Lucy Letby Baby N

Lucy Letby Innocence

Baby N
Prosecution opening statement
Defence opening statement
Defence Closing Speech
Agreed Facts
Recorded Events and Messages/Facebook
NEW:Lucy Letby in the Witness Box
Direct Examination
Cross-Examination
Witness Statements Agreed
Nurse Caroline Oakley
Nurse Melanie Taylor
Nurse Sophie Ellis
Nurse Christopher Booth
Nurse Valerie Thomas
Nurse - unnamed
Elizabeth Morgan
Witness Evidence
Dr Jennifer Loughnane
Dr Huw Mayberry
Nurse Jennifer Jones-Key
Dr A [Thirlwall: Dr U]
Dr John Gibbs
Dr Stephen Brearey
Dr Francis Potter - Alder Hey
Medical Experts Evidence
Professor Sally Kinsey (child n)
Dr Dewi Evans
Dr Sandie Bohin
NEW: Thirlwall Inquiry Evidence

Baby N

Count 17: Attempted murder of Baby N on 3 June 2016. Alleged mechanisms: Air Embolism, Throat Trauma
Count 18: Attempted murder of Baby N on 15 June 2016, at about 7.15 to 7.30 hours. (NO VERDICT)
Count 19: Attempted murder of Baby N on 15 June 2016, at about 15.00 hours (NO VERDICT)

Dr Shoo Lee's International Panel Summary Conclusions

BABY 14 SUMMARY [Baby N]
Baby 14 was a 34+4/7 week, 1.67 kg BW, twin 2, preterm male infant, with severe intrauterine growth restriction (IUGR) who was delivered by emergency caesarean section. Mother was a haemophilia carrier. Baby 14 had mild respiratory distress syndrome, reduced factor VIII 3% (moderate) and raised coagulation times (PT 15.4, APTT 69.7). Twelve hours later, he desaturated, looked dusky, was unsettled, and had increased work of breathing.

When seen by a doctor, he was screaming and had subcostal recession, but settled after half an hour. On day 13, he became mottled and had 5 episodes of desaturation, and an episode of profound desaturation. Intubation X3 was attempted but abandoned due to blood in oropharynx and trauma due to repeated intubation attempts. Chest x’ray showed right patchy consolidation consistent with infection and oedema. Intravenous Factor VIII was given. Intubation was re-attempted X5 by registrars, consultants and anesthetist without success. A laryngeal mask was used. A team from Alder Hey Hospital arrived 11 hours after onset of profound desaturation and intubated the infant. He was transferred to Alder Hey Hospital, given Factor VIII and recovered.

CONVICTION
It was alleged that the initial screaming episode was due to inflicted injury or injection of air into his intravenous system causing pain. It was alleged that the desaturation and bleeding on day 17 were caused by trauma inflicted by thrusting a nasogastric tube into the back of Baby 14’s throat.

PANEL OPINION
The initial screaming episode is unlikely to be due to inflicted injury because injury of such intensity to cause 30 minutes of screaming would have caused bleeding. It is not due to air embolism because crying due to air embolism is of short duration; it is a response to hypoxia as the infant gasps and cries for air, and quickly resolves or the infant collapses. Crying is usually associated with discomfort from hunger, hypothermia, hypoxia and pain. The desaturation on day 17 was most likely due to bleeding from haemophilia, either spontaneously or from routine cares causing blood and secretions to pool in the oropharynx and obstruct the airway. Moderate haemophilia can cause spontaneous bleeding. It is unclear if a haemophilia nursing protocol was used by the unit to prevent inadvertent trauma from standard nursing care procedures. If it was due to repeated thrusting of a nasogastric tube into the throat, the infant would have cried or screamed, and there would be evidence of lacerations in the pharynx, esophagus and vocal cords. None were reported by the intubating physicians. Trauma was most certainly inflicted during the repeated intubation attempts (8X), which aggravated the bleeding and caused epiglottis swelling. In a haemophilia patient, intubation should be performed by an experienced individual. It is inappropriate to allow junior doctors to try, and then progress up the chain to senior doctors. The patient should not have been subjected to 8 intubation attempts. The referral to Alder Hey Hospital and transfer should have been done much sooner, not 11 hours after initial desaturation.

CONCLUSIONS
1. Crying was not due to injury or air embolism.
2. The subsequent episode of desaturation was due to bleeding, likely spontaneously from haemophilia or routine cares, and exacerbated by repeated traumatic intubation attempts.

Prosecution Opening Statement

Background
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.
Child N had haemophilia. Subsequent 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.

Incident
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”.

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 which 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.

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”.

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”.
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.

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.

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.
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.

Medical Experts
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.”

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.

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.

Police Interviews
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.

Defence Opening Statement

For Child N, the defence say there are "many reasons" why a baby would shout or scream.

"It was far more likely to be hunger" - "you certainly won't find evidence of anything else".

Regarding the allegation Letby did something to cause Child N to bleed, the prosecution say the intubating doctor already saw blood, because Letby harmed him.

The defence disagree and say blood was "not identified until intubation had already happened, or was in the process of happening".

There were three attempts to intubate him.

The defence say, again, there was "sub-optimal care" for Child N.

Defence closing speech - Child N

Mr Myers refers to the case of Child N, for which there are three counts alleged against Lucy Letby. He outlines the events for Child N, who had haemophilia. Mr Myers says Professor Sally Kinsey said Child N was more likely to suffer a bleed from trauma than babies who do not have haemophilia, and the amount of blood would be larger. Prof Kinsey had said the process of instrumentation had the potential to cause bleeding, such as a naso-gastric tube. Mr Myers says the Countess of Chester Hospital did not have Factor 8 for Child N at birth. He says for the first Child N event, for which it is alleged there was trauma and/or an air embolus, he asks if Letby was even there.

Mr Myers refers to Dr Jennifer Loughanne's note for the Child N event - 'asked to see - desat - unsettled - got upset - looked mottled, dusky, sats [down to 40%] [moved to] 100% O2 'On my arrival, 40% O2, screaming'. Mr Myers says it is "plainly not an air embolus", disagreeing with Dr Evans. He says Dr Bohin said it was a painful stimulus. He said there was no sign of injury or blood.

Mr Myers says both experts put "poor opinions" forward. He refers to the first event of June 15, 2016, in the morning, at 7.15am. He says there is no evidence of anyone seeing Letby coming in and causing harm to Child N. He says the prosecution created the narrative Child N was sabotaged in advance the previous night by Letby before she left at the end of her shift. He refers to nurse Jennifer Jones-Key's note for the June 14-15 shift. He says in evidence, Jennifer Jones-Key said Child N first deteriorated at 1am, and remained at that condition through the rest of the night. Mr Myers says that "is an end to the sabotage theory", as Child N became unwell several hours into that night shift.

Mr Myers says Dr Bohin did not accept that from 1am to 7.15am, there had been a gradual process of deterioration. He refers to the 7.15am event. He says Jennifer Jones-Key referred to more desaturations 'from 7am'. He say she remembered being in the nursery, feeding a baby, and Letby came in for her shift, and Letby came into the nursery, the alarm sounds, and Letby walks over. He says there is "no indication or sensible opportunity" for Letby to cause this collapse for Child N. He says it is a continuation of the "mounting problems" for Child N which began at 1am.

Mr Myers says there is a question for when the blood is seen on Child N, before or after intubation. He says it is hard to see that if the attack happened at 7.15am, that blood would only be seen by a doctor at 8.05am. Mr Myers says it would be "reckless" if a doctor embarked on intubation for Child N while seeing there was blood in the way.

Mr Myers refers to the third count for Child N, later in the day at 2.56pm on June 15, 2016. He says the details of the event are clear, and while most of the five or six doctors described swelling, 'only' Dr Satyanarayana Saladi noted blood. He says it is right that a 3ml blood aspirate is collected. He says the defence observe it's surprising, given Child N's haemophilia, there is not more. He says it is "unclear" what the cause of the swelling is, and could be a consequence of what had gone on that morning.

Mr Myers says there are no signs of a wound found on Child N, and he was "well inspected" by doctors. He says at 7.40pm, Child N desaturated when medical personnel arrived to transport him, and he was prepared for theatre as doctors had been unable to intubate. Mr Myers says it was not surprising Child N's condition was poor given the 'long day' he had had. He says a tertiary unit doctor was able to intubate first time successfully after Child N's desaturation. Alder Hey consultant anaesthetist Dr Francis Potter was asked to give evidence. Mr Myers said he had told the court his interest was paediatric intensive care, and he had experience with airway problem resolution. He said the intubation was managed with 'relative ease'. He said Dr Potter had been "surprised" there had been difficulties in intubating Child N as he said the Countess of Chester Hospital team was "pretty competent". He says Dr Bohin "comes to the rescue [of the prosecution]" by not agreeing with the opinion of Dr Potter. He said Dr Bohin said the drugs given to Child N would have reduced the swelling. He said it was a disagreement between the two prosecution witnesses.

Agreed Facts

Recorded Events and Messages

Cheshire Police intelligence analyst Claire Hocknell is now talking the court through the first of two sequences of events for Child N.

