This page contains the complete Baby K live retrial reporting by the Chester Standard and others.
Chester Standard Live Reporting
9:28am:
This is the beginning of the retrial of Lucy Letby before a jury.
The 34-year-old former Countess of Chester Hospital nurse is accused of attempting to murder a baby girl at the hospital in February 2016.
Trial judge Mr Justice James Goss has told the jury, sworn in on Tuesday afternoon, that they are aware Letby - who denies the charge - has previously been convicted of murdering several babies and attempting to murder others.
He told them to try the case only on the evidence that is heard before them, and not to conduct any independent research or discuss the case with anyone.
9:29am: We will be providing live updates throughout the day as the prosecution is expected to deliver its opening this morning.
9:39am:
Proceedings today are expected to begin at the slightly later time of 11am. Jurors have been informed a typical court day will run from 10.30am to 4.15pm, with a lunch break at about 1pm.
They have also been told the case will not be sitting this Friday (June 14).
10:53am: The trial will be taking place at Manchester Crown Court.
11:30am: There has been a delay to the start of today's proceedings. It is expected the retrial will still take place later.
11:39am: The trial is now resuming.
11:40am: Prosecutor Nicholas Johnson KC is now delivering the opening. He explains who the legal teams are, including Benjamin Myers KC, for Letby's defence.
11:42am:
He explains there was a long trial which took place in which Letby was convicted on seven counts of murdering babies and seven counts of attempting to murder six other babies.
He says they happened when Letby was working in the neonatal unit at the Countess of Chester Hospital.
11:43am: He says those convictions are relevant as it gives the jury significant evidence to Letby's intention, as to the allegation of what the prosecution say she attempted to do to the baby girl.
11:47am:
Documents are now being distributed to the jury.
They include the neonatal unit review schedule, a floorplan of the neonatal unit with where babies were located at the start and the end of a shift. They include the baby girl on room 1 in the neonatal unit at the end of the shift.
Other babies on the unit are anonymised via initials. "Their names aren't relevant to the proceedings," Mr Johnson tells the jury.
11:50am:
Also shown is which nurses were designated to each baby for that shift.
Lucy Letby was the designated nurse for two babies in room 2 that shift.
Mr Johnson says the events relating to the baby girl were in nursery room 1, and "that gives rise to certain questions".
11:55am: Mr Johnson shows the Sequence of Events, which he will refer to as 'SoE' and which jurors can access on their iPads, showing a timeline of events which happened around the indictment period.
11:56am: Jurors have already been taught how to use the iPads this morning, which led to the later start.
12:00pm:
Mr Johnson shows the indictment which sets out the charge, that Letby attempted to murder the baby girl in February 2016.
Also provided is an agreed glossary of medical-related terms.
There are also 'agreed facts', that is material which is agreed between the prosecution and the defence.
Mr Johnson explains says such material should be treated as facts proved in the case, without the requirement for witnesses to be called to give evidence on such material.
12:02pm:
Mr Johnson says a walkthrough video has been provided of the neonatal unit, which will be played to jurors as part of the prosecution opening.
He says this is as the unit looked back in 2016, and no longer exists.
12:05pm: Photographs of the neonatal unit layout are also provided. One is from the end of a nurses' station, with nursery room 1 towards the end of the picture.
12:08pm:
Mr Johnson says the remainder of the documents folder is empty, but will be filled with records of police interviews with Lucy Letby.
He tells the jury that what the barristers say to them is "not the evidence", but to suggest what important evidence they should be looking out for, and "what the battle lines are".
12:10pm:
A video walkthrough of the neonatal unit is now played to the court.
He explains the video pre-title of 'Operation Hummingbird' is simply the name of the case, and has no relevance to the jury.
12:19pm: The video was filmed in September 2021 and shows a nurse walking through the various rooms of the neonatal unit, including nursery room 1, the 'critical room'.
12:25pm: The video walkthrough goes through the remaining rooms in the neonatal unit. There are a total of four nursery rooms.
12:28pm: The video is made accessible to the jury's iPads, which any juror can access.
12:29pm:
Mr Johnson says the date of concern is February 17, 2016.
He says by this stage, Lucy Letby had murdered five babies, and had attempted to murder three more.
She had twice attempted to murder one of the latter.
12:31pm: He says after this date [February 17, 2016], Letby murdered two of three triplets on June 23-24, 2016, and had attempted to murder twins on April 9, 2016, and a boy on June 3, 2016.
12:34pm:
Mr Johnson shows, as part of the sequence of events, Facebook searches Letby had made for family members of babies who had died in June 2015.
Mr Johnson says these are not the only Facebook searches Letby had made, as she had searched for parents of other babies who have nothing to do with the case.
He says Letby "undoubtedly" murdered babies, and then searched for their parents. Two of the Facebook searches, for parents of two different babies Letby murdered, are listed a minute apart.
12:37pm: Further Facebook searches are shown, including repeated searches for some parents of murdered babies.
12:38pm: Mr Johnson says those Facebook searches continued until after June 2016.
12:42pm:
Mr Johnson now turns to the events in February 2016, when the mother of the baby girl arrived at the Countess of Chester Hospital on the morning of Monday, February 15.
Clinical notes are shown as transcribed versions and in their original handwriting, in the sequence of events.
12:44pm: Mr Johnson tells the jury that the baby girl was "very, very premature", at a gestation of 24 weeks and six days [compared to a 'standard' 40-week pregnancy], but the mother was already in labour.
12:45pm: Mr Johnson explains that the baby girl was to need a transfer to a tertiary centre in the Mersey/Cheshire area, which would be either Liverpool Women's Hospital or Arrowe Park. The Countess of Chester Hospital was not a tertiary centre.
12:50pm:
Consultant obstetrician Dr Sarah Brigham, a senior doctor whose speciality is pregnancy and childbirth and the time after that birth, wrote there was a need to transfer the baby girl to a level 3 neonatal unit.
Mr Johnson says normally the Countess would not have dealt with such premature deliveries, but he added that events took over, and the nearest available level 3 unit at the time was Preston. Given the risks involved with transport, Dr Sarah Brigham noted in relation to the potential transfer: 'cancelled patient unstable to transfer'.
12:54pm:
Mr Johnson refers to a text message Lucy Letby had sent to colleague at this time, '...24wkr [weeker] wanted nvd [non-vaginal delivery] so was 6cm when we left this morning...'.
Nrsing colleague Alisa Simpson replied '...Aw it's a shame that Mum wasn't stable enough to be transferred out...'
12:56pm:
On Wednesday, February 17, at 2.12am, the baby girl was born.
Mr Johnson says she did "remarkably well" for such a premature baby.
'Apgar' scores for the baby girl are shown of 4/10 for one minute after birth, 9/10 at five minutes, 9/10 at 10 minutes. A number of factors including colour and response to touch are assessed. Scores of "seven or above" are considered babies in good condition, Mr Johnson says.
12:59pm: At the time of the birth, Mr Johnson says, Letby was with nursing colleague Joanne Williams, having signed and countersigned for medication for a neonatal unit baby in room 2.
1:02pm:
The court now adjourns for the lunch break.
The trial judge reassures the jury not to assimilate everything that has been said so far, as it is an introduction.
He urges the jurors not to talk to anyone about the case, including other jurors.
2:12pm: The courtroom is filling up, getting ready for the trial to resume.
2:17pm:
The trial is now resuming.
Nicholas Johnson KC continues the prosecution opening.
2:19pm: He explains the baby girl [which for this blog shall henceforth be named Child K] was intubated at 2.32am, prior to the transfer to the neonatal unit at 2.40am. To explain this process, a video is played to the jury.
2:28pm: Mr Johnson says there are a number of times the tube moved for Child K.
2:35pm:
Mr Johnson says for that shift, Dr John Gibbs was the paediatrician for that week. Dr Ravi Jayaram is listed as the on-call consultant between 4.30pm and 8.30am.
