A summary I've prepared today of the babies with throat trauma and babies who screamed. (All quotes from the media thread.)
Throat bleeding / swelling
Baby C - room 1 – designated nurse on computer out of view of baby
Ms Taylor said Lucy Letby suggested using a type of ventilation support - a Guedel device - to aid Child C.
(registrar) Davis's note is presented to the court, written at 1.30am on June 14 and timed retrospectively. The note said she arrived at the unit in "less than one minute" after the crash bleep went off.
A 'Guedel airway in situ' was noted, with chest compressions in progress. […]
Dr Davis attempted to intubate Child C, but was unable to do so as Child C's vocal cords were swollen. Dr Davis tried again with a smaller tube, twice, but was again unable to intubate.
Baby E - room 1 – LL alone in room with baby
A '13ml blood-stained fluid from NGT on free drainage' is noted. Dr Harkness says the origin of the blood must have come from somewhere in the oesophageal tract, down to the stomach. It rules out blood coming from the lungs.
Dr Evans said a second major issue was significant haemorrhaging from the upper gastrointestinal tract, somewhere between the mouth and the stomach. In a further report – after he reviewed a statement from Child E’s mother who described “horrendous crying” from her son and blood around his mouth – he suggested something “had been done or used” to cause trauma. The expert witness suggests that a piece of equipment made of rigid plastic may have been used to cause the injury to baby E.
Baby G - room 2 – designated nurse gone to lunch
Dr Ventress - Child G was then intubated, and 'IV vitamin K given due to blood from trachea'. Mr Johnson says this is another case where a baby is bleeding at the mouth.
Dr Ventress notes 'ETT removed at 6.10am. […] Blood clot at end of ETT.
'Reintubated 0615 ETT with intubation drugs. Blood-stained fluid in oropharynx.
Dr Alison Ventress is now recalled to give evidence. Dr Ventress noted 'blood-stained fluid noted coming up from trachea/between cords' during intubation.
Child G was reintubated with a mild anaesthetic at 6.15am, with 'blood-stained fluid in oropharynx' noted.
Dr Ventress says the first observation of blood was in the windpipe, whereas this was more in the throat. Mr Myers refers to the note about 'blood-stained fluid noted coming up from trachea/between cords'. He asks if that was noted after intubation. Dr Ventress said it was during intubation. Mr Myers asks if it would be unusual to see that. Dr Ventress: "It's not uncommon for the baby to [have bleeding during intubation] - it is unusual to have blood coming up from beneath the vocal cords."
Evidence not heard yet – from opening speech
Baby N – room 3 - designated nurse’s back turned for 1st event. (different date from screaming event below)
7.12am – LL arrived early for her day shift. A colleague said LL came into the room to say hello but when her back was turned LL said N had desaturated and assisted with his breathing - the alarm was not sounding.
Around 8am – Doctor tried to intubate N - He couldn’t get the breathing tube down his throat. He was “surprised by his anatomy more than anything else … I could not visualise parts of the back of his throat because of swelling”. The doctor saw "fresh blood" in N's throat, which the prosecution say was the same seen in babies C, E and G. The doctor was unable to get the breathing tube down the throat of N as he was unable to visualise the child's tracheal inlet. He attempted to intubate N on three occasions.
2.50pm – LL noted N stopped breathing, fresh blood in mouth and 3 mls aspirated from NGT. Crash call. A consultant was called at 2.59pm. While awaiting a consultant, a junior doctor looked into the airway of 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 …”
A more specialist team was called to carry out the intubation.
Dr Kinsey blood expert said such a bleed would not have happened spontaneously and swelling was evidence of trauma. He had a mild version of haemophilia. She also excluded heavy-handed intubation.
Babies screaming
Baby E - room 1 - LL alone
Court hears that on the evening of the babies' 5th day, their mum came down to the neonatal ward to bring breast milk. As she came along the corridor, she could hear screaming. She says "I could hear my son crying, and it was like nothing I’d heard before…"It was a sound that shouldn’t have come from a tiny baby. I can’t explain what it was - it was horrendous. It was more of a scream than a cry". The twins' mum says that Lucy Letby was the only person in the room with the babies but was not by the incubator - she was standing at the workstation.
Evidence not heard yet – from opening speeches
Baby I - room unknown yet - designated nurse left room
1.06am - baby I’s monitor alarm sounded and she screamed. Her nurse, having left the nursery temporarily, responded to I's alarm and saw Lucy Letby at the incubator.
An expert paediatrician who reviewed child I’s case … believed that on the final occasion the child had been injected with air into her bloodstream which led to her "screaming", followed quickly by her collapse.
Baby N - room unknown yet - designated nurse on break
1am – N’s designated nurse went on break, leaving N “stable”. 1.05am – N collapsed and was screaming and cried for 30 mins. He was resuscitated.
Independent medical experts said the baby’s sudden deterioration was consistent with some kind of "inflicted injury". 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.”
The defence say there are many reasons a baby will shout or scream - and "it is more far more likely to be hunger".