2nd June 2016
11.56am: The first is a Facebook message from a Countess of Chester Hospital doctor at 11.56am on June 2, asking Lucy Letby for an 'opinion on something'.
Lucy Letby replies: "Hope I can help!"

1.42pm: Child N is born via C-section at 1.42pm, weighing 1.67kg, at 34 weeks plus 4 days gestation. His 'APGAR' scores, recording how well Child N was doing immediately after birth, are 9/10 at 1 minute and 9/10 at 5 minutes.

2-2.30pm: Nurse Caroline Oakley records Child N was admitted to the neonatal unit at 2pm, and Child N had 'prematurity and clotting disorder'. A blood sample was taken at 2.30pm. A clinical note by Dr Anthony Ukoh reports: '34+4 baby boy cried immediately, required no active resus'. Not for IM Vit K for now until haemophilia status known'. Observations: ...intermittently grunting++'

3.10pm: A desaturation down to 67% oxygen saturation, lasting one minute, is recorded by nurse Caroline Oakley at 3.10pm. The nurse adds, in a nursing note: '[Child N] Allowed to rest. Sounds very mucousy. Grunting intermittently...dropped saturations to 67% when upset; temp being recorded and required 60% O2 to recover...awaiting blood results before being given Vit K.'

The note adds: 'Decision made to screen and [nil by mouth], IV fluids/Vit K IV as prescribed as still grunting'

6pm: An x-ray result before 6pm recorded that Child N likely had an infection.

6.47pm: Nurse Caroline Oakley recorded at 6.47pm that Child N's temperature, which had been low, was recovering. A family communication is recorded: 'Dad has visited baby on unit and updated by [Belinda] Simcock. She has also visited mum... and updated...' A haemophilia diagnosis is confirmed for Child N.

7.30-8pm: Lucy Letby is recorded as starting her night shift on June 2 at 7.30pm, in time for the 7.30pm-8pm staff handover. Letby is a designated nurse, with shift leader being Melanie Taylor and other designated nurses being Christoper Booth and Sophie Ellis. Booth has two babies in room 1, including Child N, Ellis had one in room 2 and two in room 3, and Letby had two in room 4. Two babies were in transitional care, and another baby was 'rooming in with her parents' - that baby's designated nurse was Letby.

A few minutes after entering the neonatal unit, Letby WhatsApps a colleague [Nurse E] and says she had a 'paper handover' as colleague Caroline had gone home. Nurse Christopher Booth records 'care taken over approx 2000...oxygen saturations predominantly in mid 90s-100%'. He also records the usual handover checks.

[The following messaging is with Nurse E]

Letby messages 'We have got a baby with haemophilia'
Reply: 'How many weeks?'
LL: '34'
R: 'oh'
LL: 'Everyone bit panicked by seems of things but baby appears fine'
R: 'male?
LL: 'yeah'
LL: 'Oh and had weird FB message from [doctor] earlier...' Letby adds she does not know much about haemophilia.
Her colleague replies to be careful with cannula and blood samples.

The conversation continues about discussion of other babies, and Letby messages her colleague: 'Had strange message from [doctor] earlier...'
Reply: 'Did u? Saying what?'
'Go commando? 😂
Letby: 😂😂😂😂
Letby: 'Asking when I was working next week as wants to talk to me about something, has a favour to ask..?'
R: 'Think he likes you too...'
R: 'Hmm did u not ask what it was?'
LL: 'No just said when I was working and he said wants my opinion on something'
LL: Hmm...🤔
R: 'Hmm'
LL: 'Do you think he's being odd?
R: 'Thought as flirty as u'
LL: 'Shut up!'
R: 'What?!'
LL: 'I don't flirt with him!'
R: 'Ok'
LL: 'Certainly don't fancy him haha just nice guy'
R: 'Ok'

The conversation continues back on work, asking why there was a staff shortage on the unit. One of the staff members is speculated to be off with stress.

10pm: The conversation on WhatsApp, now continuing after 10pm, discusses another baby's condition.

3rd June 2016
1.05am: Further observations are recorded regularly for Child N up to 1am. Child N then suffered a desaturation at 1.05am. Nurse Christopher Booth: 'One episode whilst I was on my break, whereby infant was crying++ and not settling. He became dusky in colour, desaturating to 40s. Responded to facial oxygen within 1-2 minutes, crying [subsided] after 30 minutes'. The note adds Child N's colour returned to pink perfusion.

2.04am: Nurse Booth added, up to 2.04am: 'No further episodes observed. Oxygen saturations have been consistently mid 90s-100%...in view of earlier episode, infant remains nil by mouth...'.

8am: Nurse Ashleigh Hudson takes over care of Child N for the day shift on June 3. Tachypnoeic on handover, unsettled'

Letby messages the same colleague: 'been busy...' adding what had happened to a number of babies during the night shift, and what staff on duty had been doing. She adds: 'Glad to be off, survived my nights tho' followed by a smiley face emoji.

Dr Sudeshna Bhowmik records a list of 'problems' for Child N, including prematurity, jaundice and respiratory distress. A plan was to discuss with Alder Hey Children's Hospital haematology, and that discussion was carried out.

A dose of vitamin K is prescribed for Child N during the day shift.

6pm: Nurse Ashleigh Hudson records a 'slightly mucky aspirate' for Child N towards the end of the day shift, at about 6pm. The note of a summary of care between 8am-6pm records Child N was 'settled for the rest of the day', with 'minimal aspirates obtained. Aspirates clear with tiny old blood specks'. Paeds have liased with AHCH'

8pm: Nurse Christopher Booth, at the time of the night shift handover for June 3-4, records at 8pm Child N was settled. A family communication note by nurse Hudson: 'Both parents updated on current condition and plan of care. Mum very anxious, worried about baby being in the incubator. Explained need for it, to keep baby warm and make observation easier...'

4th June 2016
3am: The sequence of events goes up to June 4 at 3am, where Christopher Booth records 'No significant desaturations, bradycardias or apnoeic episodes observed overnight...'

Kate Tyndall, intelligence analyst for Cheshire Police, is now talking the court through the neonatal review schedule for the events in the case of Child N.

Intelligence analyst Claire Hocknell has returned to court to talk the court through the second series (out of two) of the sequence of events for Child N.

The sequence says Child N continued to be cared for at the Countess of Chester Hospital's neonatal unit between June 3 and June 14.

14th June 2016
The rest of the sequence of events, presented electronically to the jury, begins from June 14, 2016. Lucy Letby is the designated nurse for Child N on the day shift of June 14.

7.40-8am: At 7.40am, Child N takes on a feed of expressed breast milk. Letby records notes at the handover at 8am. Letby messages a colleague to complain about having to finish up a previous shift' nurse's work, and had left a bottle 'dirty'.

Lucy Letby records regular temperature readings for Child N which are all recorded in a 'normal range'. The court had previously been told readings in the 'yellow area' (too high, or too low) would be considered abnormal, but none of the temperature readings recorded as being too high or too low. Letby notes: 'Demand feeding EBM via own bottle, completing more than required volumes....repeat SBR this morning on downward trend but not yet >50...otherwise ready for home'. In a family communication note: 'Mummy visiting this morning, carried out cares and feed. Put infant to breast. Discussed feeding at home' The notes show Child N was ready to go home, apart from further treatment required for jaundice, and was on phototherapy. Other family members visited Child N at the neonatal unit that day.

8pm: For the night shift of June 14, Child N was in nursery room 3. Nurse Jennifer Jones-Key, in a note written retrospectively, records Child N was 'nursed in incubator with eye protection insitu. Baby demand bottle feeding' at the start of the shift at 8pm.

Letby is involved in a WhatsApp message conversation with a nurse, and a Facebook messenger conversation with a doctor at this time. The nurse colleague complains about work colleagues on that night shift. Letby says she has had a "lovely run of shifts in 3". "Nice babies and parents" Letby messages the doctor to say she was planning to go to Torquay with her parents in July 2016, and discusses about her having had hypothyroidism since she was 11, and had 'blips over the past 12 months'.

15th June 2016
1am: A nursing note by Jennifer Jones-Key just after 1am on June 15 records Child N had become 'very unsettled' and was 'pale, mottled and veiny' with slight abdominal distension. A blood test was taken for analysis. Further observations are taken.

5.10am: Letby messages her colleague [Nurse E] at 5.10am: 'Awake already'
Her colleague replies: "I wouldn't come in!"
Letby: "Oh...why"
The colleague replies: "5 admissions, 1 vent"
LL: "OMG"
Colleague: "Baby [N] screened, looks like s**t"

6am: Jennifer Jones-Key's note before 6am: 'baby looked worst this morning and cap refil after 3 secs. Reviewed again by paeds...' Letby messages a doctor colleague saying she might be back in '1' again for her next day shift, in nursery room 1.

7.10am-7.15am: Lucy Letby is recorded as entering the neonatal unit at 7.10am. She messages the doctor: "No repeat today. I've escaped being in 1, back in 3". The sequence of events shows Child N had a desaturation at 7.15am.