Nursing staff are shift leader Caroline Oakley, with designated nurse Joanne Williams, and other nurses Lucy Letby and Sophie Ellis, plus nursery nurse Valerie Thomas.
A floorplan shows Letby was the designated nurse for two babies in nursery room 2 at the start of that night shift.
Two babies were being looked after in room 1 by designated nurse Caroline Oakley.
Joanne Williams was designated nurse for a baby in room 2. She was later designated as the nurse for Child K that night.
2:36pm: Between 2.36am and 2.50am, Lucy Letby was making nursing notes for one of the two babies she was designated to look after in room 2.
2:38pm: At 2.45am, Child K was given surfactant down an ET tube, to help with her lungs.
2:43pm:
At 3am, IV fluids for Child K were set up by nurses Joanne Williams and Caroline Oakley.
At that time, Lucy Letby was making entries on the notes for one of the babies she was designated nurse for - between 3.02am-3.12am.
At 3.11am, Joanne Williams entered the neonatal unit from the labour ward, Mr Johnson tells the court.
2:44pm: Notes from the transport service say Dr Ravi Jayaram made a call to them at 3.15am, to arrange transport for Child K, to a level 3 hospital. At this time, Lucy Letby was giving medication to a baby she was a designated nurse for in room 2.
2:49pm:
At 3.30am, Letby recorded observations for that room 2 baby.
Also at that time, "a lot of things were being recorded", Mr Johnson says. Letby signed for morphine for Child K with Joanne Williams. The morphine was a painkiller and sedation. It was to be given as Child K had been intubated, Mr Johnson tells the court.
It is so they don't interfere with the tube, he adds.
2:53pm:
Joanne Williams records the vital signs for Child K at 3.30am.
Just before 3.40am, Caroline Oakley was away from the unit as, at 3.40am, there is a digital record of her coming back into the unit.
Nursery nurse Valerie Thomas, looking after babies in rooms 3 and 4, was out of the unit, as again there is a record of her returning to the unit at 3.40am.
2:55pm:
At about that time, Dr Ravi Jayaram is recorded as communicating with the transport team, being on the phone at the nurses' station.
It was about this time that Child K collapsed, Mr Johnson tells the court.
The allegation, he says, is "straightforward".
2:57pm:
He says Joanne Williams had left the neonatal unit at this time to see Child K's mother, having left Child K ventilated and sedated.
Dr Jayaram was "distracted" and other nurses were out of the unit.
That would leave Sophie Ellis and Lucy Letby in the unit covering four nurseries, Mr Johnson added.
While Joanne Williams was out of room 1, Lucy Letby was in there on her own. That is what Dr Jayaram saw when he went in there at the time of the collapse, Mr Johnson says.
3:00pm:
Mr Johnson says Child K was connected to a machine checking her heart rate and oxygen levels. Those machines should have alarmed if there was an issue, but they did not. Someone had disabled them, Mr Johnson says.
"Not only that, but Lucy Letby was doing nothing.
We say that in those circumstances, the only reasonable thing for a nurse to have done was to call for help and/or use the Neopuff to breathe for the child."
The ET Tube had become displaced, Mr Johnson says.
The fact Lucy Letby was doing nothing and the alarm was not sounding was...that Letby... the convicted murderer, had displaced the tube.
3:01pm:
Nursing notes, written retrospectively by Joanne Williams, said Child K had begun to desaturate to "dangerous" levels.
Child K's ET Tube was "dislodged". It was removed and she was reintubated on the second attempt.
Mr Johnson asks the issue is how did the tube become dislodged.
3:05pm:
Child K was given a loading dose of morphine "to guard against the possibility that this very premature child had wriggled to extubate herself".
The morphine dose and infusion administration were timed at 3.50am. It is initialled 'JW', but in the handwriting of Lucy Letby.
Lucy Letby had been caught virtually red-handed by Dr Jayaram, Mr Johnson says, adding that Child K's ET Tube later dislodged twice more, and the evidence establishes that Lucy Letby was there, even though the babies she was to look after were in room 2.
3:07pm:
Lucy Letby "became closely involved" with Child K's care "despite" having primary responsibility in room 2.
She was "making [Child K] part of her business", Mr Johnson tells the jury.
At 4.20am Letby cosigned for medication for Child K while Joanne Williams was coming from the labour ward.
About 20 minutes later, medication was given to Child K by Lucy Letby and Caroline Oakley.
Between 4.48am and 5.07am, Child K's designated nurse was completing nursing notes for the baby girl. While that was happening, Lucy Letby and Caroline Oakley were giving further medication to Child K.
At 5.23am, Letby was again involved.
3:08pm: At 5.53am, a note from the transport team recorded Dr Jayaram was keen to get Child K to Arrowe Park Hospital. It was noted: 'keen not to miss window of opportunity whilst baby stable'.
3:14pm:
Between 6.04am-6.10am, Letby formally booked in Child K to the neonatal unit on the computer system.
In the checklist is the care of an ET Tube.
Much of the computerised record is taken from a handwritten form. Mr Johnson says the handwritten notes are kept with the baby by the incubator.
Mr Johnson: "She would have had to get the records for [Child K] from the incubator. Once she had completed that, she would have had to return the handwritten records to the incubator."
3:15pm:
During that time, recorded at 6.07am and 23 seconds, an X-ray is taken of Child K, by radiographer Anne Kember, using a mobile machine. The x-ray was taken in nursery room 1.
A video, demonstrating how an intubated baby has an x-ray taken by the mobile machine, is played to the court.
3:21pm:
The X-ray reports 'ET Tube in satisfactory position'.
It adds: 'NG Tube [feeding tube] in satisfactory position with its tip in the gastric body'.
Mr Johnson says the time the x-ray is recorded may not be accurate.
At 6.09am, Anne Kember is recorded as entering the neonatal unit. He says the process of the x-ray takes about 10-15 minutes, which means the x-ray happened at about 6.20am.
Within a few minutes of that, the ET Tube was dislodged again.
Mr Johnson says that Lucy Letby was trying to create the impression that Child K, "heavily sedated", had dislodged her own tube.
3:26pm:
The third desaturation happened at the time of the handover to the day shift.
A nursing colleague was the shift leader at this time. As she came in, she heard a call for help from Lucy Letby, who was not the designated nurse for Child K.
Letby was at the incubator of Child K in nursery room 1.
3:29pm:
The day shift leader, Dr Jayaram, Mel Taylor and nurse Williams went in. The issue was the ET Tube was too far in - by 1.5cm, or about 20% too far in.
The ET Tube was withdrawn and Child K picked up immediately, Mr Johnson says.
He adds this [Child K's ET Tube being dislodged] was the same problem, twice after Dr Jayaram had witnessed it.
We say that is coincidences too far, Mr Johnson tells the court.
He says Letby had tried to "create the impression" Child K had a problem.
3:31pm: Mr Johnson says Child K was moved to the transport incubator at noon, then handed over to the team taking her to Arrowe Park at 12.25pm.
3:33pm:
Later that day, Letby replied to a text by a nursing colleague, saying: "25wkr delivered so fairly busy".
Child K died at Arrowe Park Hospital on February 20. Mr Johnson says the prosecution do not say what Lucy Letby did caused Child K's death.
On April 20, 2018, at 11.56pm, Letby searched on Facebook for the surname of Child K.
3:34pm: Mr Johnson says that "has significance" when taken in conjunction with Letby's other Facebook searches for parents of babies she killed.
3:36pm: Mr Johnson says the case may come down to a single issue - 'do you believe Dr Jayaram saying what he saw? Do you believe he is telling you the truth about what he saw? And if you do, do you accept what we allege Lucy Letby was trying to do, bearing in mind what we have also proved.'
3:37pm: That concludes the prosecution opening.
3:38pm:
Benjamin Myers KC, for Letby's defence, now gives the opening statement for the defence.
He acknowledges the sympathy for the family of Child K, and recognises the loss of Child K.
