assigned nurse had ever seen a collapse and resuscitation - that's how uncommon it was."
Her colleague says Letby told her: "He's going, he's going."
"She was right," Mr Johnson says.
He says Letby was unhappy with being assigned to a different room to Child C.
He tells the jury: "She texted an offduty colleague saying that she, Lucty Letby, wanted to be in room number one, saying it would be cathertic for her, it would help her wellbeing, to see a living baby in the space previously occupied by a dead baby - Child A - a baby who had died a few days earlier.
"But the shift leader had put her in room three. So she didn't like it

Child C's death was a 'refinement of the theme' Letby had started with Children A & B​

Child C was pronounced dead just before 6am on the 14 June 2015.
At thge time, the consultant pathologist gave the cause of death as "widespread hypoxic/ischaemic damage to the heart/myocardium due to lung disease".
Child C's vocal cords were "swollen" - something the prosuection say is a reoccuring feature in this case.
Independent medical experts who reviewed the cases thought that infection was a "significant factor" in Child C's collapse, "but did not adequately explain it".
"The damage to his heart was the result of, rather than the cause of his collapse," says Nick Johnson, KC.
A second doctor said "althought Child C had pneumonia at the time of his death, she believed that was not the cause of death".
She said Child C's collapse was concerning and had no clear cause.
Her view was "the only feasible mechanism" for the excessive air in the gut at the time of the collapse was the deliberate introduction of air via the nasal gastric tube.
"This was a variation - or refinement - of a theme Lucy Letby had started with Children A and B," says Mr Johnson

'An effective way of murdering babies in a neonatal unit'​

The jury has been shown a diagram to explain how inflating a babies stomach with air or excess milk can "stop a baby breathing".
"If you are trying to murder a child in a neonatal unit it's a fairly effective way of doing it - it doesn't really leave much of a trace," says Nick Johnson KC.

Letby was interewed in 2018 and denied she had had anything to do with Child C "other than during the resuscitation".

Prosecuting, Mr Johnson says: "She said she had not been the person who had discovered the problem with Child C, although her texts put her in that room."

A year later, Letby agreed she had been the only person in the room when Child C collapsed.

Less than 24 hours after Child C had died, at 3.52pm, Letby searched on Facebook for his parents. Given she had come off duty at 8am, "the timing may suggest this was one of the first things she did having woken up".

Lucy Letby trial - latest: Nurse 'adamant' she's done nothing to harm any of the babies in the case as defence begins
 
(NOTE THIS IS PROSECUTION OPENING SPEECH, NOT EVIDENCE)

CHILD D


Chester Standard:

11:27am

Child D - murder allegation from June 2015
Child D was a baby girl, born as 'full-term' (ie not premature).
The court hears there is valid criticism for the hospital as the mother should have been given antibiotics to stave off infection, after her waters broke early, but she was not.
Although born healthy, Child D "lost colour" and "became floppy" in her father's arms. She was put under observation as she was showing signs of respiratory distress, by grunting, and her temperature dropped.

11:29am

Child D was admitted to room 1 in the neonatal unit, placed into an incubator, and given oxygen therapy and antibiotics.
She developed a very high temperature and a rise in her heart rate.
She was inturbated, and ventilated. She improved "significantly, but was still affected by her infection".

11:32am

Child D had catheters inserted and the levels of infection dropped.
"All good signs," Mr Johnson tells the court.
A designated nurse other than Letby was assigned care for Child D in room 1 on the night-shift, along with a different child in room 2.
Letby was the designated nurse for the two other babies in room 1.

11:34am

On that night-shift, Child D collapsed three times. The first at about 1.30am, the second at 3am, and finally at 3.45am.
Mr Johnson: "On each occasion, those attending were struck by the sight of mottling, poor perfusion and brown/black discolouration to her skin, mainly over the trunk.
"We've heard that sort of thing before, haven't we?
"The prosecution say that this was another case of injecting a child via an IV air embolus."

11:36am

At 1.15am, the designated nurse checked Child D, recording observations.
At 1.25am, the designated nurse and Letby noted the starting of an infusion.
An aspirate - drawing liquid through the nasogastric tube - is noted at 1.30am.
At 1.29am a doctor noted "an unusual...spreading, non-blanching rash" on Child D.

11:41am

There is a note in Lucy Letby's records she was engaged in the care of a different baby at the time, but the prosecution say nursing notes suggest Letby and the designated nurse called the doctor to the room.
The prosecution allege either the notes recorded were simply inaccurate, or Letby was setting herself up with an alibi in someone else's medical records.
Child D was successfully resuscitated.
At 2.40am, medication was administered by Letby and the designated nurse, who then left to another room.
But Child D then collapsed at 3am. Letby was in the room, the designated nurse was not, and no-one else had a reason to be in the room.

11:43am

Child D was resuscitated again but, according to the prosecution, Letby "did not leave things there".
At 3.20am, there is a record of Letby starting an infusion and Letby appears to have remained in the room, as a record shows her caring for another baby in the room at 3.30am.
At 3.45am, Child D suffered her third and final collapse. CPR began and Child D was pronounced dead at 4.25am.
The coroner gave the cause of death as "pneumonia with acute lung injury."

11:45am

Medical expert Dr Dewi Evans, the prosecution says, observed that a child "exhibiting a window of near recovery on two occasions followed by another collapse was not consistent with the fatal evolution of antenatal pneumonia."
He added the "abdominal discolouration was indicative of air embolus".

11:48am

Another medical expert said the clinical status of Child D the previous night was not that of a deteriorating baby who would be dead a few hours later.
She added the injection of '3-5ml per kilogram' of air would be sufficient to kill.
Child D had been observed in distress prior to her death, and the medical expert added this would also be consistent with cases of air embolus (air injected into the system).

11:50am

The court is told none of the medical staff on duty that night had also been present for the collapses of Child A, B or C - other than Letby.
For nursing staff, two of the nurses had been on duty for one each of the other collapses.

11:53am

Letby, in police interview, said she "cannot remember" how she got involved.
She seemed to accept that she had administered medication with a syringe at 1.25am – 5 minutes before the first collapse.
In a June 2019 police interview, she said she could not remember calling back the doctor when Child D collapsed, but it was possible she had.
It was put to Letby, in November 2020, that she had searched for the parents of Child D on Facebook.
She said that she could not recall but accepted she had done so. She said she could not explain why she had done it.

11:53am

The prosecution said: "We suggest that if you searched for that family of a baby who you had seen die you would know and remember why you had done it."

11:54am

Letby was asked about a text message in which she had referred to "an element of fate" being involved.
She said that it was 'fate that babies get unwell sometimes' but that she would have to know the context.
The prosecution say for Child D, her bad luck, or fate, was the fact Letby was working in the neonatal unit.

11:55am

The prosecution add all of Children A-D were not expected to have serious problems, but only one of them survived - and only Letby was "the constant presence".

Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders
 
(NOTE THIS IS PROSECUTION OPENING SPEECH, NOT EVIDENCE)

CHILD E


Chester Standard:

12:16pm

Child E - murder allegation
Child E, a boy, was born premature in July 2015.
The prosecution say this is the twin brother of the child poisoned with insulin.
Child E was born, weighing less than 3lbs. He was given oxygen, then weaned to air, and transferred to nursery 1.

12:19pm

The court hears Child E was at risk of a serious gastro-intestinal disorder, NEC, and was started on antibiotics, IV fluids and caffeine.
He had a nasogastric tube inseted. Fluids were inserted the following day via a long line.
He had a "mild, transient high blood sugar" was was corrected with "a very low dose of insulin", then given tiny quantities of milk the following day, every two hours.
The following day after that, he had two small vomits and air was aspirated, but otherwise the feeds were well tolerated and increased incrementally to 2ml every 2 hours.
The nursing notes indicated he was stable, on a tiny dose of insulin to correct high blood sugar.

12:20pm

At 9pm on August 3, 2015, the mother decided to visit her twin sons, and "interrupted Lucy Letby who was in the process of attacking Child E", the prosecution say, although the mum "did not realise it at the time".

12:21pm

Child E was 'acutely distressed' and bleeding from the mouth.
The mum said Letby attempted to reassure her the blood was due to the NGT ittirating the throat.
"Trust me, I'm a nurse," Mr Johnson told the court.

12:22pm

Letby said the registrar would be down to review Child E, and urged her to return to the postnatal ward.
The mum called her husband when she got to the labour ward, in a call lasting four minutes and 25 seconds, at 9.11pm.
Letby made a note in Child F's records (Child F being the twin of Child E), "after she had got rid of" the mum, Mr Johnson said.
The next time the mum visited Child E, he was in terminal decline.

12:28pm

The prosecution say the mum was "fobbed off" by Lucy Letby.
Two records are made at 4.51am, after Child E had died.
The later note records: "Mummy was present at the start of shift attending to cares. Visited again approx. 22:00. Aware that we had obtained blood from his NG tube and were starting some different medications to treat this. She was updated by Reg xxxxx and contained [Child E]. Informed her that we would contact her if any changes. Once [Child E] began to deteriorate midwifery staff were contacted. Both parents present during resus."
The prosecution say Letby's note suggests the mum was present at the start of the shift (7.30pm-8pm), and returned at 10pm, when "neither is true".
The prosecution say 9pm was an important time, as it was the time Child E was due to be fed, by his mother's expressed breast milk.
The mum said that is why she attended at 9pm. "She was bringing the milk".
The phone call at 9.11pm to her husband also fits the mum's timing, the prosecution add.

12:29pm

Letby's notes also show: "prior to 21:00 feed, 16ml mucky slightly bile-stained aspirate obtained and discarded, abdo soft, not distended. SHO [Senior House Officer] informed, to omit feed."
The prosecution say the nursing notes made are false, and fail to mention that Child E was bleeding at 9pm.
They mention a meeting that neither the registrar or the mother remember.

12:35pm

A record of feeds - a feeding chart - is shown to the court.
At 9pm, Letby has recorded information to detail the volume of fluids given via the IV line and a line in Child E's left leg, and the 9pm feed is 'omitted'.
In the 10pm column is '15ml fresh blood'.
The SHO said he had no recollection of giving advice to omit the 9pm feed.
He was on the paediatric ward most of that night, until Child E entered a terminal decline. He believes the only time he had anything to do with Child E was in a secondary role to the registrar in an examination at 10.20pm.