Jennifer Jones-Key records: 'at 0715 baby crying and dropped saturations - as seen by NNU nurse Lucy [Letby].' The nurse adds Child N had to be given 100% oxygen support by a doctor.

8am: Child N was transferred to nursery room 1 at 8am. A note is made on the resiting of the NG Tube - 'NG resited in right nostril with acide reaction. At handover baby dropped saturations and required Neopuff. Care handed over to NNU nurse Lucy Letby'. Lucy Letby is recorded as being the designated nurse for the day shift on June 15, and records, in a note written retrospectively: 'Infant transferred to nursery 1 on handover. Mottled, desaturating requiring Neopuff and oxygen...cold to touch.'

9am: Lucy Letby records, in a not written at 1.53pm for care at about 9am: 'Unable to intubate - fresh blood noted in mouth and yielded via suction ++.'

10am: Letby messages her colleague on WhatsApp before 10am: 'Thanks for staying to help. Much appreciated.' Letby records '1ml fresh blood aspirated' from Child N at 10am.

11am: A doctor colleague messages Lucy Letby before 11am to ask: "Is he ok?"

Letby notes, at 11am: 'Small amount of fresh blood orally and 1ml from NG tube' Letby messages the doctor in response: 'Small amounts of blood from mouth & 1ml from NG. Looks like pulmonary bleed on xray... "Sorry if I was off during intubation...I like things to be tidy & calm (Well, as much as possible!)"

The doctor responds: "No, you were perfectly fine with me...I thought you were wanting to just get on with in case there was another desat."

Letby replies: 'Well I have got my hair in a bun today, it's only fitting that I was 'serious Lucy' !!' Letby adds 'no more bleeding thankfully', in relation to Child N.

Cheshire Police intelligence analyst Kate Tyndall is taking the jury through sequencing evidence for June 15, when the Crown say Ms Letby twice attacked the boy

Ms Letby's nursing notes from June 15 record that Child N was 'pale/mottled' and required oxygen support

Ms Letby's notes state that Child N's parents had been informed and that they were 'understandably upset'

2.50pm: At 14:50 on June 15, Ms Letby recorded that Child N had a profound desaturation. Notes state: 'Infant became apnoeic with desat to 44%. heart rate 90bpm. Fresh blood noted from mouth'...minutes later a number of senior medics were crash bleeped to attend the child

Nursing notes record that there was difficulty trying to insert an ET tube. With two doctors failing to 'obtain a secure airway'

Two consultants from the anaesthetic team were called to help, but they also had difficulty fitting an ET tube, the nursing notes show.

Court now being shown messages between Ms Letby and colleagues that evening. A doctor [Dr A], who cannot be named for legal reasons, asked her if she was okay and told her to cry if she needed to. Ms Letby responded: 'I’m ok just feel like ive been running around all day and not really achieved anything positive for him….don’t want to cry in front of people here maybe when I’m home'

At the end of her shift, Ms Letby sent a WhatsApp message to a nursing colleague, who also cannot be named, saying: 'Losing the will'

7.40pm: Notes from 19:40 on June 15 show that there was a further 'profound desaturation'. Child N had 'colour loss' and required neopuff breathing support

At 19:48 the baby boy required resuscitation and a number of doses of adrenaline

He eventually stabilised. Ms Letby said in a message to a colleague, who can't be named for legal reasons, that Child N's parents were present and had had the boy christened.

Court has been shown numerous messages between Ms Letby and a doctor [Dr A], who cannot be named for legal reasons. In one of those messages she asks 'What do you think caused his (Child N's) bleed?'

The doctor responds: 'I think there will be a haemangioma or collection. If it was epiglottitis his crp should have been higher because he was starting to become unwell'

Doctor says he's 'optimistic he'll be okay' Ms Letby responds: 'That's brilliant news, thanks for letting me know' - soon after the boy was discharged from Alder Hey hospital

Lucy Letby in the Witness Box

Direct Examination

Lucy Letby gave this evidence on 16th & 17th May 2023.

Mr Myers now turns to the case of Child N, a baby boy born on June 2, 2016, gestational age 34 weeks plus 4 days, weighing 1,670g. Mr Myers asks Letby how important it was for her to treat these babies. "Very important - I took the job extremely seriously...we want to make sure the babies go home." Mr Myers says Child N was born with haemophilia. Mr Myers says the first event was on June 3, at 1am when Child N was said to be "screaming or crying", desaturating, and was treated with breathing support. The second event was on the morning of June 15, when Child N had a "profound desaturation", and following from that, there were attempts to intubate him, and blood was found in the oropharynx. The third event was a "profound desaturation" at about 3pm on the same day and 3ml of blood aspirated from the NG Tube, followed by multiple attempts to intubate Child N. At 7.40pm, as a team arrived from Arrowe Park, there was a further desaturation for Child N.

Mr Myers asks Letby about Child N. Letby says she had not encountered a baby with haemophilia and staff on the unit were "quite panicked" about the prospect of caring for a baby with haemophilia, as they had little/no experience either. A message Letby sent to a colleague on June 2: "Everyone bit panicked by seems of things although baby appears fine" The response: "Male?"
LL: "Yeah" The response: "Factor 8?"
LL: "Not sure I only know what's on handover sheet as Dr etc all in with him doing head scan etc" Letby said at the time, she did not know what 'factor 8' referred to. The response: "Lad with haemophilia when worked community with Leighton on placement"
LL: "Ah ok I'll have to Google it later lol don't know much about it" Response: "Have to b careful with cannula/heel pricks etc "Give Factor 8 or Factor 9 I think it is dependent on which clotting factor deficiency is "Have as infusion for rest of life"
LL: "Wow" Response: "Nearly always make [then corrected to 'male']"
"We were going out supervising parents starting to give the boy his prevention injections themselves "Wonder if knew antenatally "Must have done suppose to know now "Sure boy we went to had it thru port-a-[cath]"
LL: "Complex condition, yeah 50;50 chance antenatally" Letby says her nursing colleague had more experience, and it was a 50:50 chance that the mother would pass on the condition to the baby. She said it was something she had heard of, but did not know the details of that.

The shift rota for June 2-3 is shown to the court. Lucy Letby is on duty. She says she has no memory of the shift. A note by Dr Jennifer Loughnane for Child N at 0110: 'desat, unsettled...got upset, looked mottled, dusky, sats down to 40% - 100% O2. On my arrival 40% O2. screaming, poor trace on sats probe, pink, attempt to settle, crashed bleeped away. On return...sats 100%, asleep...' Letby denies having any involvement in the incident. A note by nurse Christopher Booth for Child N: '...One episode whilst I was on my break, whereby infant was crying++ and not settling. He became dusky in colour, desaturating to 40s. Responded to facial oxygen within 1-2 minutes. Crying subsided within 30 minutes...' Letby again denies having any involvement in this event for Child N. A neonatal schedule for June 2-3 is shown to the court. She tells the court she was doing feed/observations for one baby and assisting in prescriptions for another baby. Neither of them are Child N. The event is recorded for Child N at 1am. Letby is next recorded on the schedule at 2.30am. "Did you know there had been an incident with [Child N]?"
"No." Swipe data is shown that Letby entered the neonatal unit at 1.15am. The court has heard swipe data is collected when staff members enter the unit, not exit. Letby tells the court she may not have been in the unit at 1am. "The allegations against you are of the most grave nature, aren't they?"
"Yes." In June 2016, Letby is asked about 'concerns outside of work' - Letby said she had "an active life" with hobbies and friends. Instant messages are shown to the court, from the morning of June 13, in relation to packing for a holiday Letby took with a friend and a nursing colleague. The discussion refers to a series of Love Island and who hosted Love Island/Temptation Island. Mr Myers explains to the court who Abbey Clancy is. Mr Myers asks if Letby was thinking about killing babies during that time. Letby denies that was the case.

