Hi. Baby I's stay in hospital spanned across a lengthy period. Just when baby I should have been going home, a life that was hers for the taking came to a tragic end. The prosecution say she was 'very premature' and that this was what led to her untimely death. I put together this timeline, for people like me (ex neonatal parents) who think in 'gestations'!! Let me know if anyone finds this format helpful and I may add to it. I've tried to focus on the medical trajectory rather than other evidence presented as I know are other threads looking at this.
27 WEEKS (+3)
7th Aug -
Baby I was born at Liverpool womens hospital born @ 27+3. A statement from a consultant neonatalogist at LW hospital said she was born in 'very good condition'.and 'stabilised very quickly' with no concerns, before being admitted to the neonatal unit after being allowed to be shown to her mother.
She had 'very good gases' after being put on breathing support device CPAP.
There were readings consistent with an infection, but Child I was on antibiotics. A lumbar puncture and phototherapy were commenced.
8th Aug -
Feeds were started, using expressed breast milk and baby I continued to be 'very stable, in spite of having an infection'.She later had desats and brady's, so a second line of antibiotics was begun- to last for 5 days. The CRP infection marker was low, but the white blood cell count was elevated. After a short gap in feeds, Baby I continued to be fed. She was stable when taken off CPAP for short periods of time.
9th Aug -
10th Aug -
At five days old baby I graduates from ITU and moves into the high dependency room at Liverpool Women's hospital whilst the staff start to arrange for a transfer to CoC
12th Aug -
13th Aug -
28 WEEKS (+3)
14th Aug -
15th Aug -
16th Aug -
17th Aug -
18th Aug -
It''s transfer day. Baby I was stable on CPAP, having four hours off it. By this time she was tolerating feeds "very well". She had "normal tone, posture and movement".She weighed 90g more than her birth weight, (around 3lb 3oz) which "was good", as it was expected that babies would drop in weight in the days after birth.She was moved to room 2 at the CoC neonatal unit.
29 WEEKS GEST (+3)
21st Aug -
22nd Aug -
23rd Aug -
24th Aug -
25th Aug -
26th Aug -
28th Aug -
30 WEEKS GEST (+3)
28th Aug -
31 WEEKS GEST (+3)
Staff at the Countess suspected Baby I had NEC as her stomach had swelled. She was transferred to Liverpool Women's so she would be close to Alder Hey, if surgery was required.When the parents arrived, they were informed Baby I did not have NEC, and she improved.
Upon Baby I's return to Liverpool Women's Hospital, her blood gases and heart rate were "normal".It was thought that baby I had suspected sepsis rather than NEC, and a course of antibiotics began to cover for both possibilities.She was kept nil by mouth but was "stable" on the night of 6th September.
There was a "mechnical obstruction" in the ET tube and Child I was re-intubated. After this she "had normal gases and improved very well".Feeds were gradually increased and the course of antibiotics ended after five days.
32 WEEKS GEST (+3)
Baby I continued to tolerate and build up feeds, which was a sign the baby girl did not have NEC.
The expectations of staff at LW hospital were that she would return to the Countess of Chester Hospital and continue to improve.
12.15pm -Baby I transferred back to CoC
1.36pm - Letby records Baby I's temperature in the hotcot. She adds a note "'Abdomen appears full and slightly distended. Soft to touch, straining++. Bowels have been opened. Mum feels it is more distended to yesterday and that baby I is quiet. Appears generally pale. Not on monitor...[will continue to monitor situation]"
LL notes that mum has visited and provided cares.
33 WEEKS GEST (+3)
Letby was working a long day shift. During that day, 'baby G' (not baby I!) suffered a significant deterioration at 10.15am.
23rd Sept - LL on nightshift
24th Sept -LL on nightshift
25th Sept- LL on nightshift
34 WEEKS GEST (+3)
27th Sept- LL not working
28th Sept- LL not working
LL not working. Note recorded by nurse Shelley Tomlins ' Baby I 'remains pale but managing to complete bottles (slow to feed as windy).' The overnight shift nurse, Jennifer Jones-Key, said Baby I continued to be fed regularly, with her tummy 'full but soft'.