12:37pm

The registrar recalled being told Child E had suffered a blood-flecked vomit.
He does not recall seeing any blood on Child E's face, but regarded the presentation as undramatic.
But "around half an hour to an hour later there was a large amount of fresh blood which had come up" Child E's tube.
The prosecution said: "This was the first indication of any serious problem so far as the medical staff were concerned.
"There was a further loss of 13 mls of blood at 23:00 hrs."
"13mls may not sound much, but [the doctor] had never seen a small baby bleed like this."
This was the equivalent to 25 per cent of Child E's blood volume, a figure which the prosecution say is an under-estimate in context.

12:41pm

The prosecution add that at 11.40pm, Child E suffered a sudden desaturation.
His abdomen "developed a striking discolouration with flitting white and purple patches."
CPR was started, but Child E "continued to bleed".
Although Letby was participating in the resuscitation of Child E, she co-signed for medication given to another baby in room 4.
Child E was pronounced at at 1.40am.
The on-call consultant said Child E was a high-risk infant who had shown signs of NEC.
The parents did not wish to have a post-mortem, the consultant did not deem one necessary, and the coroner's office agreed.
The prosecution say: "As subsequent reviews have established – that was a big mistake."

12:42pm

Dr Dewi Evans said Child E's death "was the result of a combination of an air embolus and bleeding which was indicative of trauma".
The air embolus was "intentionally introduced" into Child E's bloodstream via an IV line "to cause significant harm".

12:43pm

Medical expert Dr Sandie Bohin agreed the cause of death was air embolus and acute bleeding.
She concluded that the cause of the bleeding was unknown but acknowledged “fleetingly rare” possible natural causes that could not be ruled out in the absence of a post-mortem.
Dr Bohin concentrated on the abdominal discolouration and concluded that air was deliberately introduced via an intravenous line.

12:46pm

The court is reminded by the prosecution that, once again, only Lucy Letby was "the constant presence" for all of the collapses in Children A-E.

12:52pm

In police interview, Letby said he could remember Child E and he was "stable" at the time of the handover, with nothing of concern "before the large bile aspirate".
She said she and another member of staff had disposed of the aspirate and the advice was to omit the feed.
She said Child E's abdomen was becoming fuller and there was a purple discolouration, so had asked a doctor to review Child E.
She said she had got blood from the NG tube.
She was asked about the 10pm note and said if there had been any blood prior to the 9pm feed, "she would have noted it".
She said it was after 9pm that the SHO had reviewed Child E but could not reall if it was face-to-face or over the phone.
She said she could remember the mum leaving after 'the 10pm visit'.
In a June 2019 interview, she was pressed over a conversation with the SHO.
She said she had no independent memory of it.
Shesaid she could not remember the mum coming into the room at 9pm with milk, nor Child E being upset, with blood coming from the mouth.
She said she would not have told the mum to go back upstairs.
"We have a stark contrast between what the mum says and what Lucy Letby says," Mr Johnson tells the court.
"You know he was due to be fed...breastmilk. You know, we say, that is why [the mum] was there.
"This has been wiped out of the records, by Lucy Letby, because she knows the consequences of [the mum] being right about this."

12:54pm

In a November 2020 interview, Letby is asked why she had sent a text referring to Child E had queried whether he had Down Syndrome.
She said she could not remember whether there had ever been any mention of Downs in the medical notes.
The prosecution say Lucy Letby "took an unusual interest" in the family of Child E. She did social media searches on the parents two days after Child E’s death, and on August 23, September 14, October 5, November 5, December 7, and even on December 25.
The prosecution say there were further searches in January 2016.

Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders
 
(NOTE THIS IS PROSECUTION OPENING SPEECH, NOT EVIDENCE)

CHILD F


Chester Standard:

2:20pm

Mr Johnson will now be giving details of the prosecution's case for Child F, the twin brother of Child E.

Child F - attempted murder allegation (by method of insulin poisoning)
The prosecution say Child F was marginally the younger of the twins, and he required some resuscitation at birth and later intubated, ventilated and given a medicine to help his lungs.

2:22pm

He was recorded as having 'high blood sugar' so was prescribed 'a tiny dose of insulin'.
He had his breathing tube removed and was given some breathing support.
Child F had small amounts of breast milk and given fluid nutrients via a long line.

2:24pm

If it is known in advance that a baby cannot have milk and needs to be fed fluids then the TPN bag is prepared by the Aseptic Pharmacy Unit (APU) at the CoCH on receipt of a prescription.
The pharmacy bag is delivered back to the ward and is bespoke, prepared for an individual patient.
"If, for whatever reason, there is no need for a TPN bag, there are a couple of stock bags...kept in reserve."

2:27pm

"As a matter of practice", insulin is "never" added to a TPN bag.
Insulin is "given via its own infusion, usually in a syringe which delivers an automatic dose over a period of time".
The prosecution adds insulin is not added to a TPN bag as it would "stick to the plastic - or bind" to the bag, making it difficult to accurately give a reliable dose.

2:28pm

Early on August 4, Child E had died. Later that day, the pharmacy received a prescription for a TPN bag for Child F, the twin brother.
A confirmation document was printed, at 12.32pm, for Child F. The pharmacist produced a handwritten correction to say it was to be used within 48 hours of 11.30pm that day.

2:30pm

The TPN bag was delivered up to the ward at 4pm that day.
On that nght shift, the designated nurse for Child F, in room 2, was not Letby.
Letby had a single baby to look after that night, also in room 2.
There were seven babies in the unit that night, with five nurses working.

2:33pm

Letby and the designated nurse signed the prescription chart to record the TPN bag was started and administered via a long line at 12.25am.
A TPN chart is a written record for putting up the bags, and was used for Child F. It includes 'lipids' - nutrients for babies not being given milk.
Letby signed for the TPN bag to be used for 48 hours.

2:40pm

There are two further prescriptions for TPN bags, to run for 48 hours.
Following the conclusion of a Letby night-shift, after the administration of a TPN bag Letby had co-signed for, a doctor instructed the nursing staff to stop the TPN via the longline and provide dextrose (sugar to counteract the fall in blood sugar), and move the TPN to a peripheral line while a new long line was put in.
All fluids were interrupted at 11am while a new long line was put in.


2:48pm

Child F's blood glucose increased, before falling back. A new bespoke TPN was made for Child F, delivered at 4pm.
The prosecution say this could not have been the same one fitted to Child F at noon that day which would have been either a bespoke bag which Lucy Letby co-signed for, or a stock bag from the fridge.
Mr Johnson said Child F's low blood sugar continued in the absence of Lucy Letby.
Child F's blood sample at 5.56pm had a glucose level was very low, and after he was taken off the TPN and replaced with dextrose, his blood glucose levels returned to normal by 7.30pm. He had no further episodes of hypoglycaemia.
"These episodes were sufficiently concerning" that medical staff checked Child F's blood plasma level. The 5.56pm sample recorded a "very high insulin measurement of 4,657".
Child F's hormone level of C-peptide was very low - less than 169.
The combination of the two levels, the prosecution say, means someone must have "been given or taken synthetic insulin" - "the only conclusion".
"That, we say, means that somebody gave Child F synthetic insulin - somebody poisoned him."


2:49pm

"All experienced medical and nursing members of staff would know the dangers of introducing insulin into any individual whose glucose values were within the normal range and would know that extreme hypoglycaemia, over a prolonged period of time, carries life threatening risks.
"No other baby on the neonatal unit was prescribed insulin at the time."

2:51pm

Mr Johnson: "To give Child F insulin someone would've had to access the locked fridge, use a needle and syringe to remove some insulin, or, if they didn't do it that way, go to the cotside and inject the insulin directly into the infant through the intravenous system, intramuscular injection, or - and this is what we say happened - via the TPN bag."

2:55pm

Medical experts Dr Dewi Evans and Dr Sandie Bohin said the hormone levels were consistent with insulin being put into the TPN bag prior to Child F's hypoglycaemic episode.
"You know who was in the room, and you know who hung up the bag," Mr Johnson told the jury.

Professor Peter Hindmarsh said the insulin "had to have gone in through the TPN bag" as the the hypoglycaemia "persisted for such a long time" despite five injections of 10% dextrose.

Professor Hindmarsh said the following possibilities happened.
That the same bag was transferred over the line, that the replacement stock bag was contaminated, or that some part of the 'giving set' was contaminated by insulin fron the first TPN bag which had bound to the plastic, and therefore continued to flow through the hardware even after a non-contaminated bag was attached.
"There can be no doubt that somebody contaminated that original bag with insulin.
"Because of that...the problem continued through the day."

3:00pm

Letby was interviewed by police in July 2018 about that night shift.
She remembered Child F, but had no recollection of the incident and "had not been involved in his care".
She was asked about the TPN bags chart. She said the TPN was kept in a locked fridge and the insulin was kept in that same fridge.
She confirmed her signature on the TPN form.
She had no recollection of having had involvement with administering the TPN bag contents to Child F, but confirmed giving Child F glucose injections and taken observations.
She also confirmed signing for a lipid syringe at 12.10am, the shift before. The prosecution say she should have had someone to co-sign for it.
"She accepted that the signature tended to suggest she had administered it."
"Interestingly, at the end of this part of the interview she asked whether the police had access to the TPN bag that she had connected," Mr Johnson added.

3:02pm

In a June 2019 police interview, Letby agreed with the idea that insulin would not be administered accidentally.
In November 2020, she was asked why she had searched for the parents of Child E and F. She said she thought it might be to see how Child F was doing.
She was asked asked about texting Child F’s blood sugar levels to an off- duty colleague at 8am. She said she must have looked on his chart.

3:03pm

Mr Johnson: "The fact it was done through the TPN bag tells you it wasn't a mistake - whoever was doing it was to avoid detection.
"Only a few people had the opportunity.
"We suggest there is only one credible candidate for the poisoning. The one who was present for all the unexpected collapses and deaths at the neonatal unit."

Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders
 
(NOTE THIS IS PROSECUTION OPENING SPEECH, NOT EVIDENCE)

CHILD G


Chester Standard:

3:06pm

Child G - attempted murder allegations (three attempts)
Mr Johnson said Child G, born in May 2015 at Arrowe Park Hospital, was a baby girl and born very premature, weighing 1lb and 2oz.

3:07pm

Child G suffered bleeding on her lungs and had nine blood transfusions, with a number of 'septic' or 'suspected septic' episodes requiring antibiotics, but improved and was transferred to the Countess of Chester Hospital's neonatal unit in August, and was clinically stable, being fed expressed breast milk.

3:09pm

On the night in September, Child G was in nursery 2, with a designated nurse (not Letby). There were seven babies in the unit, with five nursing staff.
Letby's assigned baby that night was in nursery 1.

3:10pm

It was a milestone night for Child G and nurses marked the occasion with a small celebration.
Child G was being fed every three hours alternately by bottle and naso-gastral tube.

3:11pm

At 2am, a feed had shown minimal aspirated of partially digested milk. The nurse took her scheduled one-hour break.
"Nothing is recorded on who was asked to keep an eye on Child G," Mr Johnson said.

3:14pm

At 2.15am, the shift leader said she was sat with Lucy Leader when she heard Child G vomiting, along with Child G's monitor alarm going off.
They ran into her nursery. Child G had vomited violently and suffered a collapse.
The prosecution said medical records suggest the shift leader nurse's memory of being with Lucy Letby for a period of time before this event cannot be accurate.

3:17pm

The prosecution say despite Child G's stomach being 'pretty much empty' prior to her feed, 45mls of milk was aspirated from her NGT.
But, the prosecution say, 45mls of milk had been administered for her feed, which then did not explain what accounted for the vomit.
Subsequent x-rays showed air in the abdomen and intestines.
Child G suffered further deteriorations. During intubation, a doctor noticed bloodstained fluid from the trachea - something the prosecution say was consistent with that seen in other collapses in the case so far.

3:19pm

At 6.05am, following a further desaturation, 100mls of air was aspirated from the NG tube. When the tube was removed, the registrar noted thick secretions in her mouth "and a blood clot at the end of her breathing tube". There were also signs of infection.
Child G was transferred to Arrowe Park, before returning to the Countess neonatal unit just over a week later.

3:19pm

During that time, Child G "recovered remarkably".

3:20pm

Five days after her return to the Countess, Child G was due to receive her immunisations, such was her improved condition.
A team of nurses came on the day shift that day, Lucy Letby being among them. Letby was Child G's designated nurse that day.

3:23pm

Child G was fed with 40ml via a NG tube by Letby at 9.15am. At about 10.20am, Child G had projectile vomited twice and went apnoeic for several seconds, the court is told. Child G's blood saturations fell to 30%. The same problem she had faced two weeks prior.
A nurse took over the care from Letby at 11.30am, as Letby was looking after two other children in room 4.
The nurse took all the observations and noted Child G was connected to a 'Masimo monitor' - which measures oxygen saturations and heart rate levels. It is a device which stays on and cannot be turned off by a baby.

3:25pm

At 3.30pm a consultant doctor was called to cannulate Child G. Privacy screens were erected and Child G was on a trolley, with the monitor still attached.
The nurse went to care for another baby.
The consultant doctor said he "could not recall" if Child G's monitoring equipment was switched off during the cannula fitting, but "it is his practice to transfer the sensor from one limb to another or if temporary detachment is required to reattach the monitor as soon as possible."
He added if Child G was not stable he would not have left her.

3:26pm

After the doctors had gone, the nurse responded to Lucy Letby's shout for help. When she attended, Child G's monitor had been switched off (power was off). Child G was struggling to breathe. Letby was giving ventilation breaths.
Child G responded to treatment.

3:28pm

In a text sent by Letby to a colleague, she wrote Child G: "...looked rubbish when I took over this morning then she vomited at 9 and I got her screened … mum said she hasn’t been herself for a couple of days”.
But the prosecution said Child G had been due to have her immunisations, something which would not have been contemplated if Child G had not been well.
The prosecution say Child G had vomited because she had been given excessive milk and air.
A subsequent MRI scan revealed neurological changes and, in August 2016, it was revealed Child G had suffered "irreversible brain damage".

3:29pm

The overfeeding "doesn't happen by accident," Mr Johnson told the court.
He added similar cases will be heard with other babies.

3:30pm

Mr Johnson: "Someone had switched off the monitor when Child G collapsed, and she was 'discovered' by Lucy Letby".

3:35pm

In police interview, Letby said she remembered the nurse had been on her break when the incident happened with Child G in nursery 2. She could not remember who had been assigned to look after her.
Letby suggested the excess air in Child G after the vomiting was the result of some sort of infection, or as a consequence of the vomiting.
She said she had withdrawn the 45mls of milk after that episode, and air had come with it, and she had seen Child G vomiting.
She said she did not know why she had gone into the room, but it was possible it was as a result of hearing Child G vomiting.
Letby 'vaguely' recalled the day Child G vomited after her return to the hospital, accepting she had been the designated nurse. She had no recollection of Child G vomiting.
In a subsequent interview, Letby accepted there were only two alternatives to the first vomiting incident - that Child G had been fed far more than should have been, or she had not digested her earlier feed.
She accepted that the clear inference to be drawn was that Child G had been given excess milk and air via the NGT. She denied responsibility for either of those eventualities.

3:37pm

For the second incident, Letby denied either over-feeding or injecting air into Child G's stomach.
In Novemver 2020, Letby denied to police that she had switched off the Masimo monitor.
She was asked about Facebook searches carried done on the day of the second vomiting incident that Letby looked up the parents of Child G. She said "she had no recollection of them".

3:39pm

The prosecution say that, within a minute or two of looking at the mother of Child G on Facebook, she then looked at the mums of two other babies listed in the charges.
One was the mum who, the prosecution said, "interrupted the attack" by Letby on Child E.

3:41pm

Mr Johnson: "The practice of the nurses on the NNU was to use the NGT to check whether an infant had an empty stomach before feeding. That was done in Child G’s case – nothing came up which means there was nothing in her stomach.
"She was then fed and her designated nurse went on a break. 15 minutes later Child G produced projectile vomits of such force that they left the cot and landed on the floor and nearby chair.
"Child G collapsed and stopped breathing. An amount of feed was aspirated from her NGT equal to what she had been given about 15 minutes earlier together with lots of air.
"There was a similar episode a few weeks later.
"These were not naturally occurring, or random events; they were deliberate attempts to kill using a slightly different method by whilst Lucy Letby sought to give the appearance of chance events in the neonatal unit at the Countess of Chester Hospital."

Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders
 
(NOTE THIS IS PROSECUTION OPENING SPEECH, NOT EVIDENCE)

CHILD H


Chester Standard:

10:35am

Child H - attempted murder allegation (twice)
Child H was born in September 2015 and had breathing difficulties shortly after birth.
She was transferred to neonatal unit nursery room 1.

10:37am

Independent experts say there was an "unacceptable delay" in tubating her and administering a protein which helps the lungs, which the prosecution say means the case is complicated by "sub-optimal treatment" at the hospital.
Additionally, Child H "was put on a ventilator she was not paralysed; she was also left with butterfly needles in her chest for prolonged periods which may have punctured her lung tissues and contributed to further punctured lungs."

10:44am

The prosecution say Letby attempted to kill Child H on September 26 at 3.24am, and on September 27 at 12.55am.
Mr Johnson said Child H had previously deteriorated on the night of September 23 and required ventilator support and intubation, followed later by oxygen support.
The court hears Child H responded to intervening treatment, but desaturations were "frequent" and "significant".
Mr Johnson said all but two events could be explained medically and responded to with routine resuscitative measures.
The two events - in the early hours of September 26 and 27, were "uncharacteristic" and required CPR.

10:49am

Letby was on duty for both those night shifts, and was the designated nurse for Child H.
That night, Child H was given a blood transfusion.
At 2.15am, medical notes by a doctor showed a re-accumulation of her left-sided pneumothorax. A further chest drain was inserted to relieve the pressure.
The ICU chart shows that Letby recorded having given Child H a dose of morphine at 1.25am and a dose of saline at 2.50am. The saline bolus was set to run for 20 minutes and would therefore have ended at 3.10am. Lucy Letby would have had the cover of legitimacy for accessing Child H's lines just before she collapsed again.
At 3.22am, Child H collapsed and required CPR. The attending doctor said the cause was unclear. He concluded the episode was 'hypoxia' (shortage of oxygen).

10:53am

Letby made notes at 4.14am, recording a lowering of the heart rate at 11.30pm which required treatment.
She recorded the additional chest drain and a blood transfusion at 2am.
Of the collapse at 3.22am, she recorded: "profound desaturation and colour loss to 30%, good chest movement and air entry, colour change on CO2 detector, neopuff commenced in 100% oxygen and help requested. Serous fluid +++ from all 3 drains, became bradycardic. Drs crash called and resus commenced as documented"
At 5.21am, Letby recorded a conversation between herself, the attending doctor, and Child H's parents.

10:54am

During the following day, Child H was relatively stable.
A different nurse was the designated nurse for Child H, still in room 1, on the night of September 26. Letby was also on duty.

10:56am

The designated nurse 'could not recall' if she had taken a break during the shift, but there would have been times she would have gone out of the room to get a drink or retrieve something from a cupboard.
Letby was looking after a child in room 2.
Child H suffered "two sudden and unexpected episodes of profound desaturation at 12.55am and 3.30am."

10:58am

The registrar responded to the emergency calls and on one occasion, saw Letby administering treatment, and took the history from her, assuming she was the designated nurse.
The nurse noted 'pink tinged secretions' around Child H's mouth.
The prosecution say this was a similar finding to that found on three other babies in the case so far.

11:04am

The nurse noted a 'profound desaturation' - a "profound drop in Child H's blood", despite air going into the lungs and carbon dioxide coming out.
Both collapses at 12.55am and 3.30am had "no known cause".
Child H was transferred to Arrowe Park Hospital at 5.25am, and was stabilised en route in the ambulance.
Her mother, who was with her spoke of a "dramatic improvement" as soon as Child H got to the hospital.
Child H returned to the Countess of Chester Hospital and the rest of her time was uneventful before being discharged.
The court hears she had not suffered any permanent consequences.