Nothing I do or say is intended to diminish that.
3:41pm:
Mr Myers says "it could be very easy for some people to approach" that Lucy Letby "must be guilty" or, 'equally as bad', that they "don't care if she is guilty or not".
He says if that was the case, the idea of a fair trial would be gone.
He adds this trial jury does not feature such people. He says they are to give a true verdict on the evidence, not one of emotional reaction, or of sympathy, or of anything heard outside the courtroom.
A fair trial on the basis of the evidence is what this is all about.
3:45pm:
Mr Myers says he wished to identify "key issues" for the defence, and this is "an outline", and will not be the same length as the prosecution opening.
He says the defence speech will come after the evidence is heard in the trial.
He adds there is no record of exactly where Dr Ravi Jayaram was or what he was doing at the time Child K desaturated.
3:48pm:
He says there are three areas, focusing on aspects of the case, for jurors to keep in mind.
The first is how fragile Child K was, clinically. He says any baby born under 37 weeks is classed as premature. At 25 weeks, Child K was "extremely premature".
He says ideally, Child K would not have been born at the Countess, but at a level 3 unit, providing the most intense and specialised level of care. He says that could not be done as doctors caring for the mother concluded the risk transferring her to a suitable unit was "too great".
The Countess was "not the level of unit designed" to care for the prematurity of the baby.
3:51pm:
The second area is the problems of care, including intubation.
He says Child K was struggling to breathe from the start of life, and was unable to breathe unaided, which he says "sadly, is unsurprising", given the level of her prematurity.
He says it is known Child K suffered an oxygen desaturation between 3.45am-3.50am. A reason for that would be the ET Tube moved.
He says the prosecution allegation is Letby deliberately moved the tubing. The defence case is Letby did not do that, and "has been blamed wrongly".
3:54pm:
Mr Myers says they will look at how realistic the prosecution's theories are, that Letby deliberately dislodged the ET Tube multiple times, during the trial.
He says the third factor is to look at what people said and did at the time, and to decide whether that is consistent with what the prosecution now allege, in particular Dr Ravi Jayaram.
3:58pm:
Mr Myers says Dr Jayaram was the lead clinician on the unit that night, the senior doctor with overall responsibility.
Mr Myers outlines Dr Jayaram's account, that he suspect the tube had been deliberately dislodged, and the alarm was not sounding.
He says Lucy Letby does not remember specifically the events of that night. He says in the background of caring for hundreds of babies, that is "hardly surprising, if she did nothing wrong".
He says the case comes to a "pretty stark issue", that Child K desaturated because Lucy Letby interfered with the ET Tube, or not.
That depends on whether Dr Jayaram's account is true and accurate, or not. He says if it is not, the jury cannot convict.
He says the prosecution and defence are in agreement that the evidence of Dr Jayaram is crucial.
4:00pm:
Mr Myers says Letby is not guilty of this allegation. He refers to the previous convictions.
It is important these convictions do not prove this allegation.
4:01pm:
He says however much dramatic impact those previous convictions have, it is crucial that the jury looks on the evidence that happened on February 17, 2016.
He says that evidence "does not support what has been alleged".
4:05pm:
That completes the opening statements.
Trial judge Mr Justice James Goss asks if the main 12 members of the jury are able to continue to serve as jurors. They agree.
The two reserve jurors, who have been present today, are released back into the general pool of jurors. They are urged, to preserve the integrity of the trial, that they do not speak about the case to any of the 12 jurors about the case until the trial is all over.
He says the same applies to the 12, not to speak to the two reserve jurors, or anyone else, about the case.
4:07pm:
That concludes today's case before the jury, and they are to return to court on Thursday at 10.30am.
He reminds them the case will not be sitting on Friday. Additionally, the case will not be heard before noon on Monday, June 17.
Manchester Evening News Live Reporting
10:35am: Day four of trial set to get underway
Lucy Letby is due to stand trial for a fourth day this morning accused of the attempted murder of a baby whilst she was working as a neonatal nurse at the Countess of Chester Hospital in February 2016.
The proceedings are expected to last up to four weeks. Letby, from Hereford, denies the offence.
10:42am: Trial resumes
The jurors are brought back into court and the trial has resumed.
The prosecution begins by reading the statement of Child K's mother.
11:08am: Statement of Child K's mother read to court
The woman said she discovered she was pregnant in August 2015 and she said she and her husband were 'both thrilled with the news'.
The pregnancy 'progressed normally' and the pair was told there were 'no issues' when they attended their 12-week scan.
A minor issue was identified at 15 weeks gestation but the couple were 'reassured everything was fine' and all tests came back 'negative', the jurors are told.
The mother described how she was returning to the Countess of Chester Hospital every two or three weeks to see a consultant.
"Everything was developing fine," said the woman, who cannot be named for legal reasons.
11:20am: Mother of Child K went into labour at 25 weeks pregnant
The woman recalled walking up in pain during the morning of 15 February, 2016, when the unborn infant was at 25 weeks' gestation.
She said her partner suggested they call the midwife who advised she attend the labour ward.
When the couple arrived, the woman said she was taken into a side room where a number of checks were done and she was told she was dilated by 2cm.
The woman said she knew 'something was happening' and that she had gone into labour. She was admitted onto the ward where she was 'closely monitored'.
The woman described treatment she received and how arrangements were being made by staff to transfer her to Arrowe Park Hospital, which the jurors heard has a specialist maternity unit which deals with very premature babies.
That evening the woman said she discussed with a medic at the Countess of Chester Hospital having a C-section.
"There was no indication from the medical team that they had any concerns regarding (Child K). She wasn;t showing any signs of distress," she said.
Her heart rate was good and a decision was made to keep the baby at the Countess of Chester, the woman said.
11:27am: Parents didn't have any concerns about Child K when she was born
The woman said that during the evening of February 16 she woke up in pain at the hospital and her partner pressed the red panic alarm on a wall in her room which was soon 'full of staff'.
The midwife got her ready for delivery and Child K was born just after 2am on February 17, the jurors were told.
Staff, she said, worked on Child K for 30 to 45 minutes, she said.
They placed a tube to aid the baby's breathing and placed a hat on the baby to keep her warm.
"As far as we were aware there was nothing to be concerned about," said the woman, describing her baby's weight at 692g or 1lb 8oz.
11:41am: Mother of Child K remembers nurse 'appearing at her side'
The woman said there 'seemed to be so many people around' as medics sought to care for her.
She said 'the next thing I remember' was a nurse appearing at her bedside. The nurse had blonde hair tied in a ponytail, was 'a little round', aged in her 30s and was wearing a blue uniform.
"She came into the room and told us (Child K) was fine. She was stable and doing really well," said the woman.
The nurse asked if they would like to see the baby and both parents immediately said yes, said the woman.
The woman described how the nurse helped her into a wheelchair and pushed her to the neonatal unit.
The nurse offered to take pictures of the infant on the father's phone. "She took several pictures," said the woman, who said after a few minutes she went back to the labour ward as she felt sleepy.
The woman said the time-stamp on the pictures showed they were taken at 4.30am on February 17 when the baby was just a few hours old.
11:55am: Mother of Child K describes 'the strangest feeling'
While she was sleeping, the woman said she was woken by someone who came into her room to say a bed was now available at Arrowe Park Hospital.
The member of staff explained how Child K had to be moved into a 'transport incubator' to get her to Arrowe Park, the jurors were told.
The woman said it was at this stage the couple decided on a name for their baby.
She said she was wheeled down to the neonatal unit to see Child K before being moved to Arrowe Park. While her partner followed the ambulance, the woman said she had yet to be discharged from the Countess of Chester and so she remained at the hospital.
She described how staff were 'desperately getting organised' so she could be discharged to make her way to Arrowe Park. She was finally discharged at 2pm and made her way straight to Arrowe Park, the court was told.