A shift pattern for Letby for June 2016 shows Letby worked long day shifts on June 8, 10, 11, 13, 14 and 15.
A doctor colleague says, on June 14: "Am I right in thinking you'll have done 6 long days in the last 8? No wonder you're tired" Jones-Key: Letby says at the end of her June 14 shift, for the handover of Child N's care to Jennifer Jones-Key: "I don't recall there being any concerns at that time" for Child N. A nursing note by Lucy Letby for June 14 is shown to the court. It includes: '...repeat SBR this morning on downward trend but not yet >50 below treatment line but otherwise ready for home'. Letby says Child N was being treated for jaundice and required further phototherapy. Once that was complete, he was ready to go home. Jennifer Jones-Key notes: '...baby very unsettled early part of night. I noticed that just after 0100 feed baby looked very pale, mottled and veiny. Abdomen slightly bigger - seen by NNU nurse Belinda Simcock, advised to place baby on saturation monitor...after 30 mins noted to be having desaturations to low 80s, no intervention required but quite frequent. Rest of observations within range....baby looked worst this morning...10% dextrose commenced...' Letby agrees Child N deteriorated during the night. ...at 0715 baby crying and dropped saturations - seen by NNU nurse Lucy. Neopuff given with 100% oxygen...noted to be mottled all over body and blue in colour and cold to touch. Decision made to transfer to nursery 1... At handover baby dropped saturations again and required Neopuff. Care handed over to NNU nurse Lucy Letby'. Swipe data shows Letby and a colleague entering the neonatal unit before 7.15am, in time for the 7.30am shift. Letby recalls she went to nursery room 3 to talk to Jennifer Jones-Key "She was a good friend of mine" - as part of getting ready to work. The handover had not yet taken place "not that I'm aware of". She said the chat happened and "within minutes" Child N's monitor went off and Child N appeared mottled. Letby says Jennifer Jones-Key was tending to another baby. Letby says she was within the doorway and had not entered the room. Child N was in a cot by the doorway. Letby said she went straight over to him and he was a 'bluish colour' and she called for help. Letby says Jennifer Jones-Key finished what she was doing and came over to help. A registrar doctor came over almost immediately to help. Child N recovered from the initial episode but deteriorated again "very quickly". "His colour was not good, he was mottled, and the decision was taken to move [Child N] to room 1". Letby says she had been in the unit for "minutes". The doctor said the decision was made to intubate Child N. Letby tells the court she got the equipment ready for intubation, including routine drugs.

A neonatal schedule shows Letby assisted in the administration of medication for Child N at 8am-8.06am. Letby is asked if she saw blood at some point during the intubation process. Letby says she does recall that, but cannot recall at what point that was. The doctor's notes: 'Attempted intubation x3...using size zero blade. Blood present at oropharynx. Unable to visualise tracheal inlet. Suction did not clear the view. Intubation abandoned due to blood present...oropharynx...trauma due to repeated attempts.' Letby recorded in her notes: '...unable to intubate - fresh blood noted in mouth and yielded via suction ++' Letby tells the court her interpretation of the note is the blood would have appeared after the attempt to intubate.

A 3pm note on a fluids chart records '3ml fresh blood' as an aspirate. Letby says she did recall seeing blood in the afternoon. The note is signed by a nursing colleague of Letby - the other hourly observations are signed by Letby. 1ml fresh blood is noted by Letby at 10am and 6pm. Blood++' is also recorded by Letby on a note, which the court hears is "after 8am". "Blood in mouth" is recorded at 9am.

Mr Myers refers to police interviews Letby had. Letby says none of what was discussed in the questioning referred to any blood seen on Child N prior to the 8am intubation. She told police the "airway issue" was from 3pm-4pm, in attempts at intubation, and recalls, from memory, seeing blood prior to 4pm. Letby denies saying she saw blood prior to 8am.

Benjamin Myers KC, for Letby's defence, is asking Letby questions for the third event for Child N on June 15, 2016. Lucy Letby's nursing note on that day, written retrospectively, includes: 'Infant has had periods of apnoea during the morning...improving by afternoon. Observations stable... Approx 1450 infant became apnoeic, with desaturation to 44% hr 90bpm, fresh blood noted from mouth and 3mls blood aspirated from NG Tube....Neopuff commenced and Drs crash called...unable to obtain secure airway...[Drs] unable to insert ET Tube...I Gel airway inserted and infant ventilated' Letby says after this event, she has some memory of it. "It was becoming increasingly chaotic- more and more staff [were called out to assist]. "There was a sense of panic that we weren't sure how we were going to manage [Child N]. "There were loads of people [called to care for him], I would say 10-15. "[Child N] needed such care that he needed two people to care for him [at all times]. A transport team from Alder Hey was called out to assist, and bring 'Factor 8' "as an emergency". Letby says Factor 8 was required for Child N, but none was available on the unit. Mr Myers says it was known Child N required Factor 8, and Child N had been at the unit since his birth.
Letby: "It became a panic then."
"I think baptism was offered to the parents at some point...there was a lot going on in the room. "The team from Alder Hey came and there was a lot of discussion...the team had brought a lot of specialist equipment over...at this time, handover was taking place [around 7.30pm] and around this time, that was when the episode happened."

Doctor's notes record: 'At 1940 desat 80 [down to] 50 [down to] 40% + associated brady. Resus...' Letby's notes written at 8.53pm recorded: 'Medical team from AHCH arrived approx 1900. Assessed [Child N] and decision made to attempt intubation in CLS theatre...at 1940 profound desaturation (30s) with colour loss. stiff and back arching. Became bradycardic....mottled++. Drs present. Resus commenced...care handed over. All events took place on NNU prior to moving to CLS theatres. NWTS team arrived 2040.' Letby says Child N "was the focus of the whole unit" at that point, and there were concerns staff could not get him intubated. "It was a real concern, we were all worried about him."
"It was something I had never experienced before - I had never seen that many people in the nursery for one baby. "The concern was if we couldn't get an airway...then we would have to undergo surgery... "It was frightening...for his safety."

Cross-Examination

Lucy Letby gave this evidence on 7th June 2023.

11:25am: Mr Johnson is now turning to the case of Child N, born on June 2, 2016. Letby, in her defence statement, says she had never encountered a baby with haemophilia before, and no-one on the unit seemed specifically to know how to care for such a baby. She says she does not believe Child N 'collapsed', and it was not accurate to say he had screamed for 30 minutes. She denied causing any harm to him.

11:30am: Letby tells the court she does not believe this event, for Child N, was a collapse which required resuscitation. The court is shown the nursing rota for the night shift of June 2-3. Letby was designated nurse for two babies in room 4. Child N was in room 1 with one other baby - the designated nurse for both babies was Christopher Booth. Letby rules out staffing levels or incompetence as factors in Child N's collapse. Letby agrees Child N collapsed just after Christopher Booth went on his break. Letby denies she was 'bored' or had 'time on her hands' working in nursery 4 that shift. She agrees Child N 'was in good shape' at the start of the shift.

11:54am: The neonatal schedule for June 2-3 is shown, with Letby's duties for her two designated babies from 8.30pm-8.38pm. One of the designated babies received a 50ml NGT feed at 8.30pm as they were asleep. Letby says that feed can take '10-15 minutes or so'. She says she can't put a 'definitive number' on it. Mr Johnson says other estimates for this kinds of feed have been 20 minutes.
Letby: "I really can't say." Mr Johnson says Letby was texting her friends 'right through this shift'. A sequence of messages is shown to the court. The first sent by Letby is at 7.33pm, followed by 7.35pm, 7.58pm, 7.59pm, 8pm ['We have got a baby with haemophilia'], 8pm, 8.01pm, 8.02pm, 8.03pm, 8.04pm [Ah ok I'll have to Google it later lol don't know much about it [haemophilia]], 8.06pm, 8.11pm [Complex condition, yeah 50;50 chance antenatally].
NJ: "That is where you got the answer from, Dr Google?"
LL: "No, '50:50' is something staff would know"
Messages are sent by Letby at 8.26pm [Ffs Mel asking me how to make up 12.5%], Letby said she was "shocked" that a band 6 colleague was asking her how to make up such a solution, when she could have looked for herself.
8.29pm: 'No I've passed her folder but now asking if can run via cannula- she needs to look herself!'
Letby says she was "not happy" with Mel.
Another message is sent from Letby at 8.29pm, and at 8.31pm, and 8.31pm, at 8.32pm, 8.34pm.
Letby is asked how she can feed a baby at 8.30pm when she was also texting.
LL: "You can't."
Letby denies feeding the baby "very quickly" by putting the plunger on the end.
Another message is sent from Letby at 8.38pm [Had strange message from [doctor colleague] earlier...']
Mr Johnson asks if Letby's nursing colleague was implying Letby and the doctor were in a relationship.
Letby says she does not know.
Letby's colleague sent two messages: "Did u? Saying what?"
"Go commando? 😂"
Letby is asked by Mr Johnson if she knows what the implication of 'go commando' means.
LL: "I don't know what was meant, I can't say right now."
NJ: "Do you think this was an army reference, being from Hereford?"
LL: "I don't know."
The messages are sent by Letby at 8.39pm, 8.40pm, 8.41pm, 8.43pm [Do you think he's being odd?], 8.44pm [Shut up!], 8.44pm [I don't flirt with him!].

12:03pm: The text message conversation was:
Letby: 'Had strange message from [colleague] earlier....'
Reply: 'Did u? Saying what?'
Letby had replied at 8.39pm: '😂😂😂😂'
LL: 'Asking when I was working next week as wants to talk to me about something, has a favour to ask..?'
Reply: 'Think he likes u too'
Reply: 'Hmm did u not ask what it was?'
LL: 'No just said when I was working and he said wants my opinion on something'
LL: 'Hmm...🤔''
Reply: 'Hmm'
LL: 'Do you think he's being odd?'
Reply: 'Thought as flirty as u'
LL: 'Shut up!'
Reply: 'What?!'
LL: 'I don't flirt with him!'
Reply: 'Ok'
LL: 'Certainly don't fancy him haha just nice guy'
Reply: 'Ok'

12:11pm: Mr Johnson says Letby was 'texting non-stop' on the nursery room. Letby says the feed "must have happened at a different time". She says she cannot answer when. She denies 'pushing it through' the feed. Mr Johnson says Child N collapsed at 1am. Christpher Booth 'one episode whilst I was on my break, whereby infant was crying++ and not settling. He became dusky in colour, desaturating to 40s. Responded to facial oxygen within 1-2 minutes. Crying subsided within approximately 30 minutes and colour returned to normal...' Letby tells the court this was not a 'collapse' as facial oxygen was all that was required, not resuscitation.