11:06am

The prosecution says medical expert Dr Dewi Evans said there was "no obvious explanation" for Child H's deterioration in those two early-morning collapses.
Dr Sandie Bohin "expressed concern" at those events, and the collapses "were more significant than the others, for which there are obvious clear medical explanations".
She was also "critical of the way the chest drains were inserted and managed".

11:09am

Letby was interviewed in 2018 by police. She confirmed she had remembered Child H because she had chest drains - which the court hears are a fairly rare thing these days.
For the second incident, Letby said she had not been the designated nurse so assumed she had not been caring for Child H.
She identified her signatures on two medicine administrations.
In 2019, she identified her signature on more documents. In this interview, she told police she had not been the designated nurse but had been giving her treatment at the time Child H collapsed.

11:11am

On October 5, 2015, the prosecution say Letby searched for the mum of Child H, the father of Children E and F, and the mother of Child I. It was her day off.
Mr Johnson said: "We say this has to be looked in the context of everything else.
"We say it is more than an innocent coincidence that once Child H was moved out of the Countess of Chester Hospital she had no further problems."



Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders
 
(NOTE THIS IS PROSECUTION OPENING SPEECH, NOT EVIDENCE)

CHILD I


Chester Standard:

11:12am

Child I - murder allegation

Child I was born in Liverpool Women's Hospital, premature, on August 2015.


11:13am

The prosecution say Letby made four attempts to kill Child I, succeeding on the fourth attempt.


11:14am

Child I was born, weighing 2lbs 2oz, but in good condition. She was intubated and ventilated, then supported by CPAP, and fed through a nasogastric tube.
In the first few weeks, she had "a few problems", but "all were resolved".

11:19am

Child I, by late September, had diminshed clinical concerns, and no breathing problems.

For what the prosecution say was the first attempt, Letby was on a 'long day' shift (8am-8pm) on September 30. She was Child I's designated nurse in room three.

According to Child I's mum, Letby expressed concern about the child and indicated Child I would be reviewed by a doctor.

When she made a nursing note, Letby "reversed the concern", and said it was the mum who had raised a concern about the abdomen, saying it was "more distended to yesterday" and Child I was "quiet...not on monitor but nil increased work of breathing”.



11:26am

A review took place at 3pm - over an hour after these notes. Child I appeared mottled in colour with a distended abdomen and prominent veins.

A feeding chart showed 35mls was given to Child I when asleep, but Letby had recorded Child I as "handling well and waking for feeds".

At 4pm, Letby recorded feeding Child I 35mls of expressed breast milk via the NGT.

An emergency crash call was called at 4.30pm as Child I had vomited, desaturated, her heart-rate had dropped and she was struggling to breathe.

Her airway had to be cleared and she was given breathing support, and Child I was transferred to room 1.

11:27am

An x-ray at 5.39pm revealed a "massive amount of gas in her stomach and bowels" and her lungs appeared "squashed" and "of small volume".

The prosecution say air had been injected into the NGT to give a 'splinted diaphragm'.

11:29am

A doctor recorded Child I had suffered a 'respiratory arrest' at 4.30pm, struggling to breathe, she was pale and distressed, and the abdomen was 'distended and hard'.

The NGT was aspirated and produced 'air+++ and 2mls of milk', after which Child I improved.

The prosecution says this is at odds with the 35mls of milk Child I was fed with at 4pm.

11:30am

The prosecution say "removed from the orbit of Lucy Letby," Child I's condition improved.


11:32am

Child I continued to improve and was in nursery room 2 on the night of October 12 by a designated nurse different to Letby. Letby was looking after a baby in room 1.

Child I was being bottle fed every 4 hours, and at 1.30am took a 55ml bottle of breast milk.

At 3am, the designated nurse left the nursery temporarily and said she asked either Letby or another colleague to listen out for Child I.

11:36am

The designated nurse, records show, helped another colleague with something in room 1.
The prosecution say it is more likely the nurse would have asked Letby to look out for Child I.

Upon the designated nurse's return to room 2, Letby was "standing in the doorway of the room" and Letby said Child I "looked pale".
The designated nurse switched on the light and saw Child I was "at the point of death". She later recalled the child was breathing about 'once every 20 seconds'.

The prosecution says the jury should consider how Lucy Letby could see a child was looking pale when the room was darkened at 3.20am, with minimal lighting.

11:39am

The prosecution say the nurse's recollection is right, as Lucy Letby made a note at the end of her shift at 8.10am:

'[Child I] noted to be pale in cot by myself at 03:20hrs … apnoea alarm in situ and had not sounded. On examination [Child I] centrally white, minimal shallow breaths followed by gasping observed.'

11:42am

The registrar was called to the unit at 3.23am. On arrival, he saw nurses giving Child I full CPR. The notes suggest he had to reposition the ETT.

A consultant doctor administered adrenaline, intubated and ventilated Child I.

An X-ray showed gross gaseous distention throughout the bowel and signs of chronic lung disease of prematurity (CLD).

Child I, the prosecution say, had the same problem that she had when Letby had fed her on September 30.

The medical team felt that the abdominal distention had affected her ability to expand the chest and in turn caused desaturation.

Both nursing and medical staff commented on a bruised like discolouration to the right of the sternum. They assumed this was the result of chest compressions.

The category of nursing care was raised a level.
"Ironically," the prosecution say, Letby was made the designated nurse, as she was more qualified.


11:43am

Medical notes showed the ETT had been "displaced" and, at 4.25am, the NGT was "curled in the oesophagus", which the prosecution say would have prevented release of the pressure created by excess air in the stomach.

11:45am

For what the proseution say was the third attempt, Letby had responsibility for Child I on the night of October 13.

Both Letby and a doctor recorded Child I had increasing abdominal distension, discolouration to the right and sensitivity to touch between 5am and 5.55am.

The X-ray taken at 6.05ams showed widespread gaseous distention sufficient to splint the diaphragm. This prevented her from breathing properly.

Child I had the same problem as before.


11:47am

At 7am, CPR was required as Child I had a 'significant desaturation'.

The doctor recorded, at 7.10am: "desaturating again despite good AE (air entry), chest wall movement and negative cold light (i.e. no pneumothorax) … at about 7.45am HR (heart rate) below 60. CPR initiated… [various boluses given] … capnography positive. Chest wall movement and equal AE noted…”

The prosecution says Child I was "brought back from the brink of death right at the end of the shift, at 7.58am".


11:48am

Letby noted at 8.43am:
"At 05:00hrs abdomen noted to be more distened (sic) and firmer in appearance with area of discolouration spreading on right hand side. Veins more prominent … gradually requiring 100% oxygen. Blood gases poor as charted …. nil obtained from NG tube throughout. Continued to decline. Re intubated at approx. 07:00 – initially responded well … resuscitation commenced as documented in medical notes. Night and day staff members present”

That was, the prosecution say, the third attempt at murder.


11:49am

Child I was transferred to Arrowe Park Hospital. She had an episode of bradycardia and desaturations after which she quickly stabilised.

The prosecution say once again, a child had recovered quickly out of the care of Letby.

Child I was transferred back to the Countess of Chester Hospital on October 17.

11:51am

On the night of October 22, Letby was on a night shift, with a different nurse being the designated nurse for Child I.

Between 8pm and Child I's collapse, the only entry Letby made in any child's records was those in her charge in room 3.

The prosecution say it was, from her records, a slow night for her.


11:53am

Just before midnight, Child I became unsettled. Letby and another nurse attended to her but Child I collapsed and required CPR.

The on-call registrar noted Child I had a mottled blue appearance of the trunk and peripheries.

After 5 minutes of CPR, Child I's saturation rate returned to 100% and she recovered to the point of 'rooting' - ie a sign of hunger, and was 'fighting the ventilator' - ie trying to breathe independently.

The ET tube was removed at 12.45am.



11:54am

At 1.06am a nurse, having left the nursery temporarily, responded to Child I's alarm and saw Lucy Letby at the incubator.

Child I was very distressed and (inserted by me: the designated nurse ?) wanted to intervene, but Letby assured her that they would be able to settle the baby.*

"Don't worry - we will sort it out," Mr Johnson tells the jury.(said by Letby?)

Child I then collapsed.

11:57am

The on-call doctor arrived and resuscitation attempts were made. Purple and white mottling were noted on Child I's skin.

All resuscitative efforts were unsuccessful and treatment was withdrawn at 2.10am, and Child I was pronounced dead at 2.30am.

In the immediate aftermath, Child I's parents were taken to a private room.

As the mum bathed her recently deceased child, Lucy Letby came into the room and, in the words of the mum, "was smiling and kept going on about how she was present at [Child I']s first bath and how much [Child I] had loved it.”


11:58am

The cause of death was given by the coroner as
Hypoxic ischaemic damage of brain and chronic lung due to prematurity and 1b. Extreme prematurity.

All loops of bowel showed significantly dilated lumen due to increased air content – in layman’s terms they were expanded like a partially inflated balloon. There was no sign of NEC (bowel necrosis) or any other bowel problem.

The prosecution say there were signs of "earlier hypoxic ischaemic damage – in other words, the earlier attempts to kill her had caused brain damage resulting from a shortage of oxygen."


12:03pm

Medical expert Dr Dewi Evans said he believed the apnoea monitor might have been switched off on October 13 for child I, and the deliberate administering of a large bolus of air into Child I's stomach via her NG tube on October 22/23.

In police interview, Letby said she could not remember the circumstances of September 30, and had taken over the care of Child I after the child had an "episode".

She said she had no recollection of the events surroudning Child I's death, and said the child had been returned from Arrowe Park Hospital too quickly.

In June 2019, she was asked about a sympathy card she had sent to the child's parents. She said it was not normal to do so - and this was the only time she had done so.

She accepted having an image of that card on her phone.

She was asked about the October 13 incident and challenged the nurse's account, adding: "Maybe I spotted something that [the nurse] wasn't able to spot", as she was "more experienced".

She was asked why she had searched for the parents' details on Facebook. She said she did not recall doing it.


12:04pm

The prosecution say Child I "was doing well by the time Lucy Letby got her hands on her.