The woman described how the couple were staying in Ronald McDonald House, specialist accommodation for parents at the hospital. "I was lying awake when I had the strangest feeling I cannot begin to describe," said the woman.
12:18pm: Woman said she knew 'straight away' things weren't great
The woman said she asked her partner if he was awake and he was, and she asked if they should go and see Child K. They decided to visit the neonatal unit which was said to be free for parents to visit at any time.
When they saw their baby, the woman said she noticed the saturation readings 'were low'.
"I knew straight away things weren't great," said the woman, who went on that a doctor 'confirmed the worst'.
The doctor said Child K had been 'fighting all night' and that medics had been struggling to improve her readings.
"I asked the doctor 'is it just a waiting game now?' and 'is she going to get better?' We had a long conversation with the doctor who explained (Child K) was not getting better and what happens next is entirely our decision," said the woman.
She described how her baby had been 'passed from pillar to post from the moment she was born'.
"Her tiny swollen body had suffered so much. We didn't want her to suffer anymore," said the woman.
The couple made a decision together to switch off Child K's life support machine 'to let her go', she said.
"This was by far the hardest decision of my life," she said.
12:20pm: Mother of Child K describes moments before baby's death
The woman said staff showed them to a family room away from the ward which was 'peaceful and quiet'.
Their baby was given to them wrapped in a blanket attached to a hand-held pump to aid her breathing, the court heard.
"She was placed into our arms." she said. "The doctor said we can do this whenever you are ready."
The doctor removed the pump and left the room, saying he would return in 20 minutes.
The woman described how Child K was in her father's arms she she passed away. Her death was confirmed at 5.28am.
1:08pm: Retired consultant paediatrician gives evidence
The first live witness of the day is Dr John Gibbs, a retired consultant paediatrician at the Countess of Chester Hospital, who describes to the jurors how a ventilator works, after watching two videos of a ventilator being operated and how its alarms work.
Dr Gibbs confirms that a nurse would fill in a chart when a baby is on a ventilator. He explains it would record oxygen saturation levels.
The doctor says it's a 'serious sign' when oxygen levels in the blood drop.
1:10pm: Adjourned for lunch
The trial has been adjourned for lunch.
1:34pm: Everything heard in court this morning
The mother of a newborn girl allegedly attacked by killer nurse Lucy Letby said it was the "hardest decision of my life" to switch off her daughter's life support, a court has heard.
Letby, 34, is accused of attempting to murder the infant by displacing her breathing tube when she was being treated at the Countess of Chester Hospital's neo-natal unit.
The youngster, known as Child K, was born "extremely premature" at 2.12am on February 17 2016 and weighed just 1lb 8oz (692g).
2:17pm: Hearing resumes
The hearing has resumed, we'll bring you the latest in the next few minutes.
2:21pm: Doctor's evidence continues
Dr John Gibbs is continuing to give evidence. The doctor is being asked about baby collapses in general. Tiny alarms attached to babies record chest movements and will go off following no activity of 20 seconds, he said.
He describes what doctors can do to assist infants when oxygen levels fall below 90 per cent, referred to as apnea. One method is to simply tap the infant to encourage breathing and another is to place a bag over the mouth to force oxygen into the baby, the court hears.
The doctor is describing what a 'collapse' means medically for an infant, as they cannot fall.
3:01pm: Cheshire Police analyst gives evidence
Cheshire Police analyst Kate Tyndall is now giving evidence.
She is being taken through a 'sequence of events' chart concerning Child K. The officer confirms the defendant conducted a series of Facebook searches of other infants who collapsed and their parents, following analysis of Letby's phone.
The officer confirms she has included summaries of Child K's clinical notes into the sequence of event chart.
3:43pm: Cheshire Police analyst outlines series of messages between Letby and her colleagues
Ms Tyndall outlines a series of messages between the defendant and colleagues. The officer confirms she also included the names of all the staff who were on duty at the relevant times in the chart.
The officer is now being taken through the timeline, with Letby said to have recorded notes for another child at 2am.
The jurors hear the medical notes confirm Child K was born at 25 weeks' gestation when she weighed 692g. Her condition was 'dusky and floppy' and her heart rate was recorded as 60 beats per minute. It had been a 'spontaneous labour'.
At 2.45am observations were recorded in the medical notes for Child K, the jurors are told.
At 2.50am the defendant made a nursing note for another baby, the court hears. By 3am a prescription was made for Child K and three minutes later a 'blood gases record' was entered for her.
4:05pm: Arrangements were being made for the baby to be transferred
The jurors hear that by 3.15am arrangements were being made for the transfer of Child K to Arrowe Park Hospital. At 3.30am Letby recorded observations for another child, the officer confirmed. Prosecutor Nick Johnson KC said we were now approaching 'the critical time'.
Observations were taken of Child K by another nurse at 3.30am, the jurors are told. A sample of blood was also taken a minute later.
4:05pm: Trial adjourned until Monday
The trial is adjourned and resumes at 12.30pm on Monday.
Chester Standard Live Reporting
12:02pm: The courtroom is filling up, and Lucy Letby has entered court.
12:04pm: The trial is now resuming, with jury members taking their places.
12:09pm:
Analyst Kate Tyndall is talking through the sequence of events, presented electronically in a 302-tile presentation. Each juror has an electronic copy of this.
The sequence of events includes timestamped details of clinical records, staff movements in the hospital, medicine administration, text messages and significant events in relation to Child K.
It also notes which clinical staff has recorded medical notes.
12:36pm: The sequence is presented in chronological order. Clinical notes which are written retrospectively are placed at appropriate points in the timeline. For example, notes written at about 8am, which record what happened at 6am, are placed in the sequence at 6am.
12:50pm:
The sequence includes a text message sent to Lucy Letby following her night shift on February 16-17, 2016. It was sent by a nursing colleague and says: 'Hope you had a good shift and are well away in the land of nod now!'
At the time, medication is being administered to Child K as efforts are made to transport the baby girl from the Countess of Chester Hospital (a level 2 centre at the time) to Arrowe Park Hospital (a level 3 centre). The jury previously heard a level 3 centre provides the highest level of care for babies born extremely prematurely.
1:01pm:
The sequence comes to its closing stages, where it records Child K was transferred to Arrowe Park Hospital and treated there from 1.15pm on February 17. The baby girl's mother was also transported to the hospital.
Child K died on February 20.
1:03pm:
The court is shown Lucy Letby made Facebook searches for the parents of babies she has since been convicted of murdering and attempting to murder.
She made a search for the surname of Child K on Facebook on April 20, 2018.
1:05pm: The court is now adjourning for a lunch break.
2:13pm: The judge and jury return to the courtroom, and the trial continues.
2:19pm:
Analyst Kate Tyndall talks through some additional documents which the jury have in their document collection.
It includes all of Lucy Letby's recorded duties and the location of all babies on the neonatal unit on the morning of February 17, 2016.
Prosecutor Nicholas Johnson explains the purpose of the entries is so it can record where the neonatal unit nurse was at various points throughout her shift.
2:23pm:
Entries highlighted are all events concerning Child K, such as the admission to the neonatal unit, communication with parents, observations and infusion.
Initial entries do not have any Lucy Letby involvement, but Letby is later involved after Child K is admitted to the neonatal unit.
2:40pm:
Benjamin Myers KC, for Letby's defence, asks to clarify a couple of matters with Mrs Tyndall.
One of them is for an intensive care record for a different baby in room 1 that night, whose designated nurse was Caroline Oakley. At 3.20am there is an entry, signed by Caroline Oakley, which reads '0320 self extubated ++ Neopuff+ peep -> [leading to] bipap 0340'.
2:43pm:
Dr Sara Brigham, consultant obstetrician and gynaecologist at the Countess of Chester Hospital, is called to court to give evidence.
Prosecutor Simon Driver asks her if, from memory, she remembers Child K or her mother. Dr Brigham replies she does not.
2:55pm:
Dr Brigham explains her role and duties within the hospital, which involve overseeing high-risk pregnancies.