12:14pm: Mr Johnson says Dr Jennifer Loughnane had a 'look of surprise' in court when she had read her note she had written Child N was 'screaming', as that was unusual. Letby says she does recall that. She denies sabotaging Child N.

12:23pm: Mr Johnson turns to the second set of events for Child N on June 15, when the plan was for Child N to go home that week. Letby agrees he only needed phototherapy at this stage. A feeding chart is shown for Child N, who was being fed mostly expressed breast milk. Child N's mother had visited on the morning of June 14, and in the evening, at 5.15pm. Child N had taken a 60ml bottle feed. Letby agrees with Mr Johnson this was "a very good sign". Mr Johnson suggests Letby did something to destabilise Child N before the end of her day shift.
LL: "No I did not." Letby says it was a "coincidence" Child N was, according to nursing notes that night "very unsettled early part of night", with observations of mottling.

12:26pm: Letby is asked about a message sent by a nursing colleague at 5.26am which said 'Baby [N] screened, looks like [s***]'
Letby responded: 'Oh no'
Letby denies she saw this as an opportunity to sabotage Child N during the day shift.
LL: "No, that's not what happened."

12:29pm: Letby messaged a doctor colleague at 6.04am on June 15: 'Wonder if I'll find my way back into 1 today then....',
This is in response to his message at 5.53am, which begins: 'What a chaotic 7 hours! Sorry - I may have filled NICU [...] Have a good breakfast 😉 I think your day may be busy.'

12:41pm: Swipe data shows that Letby is on the neonatal unit at 7.12am. Child N desaturated three minutes later and was 'crying'. Letby says she does not recall Child N crying. She says, at the time, she was in the doorway, talking to Jennifer Jones-Key - her friend, when the alarm for Child N went off. Letby says it "was very busy" and "a lot of intervention was needed" for Child N after he collapsed. She does not cite staffing levels as a contributing factor for the collapse, or a mistake by medical staff. Letby says she "does not know" if issues with intubating Child N were a factor, and does not know what caused Child N to collapse. She denies "setting up" Child N to collapse overnight.

12:45pm: Letby, in her defence statement, said she had gone to nursery room 3 not to see Child N specifically, but to speak to Jennifer Jones-Key, her friend. She said Child N was 'blue' and 'not breathing'. She shouted for a doctor colleague to assist and Neopuff breathing assistance was applied. Letby is asked about the 'Jennifer and I were talking at the doorway'. Letby says she meant only she was at the doorway, and Jennifer Jones-Key was in the nursery room.

12:48pm: Letby, in a Facebook message to a colleague: 'No repeat today. I've escaped being in 1, back in 3' at 7.12pm. Mr Johnson says Letby had gone in to room 3 as she knew by that point she was designated babies for that room. Letby says she had gone to see her friend. Letby denies sabotaging Child N. Letby agrees it was a "serious event" which happened "within a minute or two" of her entering the room. Mr Johnson says it was "bad luck?"
Letby replies: "Yes."

12:59pm: Mr Johnson asks Letby when blood was seen orally on Child N. Letby replies "the only time definitively" she recalled that was at 3pm. she says that is on her memory "sitting here now". Mr Johnson says if she had recorded blood observations at the time, would she accept that now? Letby says she would, although it may have been based on what people had informed her at the time. Mr Johnson says the one who would have informed her would have been the doctor colleague she "loved as a friend". Letby's nursing note: '...infant transferred to nursery 1 on handover. Mottled, desaturating requiring Neopuff and oxygen.' Letby says "both" she and Jennifer Jones-Key had gone over to Child N at the time of desaturation. Mr Johnson says Letby was "hoping to create the impression" on the nursing notes that the problems for Child N happened before the handover.
LL: "No, I disagree." Letby tells the court she had taken over Child N's care from 7.30am.

1:01pm: Letby's note, written at 1.53pm-2.10pm adds: 'unable to intubate - fresh blood noted in mouth and yielded via suction ++'. Letby says the 3pm blood observation was the first one she could "definitively remember". Mr Johnson says this note is a 'good hour' before that observation. Letby denies Child N was bleeding from when she first got involved that day.

2:13pm: The trial is now resuming after its lunch break.

2:22pm: Letby says she knows there was blood recorded prior to 3pm. Mr Johnson says the doctor colleague recalled, in evidence, seeing blood before the intubation process at 8am. Benjamin Myers KC, for the defence, rises to say that in cross-examination, the doctor colleague did not rule out the possibility the blood was present after the attempt to intubate. Mr Johnson says there was an attempt to intubate at 8am. Letby agrees. Letby also agrees with the observation there was swelling at the back of Child M's throat. She says she "cannot comment" further on what the doctor colleague saw.

2:24pm: Letby recorded in her notes, written at 1.53pm retrospectively: '...unable to intubate - fresh blood noted in mouth and yielded via suction ++' Mr Johnson says the doctors could not see, for the blood. Letby says she cannot say what doctors observed. Letby agrees that evidence from Professor Sally Kinsey ruled out 'spontaneous haemorrhage' for Child M at this time.

2:35pm: Letby is asked about family communication with Child N's parents. A note by Letby at the time: 'Parents were contacted by S/N Butterworth during intubation. Both mobile phones switched off and no answer on landline. Message left. Call returned shortly after and parents were asked to attend. Have been present since. Both understandably upset...' Agreed evidence said Child N's mother had said Lucy Letby had been in contact with them. Letby says "it's a difference in recollection". Mr Johnson says this is agreed evidence, it's the truth. He says Letby's note "is a lie".
Letby: "no, it's not." The mother recalled Child N 'had a bleed and was unwell', and said Letby had informed the parents of this.
Letby: "No, I disagree."
NJ: "But it's agreed evidence."
LL: "Well, I disagree with it now." Mr Johnson says this is another account from a parent which Letby says is untrue. Mr Johnson says Letby has been 'firing out post-it notes from the dock' during the trial, but had not raised this issue at the time.
LL: "I'm not sure."
NJ: "Is the answer no?"
LL: "It's not something I raised with my legal team."
Letby: "I don't want to comment on whats, ifs and buts." Mr Johnson says Letby interrupted when the mother of Child E and F gave evidence, to say she couldn't hear, and wanted to leave the courtroom when a doctor colleague began to give evidence.
LL: "Yes, because I felt unwell." Mr Johnson says: "No, no..." adding that it was because it was her boyfriend who was giving evidence.
Letby: "That's not fair." Mr Myers rises to say the line of questioning is inappropriate, and asks for the opportunity to consider the issue raised [of a dispute in agreed evidence].

2:39pm: Letby adds she did not make the phone call to Child N's parents, and denies making false entries in the paperwork. An intensive care chart is shown for Child N on June 15, saying at 10am '1ml fresh blood'. Letby says she "cannot say" if it was a vomit or aspirate. The note is in Letby's handwriting. Letby is asked what she did about it.
Letby: "I cannot say right now."

2:42pm: Mr Johnson asks what would Letby do if fresh blood was observed in Child N's mouth?
LL: "I don't know if it was in the mouth." Letby adds such an observation would have been escalated, but she does not know who to. Mr Johnson says there is no record of it being escalated. Letby agrees there is no "written record", but it may have been verbally escalated. She says 1ml fresh blood is not normal but not a life-threatening event. Mr Johnson says for a baby with haemophilia, it was serious. Letby says it would be a concern, and would be escalated.

2:46pm: A doctor in the ward does not record the bleed during the ward round, the court is told. Mr Johnson says Letby has "invented" the blood reading for 10am.
Letby: "I disagree." Mr Johnson suggests it was all designed to give an ongoing impression for a child with haemophilia. Letby disagrees.

2:48pm: Letby says it's true that an NG Tube can cause "a small amount" of bleeding in the mouth. Letby says she cannot say if she didn't escalate it [the bleed in Child N] verbally.

2:51pm: A Facebook message from Letby is sent to a doctor colleague at 11.29am on June 15. Small amounts of blood from mouth & 1ml from ng. Looks like pulmonary bleed on Xray. Given factor 8 - wait and see. Apnoeas have improved & gases good, colour & perfusion still not Great. If deteriorates will try to intubate.' The x-ray report ruled out a pulmonary bleed. Letby says this report came some time later. Mr Johnson suggests either there wasn't a problem at all, that Letby was making evidence up, or Letby was causing the problem. Letby disagrees.

2:54pm: Mr Johnson says a statement from the parent of Child N said the collapse was so serious a priest was offered. Mr Johnson says this collapse must have been the one at 2.50pm. Letby noted: 'approx 1450 infant became apnoeic, with desaturation to 44%...fresh blood noted from mouth and 3mls blood aspirated from NG tube...drs crash called...'
NJ: "What had you done to cause this in [Child N]?"
LL: "I hadn't done anything."