"What happened...followed the pattern of what happened to others before and what has yet to happen to others.

"All of a sudden out of nowhere came vomiting, breathing problems and critical desaturations.

"It was persistent, it was calculated, and it was cold-blooded."



Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders
 
(NOTE THIS IS PROSECUTION OPENING SPEECH, NOT EVIDENCE)

CHILD J


Chester Standard:

12:24pm

Child J - attempted murder charge

Child J, a girl, was initially stable but it was discovered she had a necrotic and perforated bowel. The prosecution say she really did have NEC.

She was transferred to Alder Hey for surgery to fit her with a stoma bag.


12:27pm

Child J 'recovered well' and was taken to the Countess of Chester Hospital on November 10, 2015.

She had a relatively rare type of intravenous line fitted, a 'Broviac line'.

On November 16, medical notes referred to her as being well.

But on November 27, she suffered an unexplained collapse in the early hours. Letby was on duty.


12:28pm

Before she went to work for that shift, Lucy Letby exchanged text messages with one of her colleagues.

The prosecution say It seemed that she was not happy with working conditions and she referred to the difficulties of looking after the babies who just needed feeding support.

Child J was one of those.

The prosecution add that it appeared working in such nurseries was "not sufficiently stimulating for Lucy Letby".

12:33pm

Letby was in a different room to Child J, and was not the designated nurse, but 'got involved', by co-signing for medication at 12.02am.

Letby's colleague was a band 4 nurse and not sufficiently qualified to give intravenous medication.
After 4.40am, that nurse thought Child J became pale and mottled.

She left the room for a short time, and upon her return another nurse was assisting Child J with breathing.

The last thing Letby had recorded on notes was at 3am.

There is data from the door system showing Letby coming in at 3.47am. The prosecution suggest Letby had been on a break during that time.

Just after 5am, Child J suffered another desaturation and she was moved to the hugh dependency unit in room 2.

The registrar was called and Child J was working hard to breathe, but had otherwise recovered well.

At 6.56am, Child J's alarm sounded and Letby was among those responding.

A doctor attended and took control. He noted oxygen levels were 'unrecordable' and circulation 'poor'. There were symptoms of a seizure.


12:35pm

At 7.20am, Letby co-signed a chart for a 10% glucose infusion.

At 7.24am, Child J collapsed again. The doctor assisted in resuscitating her.

Child J recovered and the doctor could not explain what happened from the results of various tests taken.
He considered the events unexplained.


12:37pm

Medical expert Dr Dewi Evans described the collapse at 7.11am as unexpected without any straightforward explanation.

He said that it was “of concern and consistent with some form of obstruction of her airways, such as smothering”.
The symptoms of a seizure suggested oxygen deprived to the brain.

Child J has not suffered a seizure since.

Dr Evans added: "Whilst I have concerns...one cannot rule out the presence of infection, despite the normal inflammatory markers… at the time of the two collapse episodes…I note also the presence of the stoma which could be the source of the organism(s) that caused her systemic infections.”

Dr Evans, in a follow-up statement, maintained 'airway obstruction' was the most likely cause of Child J's collapse.

Dr Sandie Bohin concluded that the issue was not infection because there were no “soft signs” and the gradual deterioration which might be expected, but the collapse was "sudden" and had caused seizures.

12:39pm

In interview, Letby said she had little recollection of Child J, but remembered the Broviac line.

She confirmed contact with Child J, but denied doing anything to cause her harm.

In 2020, she was asked why she had searched Facebook for Child J's parents. She replied: "I don't remember doing that."


12:40pm

The prosecution said:

"It is remarkable that on many occasions, when children who had suffered unexpected spectacular and life-threatening collapses were removed from her [Lucy Letby's] orbit, they had exceptional recoveries."



Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders
 
(NOTE THIS IS PROSECUTION OPENING SPEECH, NOT EVIDENCE)

CHILD K


Chester Standard:

12:42pm

Child K - attempted murder allegation
Child K was born at the Countess of Chester Hospital in February 2016, very premature, and weighing only 692g.
There was not time to deliver at a hospital for this type of maternity delivery care. Dr Ravi Jayaram, paediatric consultant, was present at her birth as a result.


12:45pm

Lucy Letby booked Child K on to the neonatal unit. Child had required help with breathing, but was stable and in as good a condition as a baby of that prematurity could be.
Arrangements were made for Child K to transfer her to Arrowe Park Hospital.
At 3.50am, Dr Jayaram was standing at the nurses’ station compiling his notes. Although he did not have a view into Nursery 1, Dr Jayaram was aware the deisngated nurse was not there, a fact backed up by door swipe data. Lucy etby was the only nurse in room 1, alone with Child K.
"Feeling uncomfortable with this because he was beginning to notice the coincidence between the unexplained deaths and serious collapses and the presence of Lucy Letby, Dr Jayaram decided to check on where Lucy Letby was and where Child K was."

12:46pm

"As he walked in, he could see Letby standing over Child K's incubator. He could see Child K's oxygen levels were falling. However, the alarm was not sounding and Lucy Letby was making no effort to help.
"Dr Jayaram went straight to treat Child K and found her chest was not moving, he asked Letby if anything had happened to which she replied, “she’s just started deteriorating now”.

12:48pm

Dr Jayaram found Child K's breathing tube had been dislodged.
Child K was very premature, and had been sedated and inactive. The tube had been secured by tape and attached to Child K's headgear.
Mr Johnson: "It's well recognised if you handle a child you can dislodge the tube accidentally, but any experienced staff member would recognise that.
"Dr Jayaram was troubled as the levels were falling and Nurse Letby had been the only person in the room."

12:52pm

The prosecution added: "On these monitors, all readings are set to default values in the neonatal unit.
"Saturation levels falling to the 80s, is a serious issue and if the machine is working properly, it would have an alarm if the saturation levels fell to the 80s, as Dr Jayaram noticed.
"There is an alarm pause button on the screen of the monitor - if you want to treat the child, you don't want the alarm going away. It will pause for one minute.
"Bearing in mind the rate displayed on the monitor, Dr Jayaram estimates the tube would have been dislodged between 30-60 seconds, and that is on the assumption the alarm had been cancelled once."
The court hears Dr Jayaram did not make a contemporaneous note of his suspicions or the alarm failing to activate.

12:56pm

Child K remained unwell and later died.
Medical expert Dr Dewi Evans viewed Lucy Letby’s failure to summon help as soon as possible was unusual.

12:57pm

The prosecution allege that Lucy letby was trying to kill Child K when Dr Jayaram walked in.

1:00pm

In police interview, when Dr Jayaram's account was put to her, she said no concerns had been raised at the time.
She said the alarm had not sounded. She said Child K was sedated and had not been moving around.
She also did not recall either any significant fall in saturations or there being no alarm. She accepted that in the circumstances described by Dr Jayaram she would have expected the alarm to have sounded.
she denied dislodging the tube and said she would have summoned help had Dr Jayaram not arrived, saying she was "possibly waiting to see if she self-corrected, we don’t normally intervene straight away if they weren’t dangerously low".
After the interviews - that suggestion made by Lucy Letby was referred to a nursing expert. Her view was that it was very unlikely that a nurse would leave the bedside of an intubated neonate unless they were very confident that the ET tube was correctly located and secure, the baby was inactive and then they would be away only briefly.
The nurse dismissed the idea that a competent nurse would have delayed intervention if there had been a desaturation.
Letby was found to have researched Child K's parents on Facebook in April 2018 - two years and two months after Child K had died. When asked about this, she said she did not recall doing so.



Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders

---------------------------------------------------------------------------------------------------------------------------------------------------

Sky News:

13:06

Letby was 'trying to kill' Child K when suspicious paediatric consultant walked in on her​

A different designated nurse took over the care of Child K at 7.30am, the court hears as the prosecution opening continues.
As the shift leader arrived at the unit: "Lucy Letby was again at Child K's cot calling for help."
It was found the baby's breathing tube had slipped too far into her throat.
At 9am she was transferred to Arrowe Park Hospital in Wirral where she remained unwell and died on 20 February 2016.
An independent medical expert took the view that "Lucy Letby’s failure to summon help as soon as possible was unusual", the prosecution says.
They go on: "That, together with Child K having been sedated and the alarm not sounding, made it very likely the dislodgement was a deliberate act".
They "did not believe an accidental or innocent dislodgment of the tube was a plausible explanation", it is claimed.
"We alleged she was trying to kill Child K when the paediatric consultant walked in on her," says Nick Johnson KC.
Letby is charged with the attempted murder of Child K.
She denies all the charges against her.

Lucy Letby trial - latest: Nurse 'adamant' she's done nothing to harm any of the babies in the case as defence begins
 
(NOTE THIS IS PROSECUTION OPENING SPEECH, NOT EVIDENCE)

CHILD L AND CHILD M


Chester Standard:

2:15pm

The next case concerns twin brothers.
Mr Johnson refers to Child L first.
Child L - attempted murder (by insulin)

2:16pm

Child L was born in April 2016. It is the prosecution case Letby poisoned Child L, while also attacking Child M - the twin.

2:19pm

Child L's blood glucose level was noted to be low and he was treated with a dextrose infusion. His condition improved and he was stable by the day-time shift of April 9.
Letby came on duty that day at 7.30am.
By this time, the prosecution say, Letby was supposed only to be working day shifts because the consultants were concerned about the correlation between her presence and unexpected deaths and life-threatening episodes on the night-shifts.

2:21pm

In the hours that followed, Child L's glucose levels fell abnormally low. He was given additional doses of glucose, but they proved ineffective.
The answers to these levels were found after a lab sample sent to the Royal Liverpool Teaching Hospital laboratory came back with results some time later.
The results of the test were "grossly abnormal", but nothing was done about it as Child L had, by the time the results came back, returned to normal.

2:22pm

The reading was "at the very top of the scale" the equipment could measure, the court hears.
There was no correspondingly high level of C-peptide: it was within the normal range. The only explanation for this anomaly is that what was being measured was synthetic insulin, which had not been prescribed to Child L but was stored and readily available in the neonatal unit.