She had reviewed the mother of Child K on February 15, and the plan was to administer a range of medication to 'slow down the process' as the mother presented in pre-term labour, and arrange for the mother to be transferred to a tertiary [level 3] centre.
2:56pm: Dr Brigham says the Countess of Chester Hospital accepted babies from 27 weeks gestation as a level 2 unit at the time, whereas level 3 centres 'optimally' accepted babies of 25 weeks gestation, which Child K was at this stage.
3:00pm:
A Cheshire and Merseyside Perinatal Cot Bureau note records on February 15 that the planned transfer was 'cancelled...patient unstable to transfer'.
Dr Brigham says the risk was the patient would deliver in an ambulance as the labour was progressing. The chosen level 3 centre at this point would have been Preston.
She agrees it would be "preferable" for Child K to be born in a level 3 centre, but it was "better" for the baby to be born in a level 2 centre to the back of an ambulance.
She adds that pre-term labour "can be very unpredictable".
3:04pm: An examination of the mother on February 15 showed the mother's waters could "go at any stage".
3:13pm:
Dr Brigham says it was important for pre-term labour babies not to spend too long in the womb.
It was noted on February 16 that the mother was in 'advanced labour', so the decision was made not to inhibit the process.
At 55 minutes past midnight on February 17, the emergency bell was rung. Dr Brigham notes the mother's waters broke at 1.52am.
3:17pm:
Dr Brigham says the decision not to transfer Child K's mother to a tertiary centre was, in the circumstances, the "correct" one.
She says, even with hindsight, based on the clinical decision at the time, it was "the right decision" and she stands by her judgment.
3:21pm:
Mr Myers, for Letby's defence, rises to ask about the transfer. Dr Brigham agrees that in an ideal world, the transfer would have taken place.
Mr Myers says that decision was made on the afternoon of February 15. He says, as it happened, Child K was not born for another 35 hours.
Dr Brigham says the mother was lying in a bed at the time, and the process of transfer - from the bed to an ambulance - could have caused the labour to progress. "Things can change very quickly".
Dr Brigham reiterates the decision not to transfer was "the right one". In Chester, the care was then 'optimised' for Child K's mother.
3:33pm: The trial is resuming after a short break.
3:37pm:
Nurse Yvonne Griffiths is the next to give evidence. She is currently ward manager at the Countess of Chester Hospital.
Mr Driver explains he is going to pick a few points from her witness statement and ask about those.
3:44pm:
Ms Griffiths talks about the nursing skill levels, with higher levels able to work in intensive care and high dependency units at the neonatal unit.
She says it would be important to speak to the parents and get maternal history as soon as they could, once they were made aware it would be likely a very premature baby's birth was imminent.
3:51pm: Ms Griffiths confirms the electronic nursing records, with the initials 'LL' as their author, show it is Lucy Letby who has written them.
3:56pm: Ms Griffiths explains two nurses calculate the medicine infusion for babies together, with both signing the form. Mr Driver asks if that means there is a "safety net" [so babies aren't given the wrong dose of medicine]. Ms Griffiths agrees that is the case.
4:00pm:
Mr Myers rises. He says at the time in 2016, Ms Griffiths was deputy ward manager.
Asked about the vulnerability of such babies in the neonatal unit as Child K, Ms Griffiths says: "They are just so fragile so you need to monitor them constantly."
Mr Myers says a desaturation is "not uncommon" in a neonate. Ms Griffiths agrees, and agrees that such desaturations can happen "within seconds".
She adds it's a "hands-off technique" for such neonates, as handling them could cause stress, and that is why they have electronic monitors.
4:04pm:
Ms Griffiths agrees a nurse can wait to see if a baby 'self-corrects' when it desaturates, paying attention to the skin colour of the baby as an additional observation. If the situation does not resolve, then an intervention is necessary, Ms Griffiths agrees.
Ms Griffiths agrees a nurse can wait to see if a baby 'self-corrects' when it desaturates, paying attention to the skin colour of the baby as an additional observation. If the situation does not resolve, then an intervention is necessary, Ms Griffiths agrees.
4:06pm: Mr Myers asks about nurses leaving babies alone. Ms Griffiths says that can be done if the baby is stable, and telling a nursing colleague if they are going to be absent 'for a short period of time'.
4:12pm: Ms Griffiths agrees with Mr Myers there is "nothing unusual" in going from one neonatal unit nursery room to another to help a nurse in another room, as is shown during Letby's night shift when she assists in room 1 of the unit [where Child K was].
4:14pm: One of those times where Letby assisted in room 1, Mr Myers says, was recorded before the arrival of Child K to the neonatal unit that night.
4:32pm:
Mr Myers asks about the floorplan of the neonatal unit, including the layout of the nursing stations which can be used to update computerised medical records, and where morphine is stored.
He asks about a prescription for medicine administered to Child K. Ms Griffiths agrees that the time of the prescription recorded is not the time the medicine is actually administered.
4:36pm:
Mr Myers asks how incidents are recorded on the unit.
Ms Griffiths replies it is via a 'Datix' system.
Mr Myers says that enables doctors or nurses to record concerns during the course of their duties. Ms Griffiths agrees.
The court hears the process is done online.
An example of such a Datix form is presented to the court.
4:38pm:
Mr Myers says once one of those forms is completed, they can be raised with heads of department. Ms Griffiths agrees.
Mr Driver rises to clarify a couple of matters.
4:40pm:
The 'self-correct' process, referred to in Mr Myers' questioning, is raised. Ms Griffiths says with a baby brand new to the unit, 'you would be aware of any desaturations'. She adds: "You would want to watch that carefully".
And with a baby of Child K's prematurity, they would be watched "very highly".
4:41pm:
The judge apologises to the jury for overrunning, saying they would be normally finishing by 4.30pm, but witness availability required the court to overrun.
He reminds jurors not to research anything about the case or discuss it with anyone.
Chester Standard Live Reporting
10:41am:
The trial judge, Mr Justice James Goss, and members of the jury have now come into court.
The trial is now resuming.
10:43am:
Simon Driver, prosecuting, is reading two written witness statements.
The judge reminds the jury these written statements are agreed evidence between the prosecution and the defence.
10:46am: The first is from Dr Ian Dady, who was asked to explain the process of transporting a mother in pre-term labour from a level 2 centre hospital (such as the Countess of Chester Hospital) to a level 3 centre (such as Arrowe Park Hospital). He applies it for the scenario with Child K's mother in February 2016.
10:49am:
Dr Dady says sometimes it is not possible for a neonatal bed to be found at a level 3 unit.
He adds while it is recommended that a baby at less than 27 weeks gestation "should" be delivered at a level 3 unit, "the next best" option is for the baby to be delivered "locally", as there can be risks involved with transfer.
The jury has already heard Child K was at 25 weeks gestation.
10:54am:
The process of finding a suitable level 3 centre can take "2-4 hours", Dr Dady says.
He adds it is "not uncommon" for a planned transfer to be cancelled, as what happened to Child K's mother on February 15.
10:57am:
The second statement is from Dr Jonathan Ford, consultant obstetrician and gynaecologist. At the time in 2016, he was working as a registrar and working nights.
He reviewed Child K's mother and spoke to her about the issues of extreme pregnancy.
11:00am:
Dr Ford said he reviewed Child K's mother the following day, late on February 16.
He was called back to the labour ward on February 17, with Child K's mother in pain.
At 1.52am, the birth process became "inevitable". Dr Ford delivered Child K.
11:03am:
The birth was "uneventful", Dr Ford added.
He added he had no further dealings with Child K.
11:05am: Dr James Smith is called to the court. At the time in February 2016, he was a locum (mid-level) registrar at the Countess of Chester Hospital.
11:10am:
He says he has an independent memory of Child K from the time.
On February 16, he was informed of the potential, imminent arrival of a 25-week gestation baby at the hospital that night.