2:59pm: Letby denies "shoving a foreign object" down Child N's throat.
Letby: "Absolutely not."
NJ: "It's all your work, isn't it?"
LL: "No it's not at all." Letby agrees she was 'agitated' by the need for assistance from Alder Hey, as she had not known a case before of people from another hospital coming in to assist.
NJ: "Do you remember saying 'who are these people?' 'who are these people?'"
"Yes, because I had never experienced who these people were [coming in from a different hospital.] ...It was a completely new experience." Child N later collapsed once more. She denies using the doctors being in a 'huddle' as an 'opportunity' to try and kill Child N again.

Witness Statements Agreed

Family - Mother

The court is now hearing a statement from the mother of Child N, who was born on June 2, 2016 at 1.42pm, via C-section.

The mother first visited the neonatal unit, where Child N was, at 10pm that night. Child N was kept there due to prematurity, and for the first 13 days there were no problems reported to the parents.

Child N had haemophilia and on June 15, the parents were informed the baby boy had had a bleed. The parents were informed to attend hospital as soon as possible.

Child N was in intensive care, and on arrival Lucy Letby was there with other people.

They were told they had tried to intubate Child N between 4-8am.

Child N had two collapses that day - the parents were told to go out and get some fresh air in between the two collapses. While they were out, Child N had his second collapse.

A 'spur of the moment' baptism took place. Lucy Letby stayed beyond the end of her shift, and Child N was transferred to Alder Hey, where he recovered quickly over the following couple of days.

Family - Father

A statement is now being read from Child N's father, who says Child N's mother was a haemophia carrier.

He said he could not go to all the scans, but at one of them there was a concern Child N appeared to stop growing, so steroids were prescribed.

A C-section was planned, several weeks early.

When Child N was born, he weighed 3lb 11oz.

It was "a little scary" when he was first born, as Child N needed a little oxygen, but he was then ok.

For the first 13 days, the only issue reported to the parents was an issue with Child N's liver, which he was being treated for with light therapy.

The parents visited daily.

On the day Child N was due to come home, on June 15, the father was at work. He received a call from Lucy LEtby saying Child N was 'a bit unwell' during the night, but was fine now. He did not get the impression that Child N was still unwell.

He then received a call from child N's mother to come to the hospital as soon as possible.

When he arrived, Lucy Letby was in the room with Child N, giving cares. There was "no urgency". Lucy said: "Hi. He's been a bit unwell during the night."

He said he was "shocked" when he saw Child N, as he had dried reddy-brown blood around the mouth.

"I remember being confused and thinking, 'what's wrong with him?'"

"No-one told us what happened, or why."

After going outside for a bite to eat, they returned to the neonatal unit and found the blinds were down.

A staff member on reception said Child N was "really unwell" and if they would like a priest.

Someone came into the maternity room, where Child N's mother was staying with the father. The staff member said: "You'd better come - he's really ill this time."

Upon their arrival to the intensive treatment unit, resuscitation efforts were being administered to Child N.

The father said he could not watch what was going on. Staff from Alder Hey Children's Hospital were among the staff members in the room.

After a breathing tube was fitted, Child N stabilised and 'calmed down'.

The parents spoke to a haemophiliac specialist nurse who had come from Alder Hey via taxi.

Child N was taken to the transport team, in a process "which seemed like forever", by 11pm.

Lucy Letby came to the parents and said she had stated beyond the end of her shift and hoped that
Child N was going to be alright.

Child N was taken to Alder Hey, where he stayed for a couple of weeks before going home.

When home, the parents noticed Child N had 'twitches', then later 'spasms', and at one point was not breathing.

He was taken to the Countess of Chester Hospital, and transferred to Alder Hey, where he stayed for 1-2 weeks.

Dr Sudeshna Bhowmik

Firstly, a statement from Dr Sudeshna Bhowmik is read out to the court.

Dr Bhowmik says tests were carried out on Child N for haemophilia.

It was discussed with the parents that Child N would be taken to the neonatal unit due to his prematurity, and would need an incubator for temperature control.

Child N had intermittent grunting at one hour of age, which was not unusual for babies born via C-section as there would be increased fluid in the lungs. The usual practice was to oberserve for four hours to see if the baby would settle down. Vitamin K was withheld on the risk of increased bruising/bleeding for Child N, until test results came back.

Child N was later screened for sepsis as he had continued grunting beyond the four-hour observation period. He was breathing without any support required.

He had had 'an episode' where he desaturated to 40%, with colour change noted, but had "settled thereafter" and did not need "supplementary oxygen for very long".

The rest of the examination by Dr Bhowmik on June 3 was "normal", and Child N was seen to be pink and well perfused, and doing "well from a respiratory point of view"

Nurse Caroline Oakley

A statement from Caroline Oakley is read out to the court, in which the nurse describes Child N being born, transferred to the neonatal unit, and describes being aware the mother was a haemophilia carrier.

Child N was dressed and placed in a 'hot cot'. He was 'grunting intermittently', which was not unusual. At 3pm, his temperature dropped to 36.4 degrees, and the temperature of the cot was increased to 39 degrees.

Child N had a desaturation to 67% and was given 60% oxygen support, and was screened.

Child N was presenting "quite typically" for a baby of his gestational age, and there were no overriding concerns at the time of the handover.

A second statement by nurse Caroline Oakley said there was nothing to suggest the naso-gastric tube had been moved, nor any difficulties with the tube being initially inserted.

Nurse Melanie Taylor

Nurse Melanie Taylor, in her statement, says she "vaguely" remembers Child N by the name, but does not recall the shift. She confirmed she was the shift leader for the night of June 2/3, 2016.

She was aware Child N had suffered a collapse during the night, but did not remember it happening or responding to it.

Nurse Sophie Ellis

Nurse Sophie Ellis, in her statement, says for the night shift of June 2/3, 2016, she had a vague memory of Child N as had haemophilia, which was unusual. She did not remember the details of the night shift she worked.

She says she knows, from the notes, Child N had a collapse, but does not remember being involved in the efforts to stabilise Child N. She knows the collapse happened when Christopher Booth was on a break.

Nurse Christopher Booth

Christopher Booth, in his statement, is asked about the night shift he was on for June 2/3, 2016. He said he remembered Child N as it was unusual for a neonatal baby to be a haemophiliac. He adds his memory of the shift is "limited".

He says he is "almost certain" he was caring for Child N that night. He recalls Child N was stable, with oxygen saturations "almost 100%, and "no abnormalities" presented.

He says it was likely on the hour when he left for his one-hour meal break, saying he had "no concerns". He handed over care to a nurse, but does not recall who that was.

When he returned from his break, he was "surprised" to learn Child N had become 'unsettled' and 'fractious' suffered a desaturation. He adds he had not been called back from his break.

Nurse Valerie Thomas

Valerie Thomas, in her statement, says she does not recall Child N or the night shift of June 2/3, but does know she was on that night shift. She says she was likely working in nursery room 3 or 4.

She knows Child N had collapsed when nurse Booth was on a break. She said it was "very unlikely" she would have been involved in any subsequent care.

Nurse - unnamed

Taken from Dan O’Donohue Twitter

A nurse, who cannot be named for legal reasons, said in her statement that she remembers being 'shocked' at Child N's deterioration that day. She said that he was previously stable and ready to go home that day

Elizabeth Morgan

Taken from Dan O’Donohue Twitter

Court being read a statement from Independent
Nursing Healthcare Advisor Elizabeth Morgan, who was asked by Cheshire Police whether Ms Letby's 'failure' to alert other medics that fresh blood had been aspirated from Child N's mouth that day fits with 'good practice'

Ms Morgan said in her professional opinion, it would be 'standard good practice' to escalate anything unusual - first verbally and then later recoded

Witness Evidence

Dr Jennifer Loughnane

Prosecutor Philip Astbury says Dr Jennifer Loughnane will next give evidence.

She confirms she is a consultant paediatrician at the Countess of Chester Hospital, and was employed as a registrar on the night shift of June 2/3, 2016.

She says she has no independent recollection of Child N or that night shift, other than that recorded in her notes.

At 10.55pm, she carried out a routine review, which included an examination of Child N.

Dr Loughnane has noted Child N's history up to that point in the first 12 hours of his life, and noting a concern of a growth restriction during pregnancy, and the weight of 1.67kg indicating Child N was "a small baby".

No risk factors for sepsis were detected.

Child N was 'screened [for infection] - due to grunting at four hours'. The grunting was, the court hears, due to Child N having extra fluid in the lungs.

Child N was 'self ventilating in air', 'respiratory rate 60', 'Sats 96% room air'

An antenatal plan had been put in place as Child N's mother was a haemophilia carrier.

At 1.10am, Dr Loughnane is informed about Child having a desaturation. She does not recall who did so.

The note at the time records: Child N 'got upset, looked mottled, dusky, sats 40%, O2 100%'.