2:25pm

The court is shown an 'infusion therapy prescription sheet', a written record of the dextrose bag fed to Child L.
The bag was running from noon on April 8, when it had been set up an hour earlier by Letby and another nurse.
Prosecutor Nicholas Johnson KC: "We say Lucy Letby added insulin to that bag of dextrose. She did it deliberately to kill [Child L].
"She had failed to kill [Child F] so gave an increased dose."

2:26pm

Letby had been present for the birth of Child L. She cared for him on his first day and the prosecution say would have been aware of his mild hypoglycaemia.
Child L's blood sugar level remained "dangerously low" through the day.
At 4.30pm, a new infusion bag was required and this was being applied when Child L, the twin brother, was being taken ill.

2:29pm

The prosecution says medical expert evidence is this was a case of insulin poisoning, administered intravenously via Child L's liquid feed.
In police interview, Letby said she was aware of Child L's low blood sugar levels and knew the insulin was kept in a locked fridge, with a variety of other drugs. Keys were passed around nursing staff and there was no record of who held the keys at any time.
She agreed the insulin could not have been administered accidentally, but denied being responsible.
Her explanation was it must have been in one of the bags already being received.
The prosecution say that is not a credible possibility.

2:32pm

Child M was born in good condition and was assessed as requiring 'special care'.
He had an unexpected life-threatening event at about 4pm on April 9, at the same time his twin's blood sugar was gangerously low.
The prosecution say "he came close to death", but "within four hours he was able to breathe unsupported in air."

2:37pm

At 3.30pm, a fluid bag was attached to Child M. At 3.45pm, he received intravenous antibiotics.
The notes showed Letby was one of two to administer the medicine. Digital records show Letby's colleague was using the computer at 3.45pm.
At 4pm, Child M's monitor alarmed and Letby was first to the cot.
The emergency was such that doctors were called urgently.
The consultant, Dr Ravi Jayaram attended and noticed unusual patches of discolouration on Child M’s skin which he thought particularly noticeable because of Child M’s skin tone. He thought the patches unusual because normally, if a baby arrests and there is not enough oxygen moving round the body, the baby is uniformly pale, grey or blue. What he saw he thought similar to what he had seen during the resuscitations of Children A and B.

2:38pm

Child M did not respond well to resuscitation. Six doses of adrenaline followed in 25 minutes and treatment was "about to be withdrawn", when Child M "suddenly improved".
Dr Jayaram could not find any cause for the sudden collapse, but the discolouration he saw caused him to suspect an air embolism.

2:39pm

At 9.14pm, Letby noted Child M was tensing his limbs, curling fingers and toes and rotating hands and feet inwards - signs of brain damage.
On the following night-shift, Child M had what the prosecution called a 'speedy recovery', although he did suffer further desaturations.

2:41pm

Medical expert Dr Dewi Evans said the rapid recovery would not have meant infection or a lung problem was ikely. His conclusion was airway obstruction or air embolus.
A paediatric neuroradiologist reviewed a brain scan on May 2016 and found brain damage for Child M, likely caused by the cardio-respiratory collapse on April 9.

2:44pm

Mr Johnson says when Letby's home was searched in 2018, a handwriten log of drugs administered during Child M's collapse was found, and she had made a note of the collapse in her diary.
'LD [Long day] - twin resus'.
In police interview, Letby agreed she had connected a fluid bag to Child M and had co-signed for medication at 3.45pm but could not be sure if she had administered it.
She thought she must have taken the notes home 'by accident', and had simply noted what had happened in her diary.
She denied that the notes were a "souvenir" and denied deliberately trying to harm Child M. She could think of no reason how he would have suffered an air embolism.

2:45pm

The prosecution says the cases of Child E-F and Child L-M are similar, in that one suffered an insulin overdose and the other an IV air embolism.
Mr Johnson: "We suggest that coincidences like that simply do not happen innocently. Someone was responsible and the only credible candidate is Lucy Letby."


Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders
-----------------------------------------------------------------------------------------------------------------------------------------------
Sky News:

14:29

Consultants moved Letby off night shifts after being concerned about her presence​

The prosecution has now moved onto Children L and M, twin boys who would both survive being attacked.
Prosecuting, Nick Johnson KC alleges that Letby attacked Child L first with insulin and "whilst that attack was under way she also attacked Child M".
Child L - who was born premature - was described as improved by the morning of 9 April 2016.
"By this time Letby was supposed only to be working day shifts because the consultants were concerned about the correlation between her presence and unexpected deaths/life-threatening episodes on the night-shifts," the prosecution tells the court.
In the hours that followed Letby's arrival, Child L's glucose levels fell to "abnormally low levels".
He was given an additional dose of glucose in an attempt to correct the hypoglycaemia - which proved ineffective.
Later test results revealed "very high levels of insulin" in his blood.
"Somebody poisoned Child L with insulin," says Mr Johnson, "A drug that is readily available" on the unit.

14:32

Letby increased the dose to kill Child L 'after failing to kill Child F'​

The prosecution tells the court the attack on Child L mimics that of Child F - who they say was also poisoned with insulin.
Nick Johnson KC says Letby "deliberately" set out to kill Child L.
"She had failed to kill Child F and so she increased the dose," the prosecutor tells the jury.
"She saw the opportunity to complete what she had attempted with Child F."
Independent experts say this was a case of "insulin poisoning" and was administered intravenously via Child L's liquid feed, jurors are told.
"The level of insulin was greater than the range the machine could measure," Mr Johnson says.
In a police interview, Letby said she was aware of Child L's low blood sugar levels.
She said she knew prolonged hypoglycaemia could cause severe brain damage - or even death.
"She denied being responsible, her only explanation was it must have already been in one of the bags that Child L was receiving," Mr Johnson says.
"For reasons that we will explore in evidence, we say that is not a credible possibility."

14:44

As one twin's blood sugar was 'dangerously low', another came 'close to death'​

At the time his brother's blood sugar was "dangerously low", Child M came "close to death", prosecutor Nick Johnson KC tells the jury.
Without warning, his heart rate and breathing dropped significantly and he required a full resuscitation by medical staff.
Yet "four hours later, having been resucitated, he was breathing unsupported".
At 3.30pm, a fluid bag was attached to Child M. Just 15 minutes before his collapse, Child M received intravenous antibiotics - administered either by Letby, or another nurse.
"So it was that Lucy Letby had the opportunity to interfere with Child M's wellbeing, under the cover of legitimate care," Mr Johnson says.
When Child M's monitor went off, Letby was first to the cot, the court is told.
Another nurse on shift says Letby was standing with her at a computer when the alarm activated - but agreed Letby was first to the cot.
The consultant noticed unusual patches of discolouration on Child M's skin. What he saw he thought "similar" to what had been seen during the resucitations of Children A and B, the prosecutor says.
Child M "did not respond well" and treatment was about to be withdrawn after six doses of adrenaline when "all of a sudden, he improved".
The consultant "could not find a cause for this sudden collapse".
"But the discolouration he saw caused him to suspect air embolism - an injection of air," Mr Johnson tells the court.
Letby then became Child M's designated nurse.

14:48

Child left brain damaged following 'near death experience' - as Letby made note in her diary​

Child M had a "remarkably speedy recovery" from his "near death experience", the court is told as the prosecution opening continues.
One independent medical expert said he "would not have expected such a prompt recovery" had the cause been infection or some other lung problem.
They concluded an injection of air, or an obstruction of his airway, was most likely, the prosecution says.
A neurologist reviewed a later brain scan from Child M and found brain damage "which was, in his opinion, most likely caused by his cardio-respiratory collapse" on 9 April 2016.
The court is then shown an image of Letby's diary from the time, in which she had made a note of the incident.
Letby "denied the notes were a souvenir" and denied deliberately trying to harm Child M. She could think of no reason of how he would have suffered an air embolism, according to police interviews.
The prosecution says the case of twins L and M are similar to that of twins E and F, where one suffered an insulin overdose and another an injection of air.
"What are the chances of that happening innocently?" Mr Johnson asks the jury.
"We suggest that coincidences like that simply do not happen innocently.
"Someone was responsible and we suggest the only credible candidate is Lucy Letby."




Lucy Letby trial - latest: Nurse 'adamant' she's done nothing to harm any of the babies in the case as defence begins
 
(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
-----------------------------------------------------------------------------------------------------------------------------------------------------
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
 
(NOTE THIS IS PROSECUTION OPENING SPEECH, NOT EVIDENCE)

CHILD O


Chester Standard:

3:16pm

Child O - murder allegation
Child O and Child P were two of three triplet brothers, the court hears.

3:17pm

Child O weighed 2.02kgs, which was good for a premature triplet. He was in good condition and made good progress.
He was stable up to June 23, when he suffered what Dr Evans said was a “remarkable deterioration” and died.

3:18pm

Between June 15 and June 23, Lucy Letby had been on holiday in Ibiza.

3:21pm

Child O's body was examined after his death and an injury to his liver was found.
Letby was working the day shift on June 23 and was the designated nurse for Child O and P, in room 2, with another child.
The prosecution say this "gave her an open opportunity to sabotage the babies".
The third of the triplets was in room 1, the doctors believing he was the most needy of the triplets.

3:28pm

Letby also had the responsibility of supervising a student nurse that day.
The designated nurse recorded 'no nursing concern - observations normal' for Child O.
There are three records of feeds by Letby, at 8.30am, 10.30am, and 12.30pm - the earliest signed by the student nurse, the latter two signed by etby.
In a note made by the doctor at 1.15pm, there was '1x vomit post feed' with 'abdomen distended'.
Child O was put on to IV fluids as a precaution.
Child O's heart rate was 160-170, blood gases were low, and raised CO2 level.
The doctor recorded the results as 'not normal' for a child breathing on their own and treated for suspected 'NEC'.
It was thought down to Child O's swallowing of air or the passing of a stool earlier.
An x-ray taken at the time showed a moderate amount of gas in the bowel loops throughout the abdomen.

3:29pm

Letby noted at 8.35pm - 'reviewed by registrar at 1.15pm - [Child O] had vomited (undigested milk) tachycardic and abdomen distended. NG tube placed on free drainage … 10ml/kg saline bolus given as prescribed along with antibiotics. Placed nil by mouth and abdominal x ray performed. Observations returned to normal”.