He asked on-call consultant Dr Ravi Jayaram, via a nurse, to come to the unit once the delivery was under way.
11:12am:
Dr Smith explains what Dr Jayaram's recorded notes of Child K's birth are. The birth is recorded at 2.12am and the notes are written retrospectively at 4.50am.
It was noted for Child K: 'no fevers'.
Dr Smith says antibiotics would be administered to Child K, a baby of this gestation, "as a precaution".
11:17am:
The note 'Resus by Dr James Smith' is mentioned.
Dr Smith says this is following a guidance for all babies, a "standard" resuscitation process.
This involves bringing the baby to a resuscitare - a table with a lamp and heat, to help the newborn baby with breathing and temperature.
Often, two cycles of five inflation breaths are required.
He adds that "this baby would need intubation" due to the gestation, as Child K was "so little".
11:23am:
Dr Smith adds that it is a "good sign" that gasps from the baby are recorded from three minutes. He repeats it is a "good sign" there are spontaneous respirations from about four minutes and higher than 85% oxygen saturation levels from six minutes. He says they are all signs of a successful resuscitation.
The 'Apgar' scores recorded for Child K - a rating out of 10 based on how well the baby is doing, clinically, in the minutes after beath - were not unexpected and "good".
He adds the 'initially dusky' note also recorded for Child K is "nothing unusual".
11:30am:
Dr Smith is referred to the intubation notes, which record he successfully intubated Child K at the third attempt.
He says Child K was "stable". He says it was a "technically very difficult" intubation as Child K was "small". He says "there were no concerns" and the consultant [Dr Ravi Jayaram] was present.
He says although it is not documented, from memory, "what probably happened" was he tried to intubate with a larger size tube first, then afterwards he made sure the baby was stable in between attempts through a stable heart and breathing rate. The successful intubation was done with a smaller tube.
He says Child K would have been stable the whole time as Dr Jayaram was present throughout, and if there were concerns he would have "stepped in".
He would have the confidence in me.
11:32am: Dr Smith says at this point, Child K would not be sedated or given pre-medication. He says that can be done for reintubation in the form of morphine and/or a muscle relaxant, but it is not done for initial intubation.
11:35am:
Dr Smith says the intubation being done at the third attempt was, from memory, something which gave "no concerns".
He says there was no point where there was anything concerning, that anything had gone wrong, or anything that made him feel the consultant should intubate instead.
He said if there had been any sign of trauma, or bleeding [seen in Child K at the time of the intubation attempt], he would've raised that and handed over to the consultant to intubate.
He said it was a "good" resuscitation and Child K was stable.
He confirms he would have accompanied Child K when the baby girl was being transferred to the neonatal unit.
11:40am:
Further clinical notes made by Dr Jayaram, in relation to ventilator settings for Child K, are explained by Dr Smith.
An initial blood gas reading for Child K was "good", as were other readings recorded for a baby of Child K's gestation.
11:48am: A blood sample for Child K, showed "no signs of infection", Dr Smith tells the court.
11:51am: Child K is noted to have "good chest movement" and "good air entry" on the clinical notes, in what Dr Smith says is a "normal examination".
11:56am:
Dr Smith interprets Dr Jayaram's notes to say the transfer of Child K to [level 3 unit] Arrowe Park would happen once umbilical lines [also known as central lines] are placed and x-rays are done. This would be advice given by the transport team.
He says the transport team "would be available to give advice on the phone".
12:00pm:
He says he recalls Child K having an event. He says he was outside the room at the time, and when he came in, Dr Jayaram was there, tending to Child K.
He says in the event of a "sudden desaturation", doctors are trained to look for issues in a system named 'Dope': Displacement [of the tube], Obstruction [of the airways], Pneumothorax, Equipment failure.
He says Dr Jayaram disconnected the ventilator and was manually administering breaths to Child K via a Neopuff breathing device.
I remember coming in and saying 'what's going on?' and remember what he was doing wasn't working.
He says he offered to reintubate Child K. He says he performed that procedure.
12:03pm:
He says for a reintubation, a morphine bolus can be administered as a one-off before reintubation, a "standard dose" to make reintubation "easier and for comfort".
The reintubation was done on the second attempt, with the larger size tube.
He says there was no signs of obstruction, equipment failure or an issue with the pneumothorax, but that would leave 'displacement' as the issue.
12:09pm:
A note about the x-ray is presented to the court. 'Hazy increased shadowing is present'.
Dr Smith says the fact the haziness later disappeared suggests this is down to the lung surfactant and not a sign of infection.
12:13pm: Having performed a third reintubation at about 6.10am, Dr Smith documents a summary of the events for the attention of the transport team, as his final involvement.
12:14pm: Benjamin Myers KC, for Letby's defence, is now asking Dr Smith questions.
12:19pm:
Dr Smith says a trained registrar is capable of delivering a baby in an emergency. He says for an extremely premature baby, you would want a consultant present or on their way to the hospital.
You would want the most experienced personnel there as soon as possible.
He says babies of this gestation can be born at level 2 units. He says there are "many babies per year" born at level 2 units and later transferred to level 3 units.
He says there can be a mother coming in off the street with a 23-week gestation baby ready to deliver. He says that could happen "at any point", and the team at the level 2 unit would be equipped to handle that, for later transfer to a level 3 unit.
He says he had the training for that, and intubated, cannulated, reintubated on the second and third time, and got a UVC line into Child K. "Those were the key procedures that I did". He adds it was a "team effort" with a lot of people to help in the unit.
12:22pm:
Dr Jayaram's clinical notes are presented again.
Dr Smith says Child K presents as "very premature", but babies of 23 weeks and 24 weeks are resuscitated. Child K's resuscitation went "very well", and a full-term baby would not need resuscitation as standard.
Dr Smith says he has dealt with many babies before and after this date, of this gestation, and says the resuscitation for Child K, a 25-week gestation baby, went "well".
12:28pm:
The initial heart of 60, recorded in the notes, is "not a good heart rate", Dr Smith says, but for a 25-week gestation baby left Dr Smith "encouraged" as it meant Child K would not need medication to get the heart rate up.
Dr Smith says "you have to take into account" a 25-week gestation baby's condition, and 'initially dusky, floppy, no resp effort' [as recorded on the notes] "is not anything unusual".
He says a 25-week gestation baby "needs a lot of help" but the resuscitation "went well".
12:30pm:
Dr Smith agrees a baby of a 25-week gestation can "deteriorate very quickly".
He adds it is a "technically difficult procedure" to intubate a baby such as Child K. He says it is something "that can happen", that it can happen in one go, or more than three. He adds he has successfully intubated on the first attempt on a 23-week gestation baby.
12:35pm:
He says one of the reasons the first intubation might not work is the tube might not make it through the vocal cords, so a smaller size tube would be needed. He says that is "probably" why he thinks a larger size tube was used first time round.
Mr Myers says that was what Dr Smith said in the first trial. Dr Smith agrees with it.
Mr Myers asks if there is a "danger" in using a tube "too small".
Dr Smith it is a "scenario that has never occurred" to him. He says the tube was "functioning properly" as all the readings were indicating it was, including a blood gas reading taken after intubation.
Mr Myers asks if the larger size tube was used as it was "optimal".
Dr Smith says the range of tube sizes used for Child K, based on a calculation involving her weight, included the smaller and the larger sizes as suitable ones. He says the larger one would be used first, but "that is not to say" the smaller tube was "inadequate".
He says he would probably have asked Dr Jayaram whether to use the larger size tube.
12:42pm:
Mr Myers asks about the first desaturation for Child K, and the 'Dope' system.
He says there is no reference to a dislodged tube in Dr Jayaram's written notes.
Dr Smith says he has no memory of seeing blood-stained secretions before reintubation, or any sign of trauma. He says if he had seen it, he 'does not believe he would not have handed it over to Dr Jayaram', who was "right there".