(Incident 1?) Letby was looking after three babies in room three that day, including Baby I. Feeds are continued for baby I. (35mls expressed breast milk and fortifier.
10am: feed is by bottle
1pm: NG feed (baby is asleep) Note recorded by LL 'EBM+fortifier, NGT, vomit aspirated 5ml, ph5'.
3am: Letby records, 'Reviewed by Drs, appeared mottled in colour with distended abdomen and more prominent veins. Advised to continue. Temperature within normal range with hot cot at 38 degrees. Full monitoring recommenced. within normal range.'
4pm: NG feed ohas an aspirate of 3ml, with Baby I 'asleep'. It is signed by Letby's initials.
4.30pm: Feed chart for Baby I records
'large vomit and apnoea - nil by mouth'. It is not signed by anyone.
4.30pm: LL notes baby I had a large vomit from mouth and nose++ suction given. Became apnoeic with bradycardia and desatuartion (30s). Help summoned and IPPV given for approx 3min in 100% oxygen to recover. Drs were crash called.
'Transferred to nursery 1...'
A doctor records he is crash called. He notes 'Chest clear... Abdomen distended, active bowel sounds all zones'
5.23pm: LL receives text from a colleague thanking LL for a birthday message.
5.45: Medication of glucose and sodium chloride is co-signed by Letby (and for 6pm)
5.39pm: An x-ray is taken of baby I with the radiologist recording: 'There is splinting of the diaphragm due to bowel distension...there is moderately severe bowel distention which is thought to involve both large and small bowel.
'The appearances are suspicious of NEC...'
6.00pm: Medication of glucose and sodium chloride is co-signed by Letby (same as above)
A CRP blood reading for baby I is 'less than 1'.
7.30pm Baby B suffered another deterioration. LL notes she became apnoeic - abdomen distended++ and firm. Bradycardia and desaturation followed, SHO in attendance and registrar called...
'Nil by mouth. NG tube on free drainage. Cannula inserted but tissued during saline bolus (5mls given).
'Colour appears pale but improved from earlier in shift. Abdomen appears full and distended. Veins more prominent. Not further vomits. Responsive but quiet on handling.'
For the family communications: 'Mummy present when reviewed by Drs. Had left unit when baby I had large vomit and transferred to nursery 1. [Mother] up to date with current plan...'
8pm:The doctor records 'ticks' for temperature instability and apnoea for Child I.
8.26pm: Letby's final note from 8.26pm: 'Baby I is now very pale and quiet.'
8.30pm: Nurse (BB) who took over care of Child I for the night shift, records: 'During handover that baby I's abdo became more distended and hard she had become apnoeic nad bradycardiac and sats had dropped. IPPV given and despite a good seal with Neopuff there was still no chest movement...'
Multiple texts exchanged between LL and colleagues that evening.
1st Oct -
8.30am:Nurse (AH) was the designated nurse this day)
8.30am: Nurse (BB) inputs an Incident for 8.30pm the previous night, about administering an antibiotic infusion over 10 minutes instead of 30 minutes. 'Although correct dose was given it was delivered at a faster rate.
'When aware of mistake, infusion was adjusted. Reg and shift leader informed'.
8.44am: note by Nurse (BB) 'handling much better without desats/Bradys'.Was initially very pale colour has improved, abdo remains distended and firm but less distended than at beginning of shift'.
A doctor, during the ward round, said it was considered to restart feeds for baby I. The parents were concerned that baby I may be lactose intolerant, and that had possibly led to abdominal distention.
1.36pm: Nurse (AH) notes baby I appears pale but pink and well perfused...' followed by a number of medical notes
7.48pm: Review by Paeds SHO...abdomen is softer and less distended, ? start cautiously feeding...'
35 WEEKS GEST (+3)
36 WEEKS GEST (+3)
36 WEEKS GEST (+3)