3:31pm

Prior to Child O's collapse, a colleague said of Child O: "“he doesn’t look as well now as he did earlier. Do you think we should move him back to [room] 1 to be safe?"
Letby did not agree.
The prosecution say this echoes the final, fatal collapse of Child I.

3:33pm

Letby had taken Child O's observations at 2.30pm as 100% oxygen saturations and normal breathing rates.
From her phone, she was on Facebook Messenger at the time, and at 2.39pm, the door entry system recorded her coming into the neonatal unit.
Within a few minutes of that, Child O suffered his first collapse.
Letby called for help, having been alone with Child O in room 2 at the time.
Child O's heart rate and saturations had dropped to dangerously low levels. A breathing tube was inserted by the medical staff and he was successfully resuscitated. He was kept on a ventilator.

3:35pm

At 3.49pm, Child O desaturated again. doctors removed the ET and replaced it "as a precaution". Letby's written notes suggest she was the one who called for help.
Child O suffered a further collapse at 4.15pm which required CPR. Those efforts were unsuccessful and Child O died soon after treatment was withdrawn at 5.47pm.
A consultant doctor noted Child O had an area of discoloured skin on the right side of his chest wall which was purpuric.
He noted a rash at 4.30pm, which had gone by 5.15pm, and did not consider it purpura, but unusre what it was or what had caused it.
The doctor was particularly concerned about Child O's death as he was clinically stable before these events, his collapse was so sudden and he did not respond to resuscitation as he should have.

3:37pm

After the shift, Letby sent a series of messages to the doctor on Facebook, and to her colleague. She suggested Child O "had a big tummy overnight but just ballooned after lunch and went from there."
A post-mortem examination found free un-clotted blood in the peritoneal (abdominal)space from a liver injury. There was damage in multiple locations on and in the liver. The blood was found in the peritoneal cavity. He certified death on the basis of natural causes and intra-abdominal bleeding.
He observed that the cause of this bleeding could have been asphyxia, trauma or vigorous resuscitation.
The prosecution say no-one would have thought a nurse would have assaulted a child in the neonatal unit.

3:38pm

Dr Dewi Evans concluded Child O's death was the result of a combination of intravenous air embolus and trauma. The liver injury was not in his view consistent with vigorous CPR. His view was that the liver damage would have occurred before the collapse and contributed to it and was probably the reason for his symptoms through the morning. As for the air in the bowel loops, Dr Evans concluded that that was consistent with excessive air going down via the NGT.

Dr Bohin concluded concluded that together with the chest wall discolouration seen by the doctor that was indicative of air having been injected into Child O's circulation. She agreed that the abdominal distension was due to excess gas via the NGT.

3:39pm

Dr Andreas Marnerides, the reviewing pathologist, thought that the liver injuries were most likely the result of impact type trauma and not the result of CPR.
He thought that the excess air via the NGT was likely to have led to stimulation of the vagal nerve which has an effect on heart rate and would have compromised Child O's breathing.
He could not say whether it was either of these factors in isolation or in combination which caused Child O's death.
He certified the cause of death to be “Inflicted traumatic injury to the liver and profound gastric and intestinal distension following acute excessive injection or infusion of air via a naso-gastric tube” and air embolus.

3:41pm

In police interview, Letby said she had responded to child O's alarm at 1.15pm and found he had vomited.
She responded first at 2.40pm and discovered mottling all over with purple blotches and red rash. She said that his abdomen just kept swelling and suggested thatsometimes babies can gulp air when they are receiving assistance from Optiflow, as Child O was.
A year later, on the anniversary of Child O's death, Letby carried out a search on Facebook on the surname of the child.

Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders
-----------------------------------------------------------------------------------------------------------------------------------------------------
Sky News:

15:21

Letby allegedly murdered two out of three triplets​

The prosecution alleges Letby murdered two out of three triplets - these are Children O and P.
Child O's death was eight days after, the prosecution claims, Letby tried to kill Child N.
Prior to the attack, Letby had been on holiday in Ibiza.

15:33

Letby 'sabotaged' triplet boy while supervising student nurse​

When Child O's body was examined after his death, "an injury to his liver was found", the prosecution opening continues.
Letby was working the day shift on 23 June and came on duty at 7.30am.
She was the designated nurse for Children O and P - two of three triplets.
"This gave her an open opportunity to sabotage the babies," prosecutor Nick Johnson KC says, although Letby was also supervising a student nurse at the time.
Their triplet brother - who is not mentioned in the indictment - was in a separate room, as he was deemed "the most needy" of the triplets.
As of 9.30am there was no cause for concern and there are three records of feeds made by Letby.
Prior to Child O's collapse, a colleague said to Letby: "He doesn’t look as well now as he did earlier.
"Do you think we should move him back to room one to be safe?"
Letby did not concur, the court is told.

15:38

Triplet Child O died 'within a few minutes' of Letby entering neonatal unit​

Letby recorded that she had taken Child O's observations at 2.30pm on 23 June, the prosecution says.
But data from her phone shows she was sending Facebook messages and the door recorded her as entering the unit at 2.39pm.
Nick Johnson tells the jury: "Whether the timing of that observation is correct or accurate may be a matter we will consider in the evidence."
Within a few minutes of her entry onto the ward, Child O suffered his first collapse.
Letby was alone in his room at the time, the prosecution says.
A breathing tube was inserted and he was successfully resuscitated. He was then kept on a ventilator.
At 3.49pm his oxygen levels fell again. Letby's notes suggest it was she who called for help.
Child O suffered a further collapse at 4.15pm and resuscitation attempts were unsuccessful.
He died a short while after.

15:48

Child O, a triplet, died with liver trauma 'likely the result of an assault'​

We are still hearing the prosecution opening - all the alleged victims are being identified as Child A-Q and the jury is currently being told about Child O, one of two triplets to have died.
The consultant said he was "particularly concerned" about Child O's death because he had been "clinically stable" beforehand.
The prosecution tells the court that Child O's collapse was "so sudden" and he did not respond to resuscitation as he should have.
Trauma was found on Child O's liver. One doctor said this could have been due to vigorous CPR.
However, prosecutor Nick Johnson KC says: "Of course, it wouldn't have occurred to him that a nurse would have assaulted a child on the neonatal unit."
One medical expert, who received the case, concluded that Child O's death was a result of an injection of air and trauma - it was not his view that the liver damage was consistent with CPR, the jury is told.
Mr Johnson says experts concluded the damage was "likely the result of some impact trauma".
"In brutal terms, an assault," the prosecutor says.
He certified the death to be: "Inflicted traumatic injury to the liver and profound gastric and intestinal distension following acute excessive injection/infusion of air via a naso-gastric tube, and air embolus."
One year later, on the anniversary of Child O's death, Letby carried out a Facebook search for the family's surname, it is claimed.

Lucy Letby trial - latest: Nurse 'adamant' she's done nothing to harm any of the babies in the case as defence begins
 
(NOTE THIS IS PROSECUTION OPENING SPEECH, NOT EVIDENCE)

CHILD P


Chester Standard:

10:38am

Child P - murder allegation
The prosecution allege Child P was murdered the following day from brother Child O.

10:39am

Letby was the designated nurse for Child P.
Letby fed Child P donor expressed breast milk at 8am, 10am, noon, 2pm and 6pm.
The final feed, if accurately recorded, was about 13 minutes after Child O had died.

10:45am

A feeding chart is presented to the court.
All the feeds from 8am-4pm are signed by a student nurse and co-signed by Letby.
The 6pm feed is signed only by Letby.
The court hears on the day shift feeds there is nothing more than a 'trace' aspirate (checking if there is anything in the stomach before the baby is fed), apart from a small amount of vomit at noon. The 8pm feed - the first after Letby's shift, produced a 14ml milk acidic (pH3) aspirate.

10:47am

The court hears because Child O had died in unusual circumstances, Child P was reviewed by Dr Gibbs at 6pm. The abdomen was “full … mildly distended”. There was no tenderness and he had active bowel sounds – good signs.
He was screened for infection.
An x-ray taken at 8pm showed striking gaseous distension throughout the stomach and whole bowel.
Lucy Letby made her nursing notes at 8.24pm - therefore she was still in the neonatal at this time, Mr Johnson tells the court.

10:47am

The allegation is Letby "deliberately caused the problems" as she was ending her day shift, so she would not be detected, Mr Johnson tells the court.

10:49am

On that night shift, milk feeds were stopped for Child P on the grounds that a further large part-digested aspirate was drawn up the NGT at feeding time.
At 6.39am, a nurse recorded the abdomen was "soft and non distended."
25ml of air had been aspirated by one of the nurses, and the NGT had been placed on "free drainage".
Mr Johnson said the "problem" Child P had when Letby handed over to the night shift had been resolved. The problem appeared to be air.

10:51am

When the next day shift happened, Letby was Child P's designated nurse again.
He was with his other brother - the third of the triplets - in room 2.
The court hears as events unfolded, while Letby was the designated nurse for the other triplet, care was transferred to another nurse.
Text messages Letby sent to a doctor at just after 8.30am suggest she had sent, or was sending, her student with a baby who needed an MRI scan.

10:54am

A registrar noted Child P, at 9.35am, had “desat + bradys” and had a moderately distended / bloated abdomen and slightly mottled skin.
Letby's nursing notes from that night (9.18pm-10pm) recorded: "Written in retrospect...NG tube on free drainage - trace amount in tube. Abdomen full – loops visible, soft to touch … Reg...arrived to carry out ward round – [Child P] had apnoea, brady, desat with mottled appearance requiring facial oxygen and neopuff for approx. 1 min. Abdomen becoming distended. Decision made to carry out bloods and gas (approx. 09:30)”

10:55am

The prosecution says it follows the problem with which Child P had been handed over by Letby to the night shift, but then apparently reappeared within 90 minutes of Letby taking over again.
15 minutes later, Child P had an acute deterioration. A crash call went out. Child P was intubated and improved, and efforts were made to transfer him to Arrowe Park Hospital

10:57am

Child P desaturated again at 11.30am. He was given adrenaline.
His spontaneous circulation improved but he continued to deteriorate through the day.
A punctured lung was identified from an x-ray taken at 11.57am, treatment started at 12.40pm.
The transport team arrived at 3pm. Just before they arrived, Child P's blood gases were taken and were satisfactory.
A doctor was hopeful of Chils P's prospects.
The court hears Letby said to her something like:"he’s not leaving here alive is he?"