'On my arrival, 40% O2, screaming, sternal recession, poor trace on Sats probe, pink'.

The desaturation was "significant", Dr Loughnane tells the court.

Mr Astbury asks about the significance of the word 'screaming'.

Dr Loughnane says that 'screaming' is not a word she would tend to write very often in her neonatal notes. She says that would indicate Child N was particularly upset.

Dr Loughnane said attempts were made to settle the baby, but was crash bleeped away.

On her return, Child N's saturation levels recovered to 100%, and he was "asleep". The time of Dr Loughnane's return is not recorded.

The plan was to continue to observe Child N and carry out the blood gas reading at 2am, indicating the note was made sometime before 2am.

A blood gas reading is carried out at 2.04am, and Dr Loughnane says there is a raised lactate reading for Child N.

Cross Examination
Benjamin Myers KC, for Letby's defence, is asking Dr Loughnane questions.

He says Dr Loughnane covered a lot of areas of the hospital on that night shift. She replies the arrangement was standard for most hospitals.

Mr Myers refers to notes made before the handover took place, in relation to Child N "intermittently grunting++" and an event of Child N desaturating to 67%.

He asks if it is possible for a baby to desaturate because they are upset, via a 'false desaturation' from the Sats probe not picking up the trace.

Dr Loughnane says that can be the case, but it would usually be recorded as such in the medical notes. The number on the oxygen saturation reading could be lower, or not be displayed at all.

Mr Myers asks about Child N 'screaming' and being 'pink', which he says if Child N had suffered a desaturation, he was "certainly recovering" from that. Dr Loughnane agrees.

Mr Myers asks about the relevance of the 'poor trace on Sats probe'.

Dr Loughnane says she had been told of the 40% sats reading, but on her arrival, she had seen Child N was pink.

Mr Myers says there were no signs of Child N having any fresh blood anywhere. Dr Loughnane agrees.

Dr Loughnane also agrees it is rare to be looking after a baby at the Countess of Chester Hospital - or any hospital - who has haemophilia.

Mr Myers says other than the raised lactate reading, the blood gas record at 2.04am was normal. Dr Loughnane agrees.

The prosecution rise to clarify the '40% O2 (on my arrival)' note, and ask if that is a saturation reading or the oxygen support for Child N. Dr Loughnane says she cannot be sure, but believes it would be the latter.

Mr Astbury says if the 40% oxygen saturation recorded by the nurse was inaccurate, it would have been noted as such in medical notes. Dr Loughnane agrees that would be the case.

That completes Dr Loughnane's evidence.

Dr Huw Mayberry

Taken from Dan O’Donohue Twitter

Dr Huw Mayberry is first to give evidence today - via live link from Australia. Dr Mayberry currently works as a registrar in Melbourne, back in 2016 he was at the Countess of Chester Hospital

Dr Mayberry is being asked about the events of June 15, 2016. Child N crashed several times throughout that day - at one point requiring full resuscitation and six doses of adrenaline

Dr Mayberry was crash bleeped to attend the neonatal unite at around 15:00 due to a 'sudden desaturation following 3ml aspirate of blood from NG (tube)'

The doctor tells the court he tried to intubate Child N, but he 'was unable to get a very clear view because there was substantial swelling within the airway'. He said that this swelling was 'unlike anything I had encountered previously'

He said the infant's epiglottis (flap of tissue at the back of the throat) was 'quite swollen, it looked quite large and reddy pink in colour'. He adds 'I had not seen this in my practice before, only in textbooks'

He tells the court that his initial thought was that this could be epiglottitis - this often caused by an infection, but can also sometimes happen as a result of a throat injury

Dr Mayberry tells the court that he does not recall seeing any blood in Child N's throat. Asked if he could he could give a cause for the swelling, he says 'no it’s not something I've had much experience of'

Cross Examination
Ben Myers KC, defending, is now questioning Dr Mayberry. He asks in his professional opinion what can be the cause of blood - he says he told Cheshire Police it could have been a result of gastric irritation or Necrotising enterocolitis (NEC)

He says it could also have been a result of Child N's blood disorder, which resulted in a deficiency of an essential blood-clotting protein

Nurse Jennifer Jones-Key

Taken from Dan O’Donohue Twitter 03/03/23

Nursery nurse Jennifer Jones-Key is now in the witness box. She was on a night shift on 14 June 2016 and was Child N's designated nurse along with Neonatal assistant Lisa Walker. They took over Child N's care from Ms Letby, she tells the court there was no concerns on handover

Ms Jones-Key's nursing notes, written retrospectively at 5:51am on 15 June, state that 'just after 1am baby looked very pale mottled and veiny'

She recalls that over that morning Child N 'started to have a few desaturations' and was placed on full monitoring

Ms Jones-Key tells the court that Child N 'settled down' but 'from 7am onwards he was having more desaturations'

The nurse says shortly after 7am, Ms Letby came in to 'say hello'. At that point, she said 'I think the monitor went off, so Lucy went over to see. He went quite pale, I think he’d stopped breathing, I got the neopuff'

She's asked by the prosecutor where Ms Letby was in the room, she doesn't remember. She is asked again why Ms Letby was in the room - 'just to say hello, because we were friends', she says

She doesn't remember any conversation between them. She says the decision was taken to provide respiratory support to Child N . A nursing note from that morning states: 'noted to be mottled all over body and blue in colour and cold to touch'

Ben Myers KC, defending, is now questioning the nurse. He asks if Ms Letby was 'quite a good friend', 'Yes' she responds. He asks, in her opinion, if Ms Letby was a 'capable and hard working nurse', she agrees

Mr Myers asks, in her knowledge, whether Ms Letby only gave 'the highest level of care' to the babies she cared for, she responds 'yes definitely’

Mr Myers is referring back to Child N's desaturation that morning, he says essentially Ms Letby said hello to Ms Jones-Key then responded when the baby boy's monitor went off - Ms Jones-Key agrees

Dr A [Thirlwall: Dr U]

Taken from Dan O’Donohue Twitter

We're now hearing from another doctor, who cannot be named for legal reasons, about the events of June 15.

The medic tells the court that he recalls Child N as he had trouble trying to intubate him, he says 'which for me is not a frequent occurrence'

Notes from the early hours of June 15 show that the doctor ordered a blood test as Child N was mottled in appearance and he wasn't sure why

The mottling eventually resolved, but over the next few hours Child N suffered five desaturations. The doctor said this made him think the baby boy had an infection. A septic screen of his bloods was then ordered

He tells the court that results ruled out infection as a cause. He said there was some concern about blood 'not being delivered to the skin in way that is normal'. By 8am on 15 June, Child N's mottling had returned. The doctor took the decision to move him to Nursery 1

Nursery 1 allows for more intensive care and treatment

The doctor tells the court that on that morning he took the decision to intubate Child N and put him onto a ventilator. He recalls seeing 'unusual' swelling and blood in the back of the baby boy's throat

After three unsuccessful attempts to intubate, the doctor abandoned the procedure. His note from that morning states: 'intubation abandoned due to blood present at oropharynx and likelihood of trauma due to repeated attempts'

Child N was then placed on non-invasive respiratory support

Cross Examination
Ms Letby's defence lawyer Ben Myers KC is now questioning the doctor.

Myers is asking the doctor when he saw the blood in Child N's throat. He said 'I believe blood was there at insertion attempt number one' Myers puts it to him that 'if you can't see, you wouldn't attempt it?' He replies:'You can do, if quite certain of position'

Mr Myers has just quoted the doctor's police statement from 2018. In this he says he was 'not sure' if the bleeding was his 'fault' due to his attempts to move the tongue with a medical implement to intubate

Dr John Gibbs

Taken from Dan O’Donohue Twitter

Retired consultant paediatrician Dr John Gibbs is now in the witness box. He was called to attend Child N at around 16:00 on June 15

Citing his notes, Dr Gibbs recalls that a specialist team had been called to help doctors with Child N's breathing (due to various problems with trying to intubate)

The team from Alder Hey Children's Hospital arrived in Chester at 19:20. They were made up of experienced intensive care consultants and an ear, nose and throat surgeon. Plan was to take Child N try to intubate, if that failed an emergency tracheostomy would take place

Dr Gibbs tells the court that Child N suffered a 'sudden deterioration' before the team could carry out the procedure however. Heart rate dropped to 60bpm, oxygen dropped to 40% - 'clear he was not being ventilated properly', Dr Gibbs said

At this point, Dr Gibbs said chest compressions were started and six doses of adrenaline were given over 30mins. A specialist doctor from Alder Hey also finally managed to intubate the baby, which allowed him to be placed on a ventilator

Asked for his conclusions about the events of June 15, Dr Gibbs says the blood could have been a result of a bleed on the lung - but adds 'why had that swelling documented by colleagues, I really don’t know'

Dr Gibbs says that 'in the end I don’t think infection was the cause' of Child N's collapse

Dr Stephen Brearey

Taken from Dan O’Donohue Twitter

Dr Stephen Brearey is now in the witness box. He was on duty on the afternoon of June 15. He was called to help with Child N by a colleague as doctors were having difficulty intubating the infant