12:44pm: Dr Smith agrees there is no record saying the ET tube was checked or that it was clear, from what he can see.
12:51pm:
An intensive care chart is shown for Child K. Mr Myers refers to a '94' leak reading recorded at 3.30am.
Dr Smith denies this means 94% of the ventilated air is leaking. He refers to the 94% oxygen saturation for Child K, and an 'FiO2' [carbon dioxide clearance] reading of 49 shows the tube is "doing what it is supposed to do".
He says it shows there is some air leak, but does not mean only 6% of the air is getting in, as it "does not make any sense".
He adds: "I didn't build the ventilator", so the person who did would have to be called to explain that leak reading.
Mr Myers asks if the number is a high leak. Dr Smith says it is a high number for a leak.
12:55pm:
Dr Smith says he has no memory of the leak reading at the time, or any concern. He believed if there had been concern raised, it would have been done at the time.
He says the readings recorded for Child K do not suggest an immediate reintubation.
1:02pm:
Mr Myers asks about the second desaturation for Child K, around 6.15am.
The tube is pulled back from 6.5cm to 6cm in by Dr Jayaram. Dr Smith says that is to see if there is any effect on oxygen saturation levels.
He says the levels drop further, so that had not worked, so the tube is taken out.
Dr Smith says the tube going in at 6.5cm is based on a calculation on weight and size, so the reintubation was put in at that position again.
1:03pm: Mr Driver rises to ask about Apgar scores, which Child K scored 4, 9 and 9 [out of 10] after 1, 5 and 10 minutes after birth. Dr Smith says that is a standard test for all babies no matter their gestational age.
1:04pm:
That concludes Dr Smith's evidence.
The court is now adjourning for the lunch break, to return after 2pm.
2:14pm: The courtroom is filling up for the afternoon session.
2:21pm: The judge and jury have returned to the courtroom, and the trial resumes.
2:24pm: Nicholas Johnson KC, prosecuting, says due to witness availability, the next witness will be Dr Srinvasaro Babarao, a doctor from Arrowe Park. The jury is informed this doctor is unavailable after today.
2:27pm:
Dr Babarao, a consultant neonatologist, says at the time he was working at Arrowe Park Hospital. Currently he works at Liverpool Women's, and Alder Hey Children's Hospital.
He says he only had hands-on contact with Child K after the transfer to Arrowe Park.
2:34pm:
Benjamin Myers KC, for Letby's defence, asks Dr Babarao to explain the difference between a consultant neonatologist and a paediatrician. Dr Babarao does so.
A consultant neonatologist looks after babies from 22 weeks gestation to up to a few months in the neonatal unit.
Mr Myers asks why it is better for a very premature baby to be treated at a level 3 unit.
Dr Babarao says such centres are more specialised, with more experienced staff to provide more intensive treatment to such babies.
My Myers asks if there would be a higher concentration of expertise there. Dr Babarao agrees.
He agrees that upon arrival, Child K was extremely ill, and had a 'severe lung disease' from an x-ray. The blood pressure was 'low and difficult to manage'.
He agreed Child K's blood sugars were a problem and there were problems with blood clotting, as well as 'kidney problems associated with extreme prematurity'.
He says he wouldn't be able to say for sure if Child K would have been better if she had been born at a level 3 centre. He agrees the outcome "may have been better".
2:38pm:
Mr Myers asks about intubation.
Dr Babarao says at the time, for extreme pre-term babies, the guidance was to stabilise babies with an ET Tube and surfactant given, "ideally, within the hour" [of birth].
Mr Myers asks about the uses of surfactant.
He says that should be supplied as 'quickly as possible' after intubation. Dr Babarao says ideally, at the time, it was good clinical practice, but there was no established guidance.
He says for a level 3 centre, it would be done as soon as the intubation was done.
2:45pm:
Dr Babarao is asked to look at the 3.30am intensive care chart for Child K on February 17.
He is asked about the 'leak' reading. Dr Babarao says the '94' reading is "very high" and agrees it would "not be an acceptable number".
The 'VTE' reading - the volume of gas - is '0.4' and "low".
Dr Babarao says those figures, "on their own", would be of concern. He says he would look at the other figures and the presentation of the baby.
He agrees those figures would be brought to his attention, and agrees he would check the baby to make sure they look ok and the chest is moving.
2:52pm:
Dr Babarao agrees the cause of the leak could be displacement, incorrect siting of the ET Tube, or an issue with the equipment.
He agrees he would check the tube so it had not been lodged, as well as its size and placement.
He adds that for the smaller size ET Tube, it would be unusual to see a leak reading of 94.
Dr Babarao agrees it is "theoretically possible" an intubated baby could breathe for themselves, produce 94% oxygen saturation levels, even with the leak.
He says "there has to be something else" that caused a '94' leak, and not just a smaller ET Tube.
3:00pm:
Dr Babarao is asked about a mortality review for Child K, carried out at Arrowe Park.
Two conclusions were reached - one was that her condition on arrival at Arrowe Park meant her death was "unavoidable".
He agrees the death could have been potentially avoidable, if it had been possible for Child K's mother to be transported to Arrowe Park before the birth.
The review team's opinion was of 'Grade 2 - sub-optimal care' for Child K.
Explaining that, Dr Babarao says if Child K was born in a level 3 centre, the outcome may have been better. There was a delay in transfer due to a number of reasons, and there were issues in stabilising Child K.
As part of the 'golden hour' of best practice for a baby, there was a delay in getting IV fluids and antibiotics and a central line in. He adds there were 'three accidental extubations', which Mr Myers says is the issue in the trial and are of 'some debate'.
He says one of the ones he was aware of was when he was present as part of the transport team.
3:01pm:
Mr Johnson asks if deliberately moving Child K's ET Tube would help or hinder her.
Dr Babarao says "it would create more issues".
Mr Johnson asks if that includes death. Dr Babarao: "Yes."
3:04pm:
Mr Johnson asks about the hospital panel's mortality review for Child K.
Dr Babarao said at the time, he was provided different information for the reason why the transport for Child K's mother was cancelled. He agrees the reason - that the mother's labour was progressing - was reasonable, as a matter of safety.
He says he was not aware the transfer at the time would have been to Preston, not Arrowe Park.
3:07pm:
Dr Babarao said the neonatal unit "did the right thing" in arranging transfer as soon as possible.
Mr Johnson asks about the smaller 2mm intubation tube, which the court heard was used after the larger 2.5mm tube did not go in on the first or second time. Dr Babarao says that would be correct procedure.
3:10pm:
Mr Johnson says the '94' leak reading is the same reading at 3.30am as for the oxygen saturation reading, with the VTE reading of 0.4 the same as the inspiratory time reading also on the chart for 3.30am.
Asked which is the most important reading for the baby, Dr Babarao says firstly the baby's presentation is the most important. He adds the most important reading on the chart is the oxygen saturation reading. He adds that is a snapshot at that moment in time. He agrees that you 'have to have a holistic approach' and look at the baby at all times.
3:16pm:
Dr Babarao is asked when Child K is first noted to have had a significant downturn.
He says, on a supplemental question from the judge, that he did not have the medical notes from Chester, and the panel would have had anecdotal evidence from staff there.
He said there were delays after the initial call to the transport team at 3.15am. He agrees those delays were not the fault of medical staff.
3:18pm: Dr Ravi Jayaram is the next witness to be called to give evidence.
3:20pm:
Dr Jayaram is a consultant paediatrician at the Countess of Chester Hospital. He says he started in the field of paediatrics in February 1992.
Mr Johnson says a number of witness statements Dr Jayaram has made have been in the case of Child K.
He says, independently, he has a memory of certain events from the night of February 16/17, 2016.
3:24pm:
He explains to the court the on-call system for consultants at the hospital. He says there is an obligation for on-call consultants to be available at the hospital within half an hour, and he lived within that area.
He says he cannot remember, but would probably have been aware on February 16 that there was a possibility of Child K's imminent birth that night.