10:59am

Child P's final collapse came at 3.14pm and, despite resuscitative efforts, he died at 4pm.

A post-mortem examination had the coroner concluding Child P died from Sudden Unexpected Postnatal Collapse but he was unable to identify the underlying cause. He certified the cause of death as “prematurity”.

Medical expert Dr Dewi Evans initially suggested the cause of death was complications from his pneumothorax. He was, however, suspicious of the large volume of air in the stomach and intestines evident on x-ray. In his subsequent reports Dr Evans concluded that excess air in the stomach could have “splinted” Child P's diaphragm compromising his breathing.

11:00am

Dr Sandie Bohin also concluded that the abdominal distension splinted Child P's diaphragm resulting in an inability fully to expand his lungs and causing his collapse. Subsequent resuscitation and intubation involved high ventilatory pressures, which together with vigorous resuscitation, can cause pneumothorax. She described the abnormal gas pattern seen in Child P's stomach through to his rectum which she concluded it was caused by the exogenous injection of air via the NGT – describing that as “the only plausible explanation”.
This excess gas splinted the diaphragm, compromised breathing and it caused Child P's collapse.

11:01am

Mr Johnson tells the court: "As with all these cases – it is the coincidence of problems happening when Lucy Letby was about and the coincidence of the same problems happening with different babies at different times, which we suggest is so telling and indicates that it was her malign hand at work."

11:04am

In police interviews, Letby said the student nurse fed Child P at two-hourly intervals on June 23, and she had fed Child P alone at 6pm.
She said she had agreed to be Child P's designated nurse because the parents had asked for some continuity.
Early in the shift, around 8am, she said could see “loops” in his tummy and brought these to the attention of the doctor, and notes were made later that day.
If what she noted was true, the prosecution say, it would say when she took over the care from the previous night, he had a developing problem, but the prosecution says we know that was not the case.
A note by a nurse at 6.39am 'ran contrary' to Letby's note, as the problem 'had been resolved' during the night.
Mr Johnson: "This is another example of Lucy Letby making factually false entries in the notes to cover herself."
Letby denied deliberately causing Child P any harm.

Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement

-------------------------------------------------------------------------------------------------------------------------------------

Sky News:

11:07

Letby took photograph of Child O and P in their cot after their deaths​

Independent medical experts concluded Child P died from "somebody injecting him with air" via his nasogastric tube into his stomach.
There was also an injury to Child P's liver, but this was probably caused by CPR rather than a "deliberate assault" - as the prosecution says was seen in his brother.
In a police interview, Letby admitted feeding Child P alone at 6pm, the day before his death.
The prosecution claims she then made "factually false" entries in Child P's medical records to cover herself - with phone records showing she was texting at the time she claimed to have been making observations.
After Child P died, she spent time with his parents and at one point took a photograph of them both together in a cot.
She denied deliberately causing Child P any harm.

Lucy Letby trial - latest: Nurse 'adamant' she's done nothing to harm any of the babies in the case as defence begins
 
Last edited:
(NOTE THIS IS PROSECUTION OPENING SPEECH, NOT EVIDENCE)

CHILD Q


Chester Standard:

Child Q - attempted murder allegation
Child Q was born on June 22 - the day after Child O and P. He was premature but a good weight, and on CPAP for the first 20 hours.
He was admitted to the neonatal unit as he needed breathing support, but was initially stable.
He had a catheter in place via his umbilicus for nutrition, however he was well enough to commence feeding via his NGT. Initially he was put into room 1.

11:08am

Nursing staff noted small amounts of bile when they checked his NGT on June 23-24. These were not of sufficient concern to stop him being fed milk.
A different nurse was Child Q's designated nurse on the night shift for June 24. She monitored him through the night, and fed him 0.5ml of milk every 2 hours at 3am, 5am and 7am.
The nurse was content with the condition, although the blood gases deteriorated slightly, so she referred the results to a doctor. The doctor reviewed them and was not concerned.
The day shift on June 25, Letby was on duty and was Child Q's designated nurse. Child Q had been moved into room 2.

11:10am

Letby made notes on Child Q's fluid/feeding chart at 8am. Child Q was receiving nutrition Babiven via a UVC.
Just after 9am, Letby and the nurse were together in nursery 2, and it was feeding time. The other nurse attended to another child in the room.

11:14am

According to the record, Child Q's heart and respiratory rates both increased for a short period of time.
But, the prosecution say, the feeding chart shows something 'unusual'.
That chart is shown to the court. The 9am fluid chart, in Letby's handwriting, appears unfinished, with numbers noted for fluids, but no record for the feed or Letby's signature initials at the bottom of the 9am column.
The prosecution suggests something caused Letby to leave halfway through doing this.

11:16am

Letby signed for medication for another baby at 9.04am.
The other nurse agreed to keep an eye on Child Q at 9am.
A few minutes later, Child Q's monnitor alarms activated to alert staff to a deterioration in his condition.
Mr Johnson: "We say that Lucy Letby had sabotaged [Child Q] and had injected him with air and a clear fluid into his stomach via the NGT. She was trying to kill him."

11:19am

The nurse called for help and was joined by another nurse. Child Q had been sick and nurses used a suction catheter while respiratory support was given. Lucy Letby appeared soon afterwards together with doctors who were responding to the call for help.
Medical notes indicates doctors were called to the unit at 9.17am as Child Q had "just vomited" and oxygen saturation levels were in the "low 60s".
The prosecution say medical staff gave him assistance with breathing using a Neopuff device and applied suction to clear his airways. The records indicate not only had his oxygen dropped but also his heart rate. He is described as “mottled” in appearance and, most significantly, a substantial amount of air was aspirated from his stomach via the NGT.
Mr Johnson tells the court the air had been put in there by Letby, as if the feeding chart had been followed correctly at 9am, the person feeding - Letby - would have aspirated Child Q's stomach to check there was nothing there before administering the 0.5ml milk feed.

11:22am

Another nurse's medical note on an 'apnoea/brady/fit chart' notes: "09:10; brady 98; desat 68; fit ?; baby found to be very mucousy, clear mucous from nasopharynx oropharynx removed clear fluid +++.
"O2 via neopuff given post suctioning. Dr... emergency called to attend.
"NGT used to aspirate stomach by Nurse L Letby”
The prosecution say given that Letby was Child Q's designated nurse and she performed the aspiration of air, it might be thought surprising that she did not make the note – yet she did make notes in records of other babies’ notes at about the same time.
Mr Johnson: "We question whether this is an attempt by her to create a documentary alibi."

11:27am

Computerised nursing notes made by Letby for that morning: "“09:10hrs [Child Q] attended to by SN... – he had vomited clear fluid nasally and from mouth, desaturation and bradycardia, mottled ++. Neopuff and suction applied. [Registrar] attended. Air ++ aspirated from NG tube”.
Following the collapse, blood was taken to test for infection and other parameters. A venous blood gas test showed results suggesting that he was unwell but this had resolved by 11.12am. He was started on a course of antibiotics as a precaution.
The doctor's view recorded at the time said Child Q's collapse was a result of “presumed sepsis with jaundice”.
At that stage a chest x ray was taken which showed nothing untoward. The more detailed blood tests were recorded at 1.50pm and showed slightly abnormal results which were treated.
Child Q had made a reasonable recovery through the day and at 7.20pm was "looking tired". Doctors took the decision to intubate him because his respiratory rate was down to 19 (low)and his heart rate was between 160-200 bpm (high). At that stage his blood gas readings were good.
The proseution say Lucy Letby was "worried" when she got home that night.
She texted a doctor at 10.46pm and asked "do I need to be worried about what Dr G was asking?"
The doctor sought to put her mind at rest and told her that Dr G was only asking to make sure that the normal procedures were carried out. She replied that after Child Q had collapsed she (LL) had walked into the equipment room and Dr G had been asking the other nurse who was present in the room (when Child Q had collapsed) and how quickly someone had gone to him because she (LL) had not been there.
She continued her texts to the doctor, telling him that she had needed to go to her designated baby in room 1.

11:29am

The following day, Child Q's gases were unsatisfactory, but he had been extubated 4 hours earlier and was in air with high saturations.
Medical staff noted a 'mildly dilated loop of bowel' on Child Q's left side and raised the possibility of NEC and surgery.
Child Q was transferred to Alder Hey, where he quickly stabilised and no surgery was required.
The prosecution say this was "another child who had suffered life-threatening problems and...when out of the orbit of Lucy Letby, he made a rapid recovery."

11:29am

Other than three days the following week, that was the last time Lucy Letby worked in the neonatal unit at the Countess of Chester Hospital, the court is told.

11:33am

Medical expert Dr Dewi Evans said Child Q's collapse was due to 'inappropriate care', and he had been injected with air via the NGT.
The significant amount of air aspirated from his stomach 'could not have arisen in any other way'.

Dr Sandie Bohin noted Child Q was well up until June 25 and believed something happened between 9am and his collapse.
He was only being fed what Dr Bohin describes as “tiny” amounts of milk yet he had taken in “copious amounts of air” from the NGT. This was abnormal.
The effect of a large volume of air in the stomach would “squash” the lungs leading to desaturation and instability. Although a baby may recover quickly after such an event, he may remain unstable for some time thereafter.
She agreed with Dr Evans’ conclusion that events were consistent with the introduction of a large amount of air via the NGT.

A professor reviewed brain imaging of Child Q taken in November 2019 - more than three years later. He found evidence of abnormalities which whilst they were not diagnostic of him having suffered a brain injury as a result of being given excessive air and liquid via his NGT, they could be explained.

11:34am

In Letby's home search, officers recovered the handover sheet from the morning of June 25 which included Child Q's name. This was a document which should not have left the hospital.
When interviewed by police, Letby agreed Child Q had been well enough for her to leave him on the morning of June 25.
When asked about the excess air aspirated from his stomach, she suggested babies sometimes gulp air when they vomit. She denied putting excess air down the NGT.

Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement
 

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