Dr Brearey made an unsuccessful attempt to intubate the baby boy. He tells the court from reviewing his notes it wasn't successful due to blood and swelling at the back of Child N's throat, which blocked vision of his airway

Cross Examination
Mr Myers is now questioning Dr Brearey, he's asking him about Child N's blood disorder, which increases the risk of bleeding

Mr Myers is taking the court back over notes of that day, they show that there was seven attempts to intubate Child N (before Alder Hey team succeeded). Mr Myers asks if this is something that should have been possible to do, he replies 'in normal circumstances yes'

The medic tells the court that he 'can think of no natural, normal cause for why deteriorated multiple times' and then improved afterwards at Alder Hey

Dr Francis Potter - Alder Hey

Taken from Dan O’Donohue Twitter

Dr Francis Potter is now in the witness box. He was part of the Alder Hey team that assisted on June 15 - he said he remembers the case as it was 'quite unusual' for his team to get a call to go out and assist

He says when he arrived Child N was 'mottled and grey' in appearance - he recalls starting use of a bag and mask to ventilate the baby boy. When this didn't work, chest compressions were commenced

Dr Potter says after Child N stabilised and was transported to Alder Hey he recovered 'fairly rapidly' - within 48hrs he had left intensive care

Cross Examination
Mr Myers is now questioning the medic. He asks whether repeated attempts to intubate could cause stress to the baby, he says it would cause stress to the person trying to intubate

He said 'failure makes the second attempt more difficult and third more difficult'...he adds that rather than making repeated attempts, they should be limited and someone with more experience should be called to help quickly

Medical Experts Evidence

Professor Sally Kinsey

Taken from Dan O’Donohue

Blood expert Prof Sally Kinsey is now in the witness box. She was approached to review Child N's case

Child N has a rare blood disease, Prof Kinsey is explains to the jury that this can cause 'catastrophic' bleeding following minor injury. Child N had a 'moderate' variant of the condition, she tells the court

Prof Kinsey is asked whether the blood seen in Child N's throat that day could have been caused as a result of self injury or a spontaneous bleed due to his blood condition - she says no

Cross Examination
Ben Myers KC, defending, is now questioning the witness. He says his questioning will focus on whether a physical act can be established for causing the bleed

Prof Kinsey tells the court that Child N's blood disorder did make him "more likely to bleed", but said: "He won’t just bleed for no reason."

Dr Dewi Evans

From Dan O’Donohue twitter
Medical expert Dr Dewi Evans is now in the witness box, he was asked to review the case by Cheshire Police.

Dr Evans’ opinion is that the bleeding in Child N's throat was not caused by the attempts to intubate, but instead some preceding trauma

Dr Evans says Child N's 'progress was pretty uneventful' and was 'making satisfactory progress for a baby that was premature but otherwise well' in the weeks from birth to 15 June

Court being taken back over timeline of Child N's crashes on 15 June - which culminated in CPR and him having six doses of adrenaline, before he was eventually transferred to Alder Hey Hospital

Dr Evans is giving his analysis on Child N's first collapse on June 3. The baby suffered a profound and sudden collapse in the early hours of that day.

This was preceded by, what one doctor recalled, as 'screaming' - Dr Evans said that is 'very unusual' for a child of this age

Dr Evans says he went and reviewed scientific research papers on air embolus (injection of air) - these found that in some cases where babies had been injected accidently with air, there was a period of screaming before desaturation an death

He said what happened with Child N was 'repeated' in what we have seen in previous cases

On the 15 June incident, Dr Evans said in his opinion the bleeding 'was a result of trauma to his upper airway'

Cross Examination
Ms Letby's defence lawyer Ben Myers KC is now questioning Dr Evans

Mr Myers points out that Dr Evans wrote several reports on the collapse of Child N. In his first report written in 2018, the medic didn't mention the incident on 3 June. He tells Mr Myers he 'overlooked' it and later included in subsequent reports

Mr Myers says 'if you considered it significant you would have said so in your first report'

Mr Myers puts it to Dr Evans that there is 'nothing' in the medical notes for Child N 'to support a suggestion that there was an inflicted injury'. Dr Evans disagrees, he says that was his opinion when he authored his report in 2019 and says 'that is my opinion now'

On whether Child N had received an injection of air on 3 June, Mr Myers put it to Dr Evans that there was no evidence of an injection of air and that the medic was attempting "to work a piece of evidence in to support" his theory on air embolus.

He disagreed and said he was "applying standard clinical practice" in his review and said it was written with knowledge of previous babies in this case. "I think that we have to seriously consider that this baby was a victim of air embolus on 3 June", he said.

Mr Myers has jut been questioning Dr Evans about how he was approached to review these cases. He says he was approached. Mr Myers pulls up an email from 2017 that Dr Evans sent to the National Crime Agency telling them the death's at Chester 'sound like my kind of case'

He accuses Dr Evans of 'touting for work' and says he was using his review to 'fit the allegation not the facts'. He puts it to him that air embolus was mentioned to him by Cheshire Police before the review, he denies accusations - accuses Myers of 'going on a wild goose chase'

Further detail from Chester Standard HERE

On Tuesday, March 6, jurors were read an email sent by Dr Evans to the National Crime Agency (NCA) in May 2017, ahead of his involvement with Cheshire Police.

In his message to “Nick” at the NCA’s national injuries database, Dr Evans wrote: “Incidentally I’ve read about the high rate of babies in Chester and that the police are investigating.

“Do they have a paediatric/neonatal contact? I was involved in neonatal medicine for 30 years including leading the intensive care set-up in Swansea. I’ve also prepared numerous neonatal cases where clinical negligence was alleged.

“If the Chester police had no-one in mind I’d be interested to help. Sounds like my kind of case.

“I understand that the Royal College (of Paediatrics and Child Health) has been involved but from my experience the police are far better at investigating this sort of problem.”

Ben Myers KC, defending, said to Dr Evans: “This is you putting yourself forward. In effect, touting for this job.”

Dr Evans replied: “I was offering my professional opinion if that was in their interest.”

Mr Myers said: “It’s you ready to give them what they wanted, Dr Evans?

The witness said: “No, no. I have dealt with several police cases where I have said ‘this case doesn’t cross the threshold of suspicious death or injury’, or whatever.

“My opinions are impartial and independent.

“I also give evidence to law firms representing defendants. In the last five years I have given more reports relating to defendants than the police or the prosecution.”

Mr Myers went on: “At some point before you started writing reports you were told by the police about suspicious rashes and air embolus, weren’t you?”

Dr Evans said: “That is completely untrue. It’s totally untrue.

”The first time I heard a local doctor mention air embolus was a couple of weeks ago.

“The first person I know to raise the area of air embolus was me. I did that in case number one and I thought ‘oh my god, what is going on here?’

“I was not told anything about any suspect. I knew absolutely nothing.”

Dr Sandie Bohin

Taken from Dan O’Donohue Twitter

Dr Sandie Bohin, who also reviewed the case, is now in the witness box. She said the bleeding suffered by Child N on 15 June could have been caused by 'local trauma to the mouth'

On the incident on 3 June, Dr Bohin says she has 'never experienced' a neonatal baby crying for 30mins. She says it is an 'extraordinarily long' time and puts it down to an 'inflicted painful stimulus'

Thirlwall Evidence Documents

INQ0049390 - Pages 3 - 4 of Table prepared by Eirian Powell regarding [Child N], [Child O], [Child P] and [Child Q], dated 15/04/2016.

Source Date:

15 April 2016

Publication Date:

12 September 2025

Link:

Download (663 KB)

INQ0000579 - Pages 16, 33 of Medical Records of [Child N].

Source Date:

15 June 2016

Publication Date:

12 September 2025

Link:

Download (235 KB)

INQ0000579 - Pages 40-45 of Medical Records of [Child N], dated 15/06/2016

Source Date:

15 June 2016

Publication Date:

9 September 2025

Link:

Download (727 KB)

Lucy Letby Innocence

Lucy Letby Baby N

Contents

Main Page

Baby N

Dr Shoo Lee's International Panel Summary Conclusions

Prosecution Opening Statement

Defence Opening Statement

Defence closing speech - Child N

Agreed Facts

Recorded Events and Messages

Lucy Letby in the Witness Box

Direct Examination

Cross-Examination

Witness Statements Agreed

Family - Mother

Family - Father

Dr Sudeshna Bhowmik

Nurse Caroline Oakley

Nurse Melanie Taylor

Nurse Sophie Ellis

Nurse Christopher Booth

Nurse Valerie Thomas

Nurse - unnamed

Elizabeth Morgan

Witness Evidence

Dr Jennifer Loughnane

Dr Huw Mayberry

Nurse Jennifer Jones-Key

Dr A [Thirlwall: Dr U]

Dr John Gibbs

Dr Stephen Brearey

Dr Francis Potter - Alder Hey

Medical Experts Evidence

Professor Sally Kinsey

Dr Dewi Evans

Dr Sandie Bohin

Thirlwall Evidence Documents