He says he would have been called that night by Dr Smith to attend the hospital at the time Child K was being born.
3:30pm:
Dr Jayaram is asked to look at his clinical notes, written retrospectively, for Child K's birth.
Child K was born at 2.12am, weighing 692 grammes.
He says there is an initial inspection of such babies, noting 'initially dusky, floppy, no resp effort'.
He says the aim is to get gas into the lungs, then the heart "should pick up", so two cycles of inflation breaths were used.
3:36pm:
Dr Jayaram explains the intubation process.
He says it is a "less urgent situation" in this case as Child K's readings were normal.
He says it is important with doctors in training that they get experience, but the child's safety is important. He says in this situation, with Child K's readings, that meant Dr Smith could carry out the intubation. If there was difficulty getting oxygen in, then Dr Jayaram says he would have taken over.
He says it "does not really matter" what size the intubation tube is, as long as it functions as it should.
3:46pm: Dr Jayaram explains the blood gas readings for Child K at this stage would be seen as "acceptable".
3:52pm:
Dr Jayaram explains the process of administering surfactant, which led to a drop in the oxygen level requirement for Child K from 60% to 50%, which was "good" for her.
He says if the tube is in the wrong place at this time, it would result in surfactant going in only one of the lungs.
He says x-rays are not usually done until 4 hours after birth, as they are looking for surfactant deficiency, the signs of which may not be visible until then. X-rays would only be done earlier if they think they would help with the management of the baby.
3:59pm:
Mr Johnson says a blood sample from Child K was taken to a lab and, five days later, showed there was no sign of infection for the baby girl, which he says is a "fact".
Dr Jayaram explains the process of morphine administration, which was a continuous infusion.
He adds Child K was 'pink, tone good'. Presenting as 'pink' suggested oxygen saturation levels were "in the 90s [percentage]".
4:01pm: A capillary refill test - "a piece in a jigsaw", showed "good capillary refill" and meant Dr Jayaram was "happy with her circulation".
4:03pm:
Dr Jayaram says with Child K being born in a level 2 centre, the plan was to stabilise Child K first before arranging transfer to a level 3 centre.
The plan was to put in arterial and central lines and conduct x-rays to check the positioning of those lines.
4:12pm:
Dr Jayaram is asked about the Apgar scores, which he says are good [9/10] by five minutes after birth.
Mr Johnson says Dr Jayaram's notes are written retrospectively at 4.50am, from birth at 2.12am.
4:13pm: A four-minute video of how a resuscitare is operated is shown to the court.
4:17pm: Dr Jayaram confirms the equipment used at the neonatal unit in 2016 was similar to the equipment demonstrated in the video.
4:18pm: That concludes proceedings for today. The trial will continue, with Dr Jayaram continuing to give evidence, on Wednesday.
Chester Standard Live Reporting
10:28am: The courtroom is filling up, with Lucy Letby in court, and a packed public and press gallery.
10:32am: Trial judge Mr Justice James Goss and the jury have now entered the courtroom, and the trial will resume.
10:34am: Dr Ravi Jayaram will continue to give evidence, with prosecutor Nicholas Johnson KC asking questions.
10:37am:
A floorplan of the neonatal unit is shown to the court. Dr Jayaram has written two indicators on it in nursery room 1, circled 'A' and 'B'.
'A' is where the incubator was located. 'B' will become relevant later on, the court hears.
10:45am:
Dr Jayaram tells the court, once a baby is stable, then the transport team is called, as it can take time for them to arrive.
He says the medical team have to ensure the baby remains stable pending their arrival.
A call to the transport service was made at 3.15am. A record is shown to the court, written by the transport team. The accepting hospital is Arrowe Park.
There is a summary of the resuscitation efforts, with intubation '@18-20 minutes of life' and 'surfactant 35min of age'.
An internal transport team note is made: 'Called APH NICU to check for a cot' at 3.31am.
The transport team registrar relayed a message to be given to Dr Ravi Jayaram, which was noted that Dr Jayaram was agreeable with the plan of action.
The plan for the Countess team for Child K was to insert UAC and UVC lines, take an x-ray to confirm the positions, and give antibiotics and vitamin K.
10:47am: Dr Jayaram says at the time, he was in the neonatal unit at a nursing station with a telephone, on the outside of and adjacent to nursery room 1. He indicates his position on the floorplan shown to the court.
10:48am: Dr Jayaram says he would have his back to nursery room 1, and there was no window into the room on nursery room that wall, so he could not look inside from that position.
10:57am:
An observation chart for Child K is shown to the court, with hourly readings at the half hour from 2.30am.
Dr Jayaram explains the various readings, including the incubator settings. The oxygen saturation reading is 94%.
An intensive care chart is shown, with the first readings at 3.30am. The leak '94' reading is referred to, and the VTE [tidal volume of air going into the lungs].
Dr Jayaram says he was not aware of these readings at the time.
He says those readings are calculated by the ventilator. He says it is important to have some kind of leak, or the tube is too tight.
He says the important thing is to ventilate the lungs, and in the context, Child K was not needing high-pressure ventilation and oxygen saturation levels are good.
He says intubation is a risk in itself.
He says it is important to know about the leak, but the reading in isolation is not significant and they would not act upon it if everything else looked stable. It would only be looked at as a reading if the baby was deteriorating, he adds.
I don't normally look at the leak, to be honest, unless there's an issue with ventilation.
11:00am:
A morphine signing chart is shown for babies on the neonatal unit. They include prescriptions for Child K, the first of which is at 3.30am, signed by Joanne Williams and Lucy Letby.
Dr Jayaram says they wouldn't have signed it out if a prescription had not been written. He says he does not know whether that 3.30am time is the time the morphine is signed out by nursing staff, or the infusion took place, but suspects it was the former.
He adds morphine is for the baby's comfort, particularly after intubation. He says that is done "as a matter of routine".
11:03am:
Mr Johnson refers to the desaturation event for Child K.
Dr Jayaram is asked where he was immediately before. He says he was sitting at the nurses station with his back to the wall.
He says Joanne Williams told him she was going to update Child K's parents, likely with where Child K was going to be transferred. She said Lucy Letby was going to be 'babysitting'.
He says at this point in Feb 2016, "we had had a number of unusual incidents with babies, and a number of colleagues had noted an association with Lucy Letby.
"I was sitting...and I will be very honest I was very uncomfortable. I just had a feeling, knowing what happened before, and my internal dialogue was 'stop being stupid, get on with your work', and I just wanted to go in and reassure everything was ok.
It was around 2.5, 3 minutes [after Joanne left] that I stood up and walked in."
I went through the doorway [into nursery 1].
11:07am:
"I came through that door...and walked towards the incubator.
The first thing I did was look up at the monitors ['A' on the floorplan diagram]. I saw [Child K's] oxygen saturations were dropping, in the 80s and going lower."
"Lucy Letby was standing at point 'b', next to the incubator. She was not looking at me, she did not have her hands in the incubator. She was facing in my direction, but she was not looking at the monitor.
As I approached, I can't remember my exact words, but it was something like 'What's happening?'" "
He says Lucy Letby said: "It looks like she's desaturating."
"What's of note is the monitors usually alarm if desaturation is below 90%. I didn't see if the button to suspend the alarms had pressed.
NJ: Was there a sound of the alarm?" Dr Ravi Jayaram: "No."
11:09am:
He says Child K's chest was not moving well. He says the ventilator was still working.
He says he took a stethoscope and now heard 'poor air entry'.
He says a systematic approach was taken to work out the issue that had led to the desaturation, 'ABC'.
A is for airway, so there was a check with the ventilator, and Dr Jayaram says the ventilator was working.
11:11am:
He says an issue with the ET Tube would present itself as desaturations over a period of minutes.
He adds another issue would be if the ET Tube position had migrated, including if it had dislodged.
He says one way to assess that is to disconnect the baby from the ventilator.
11:17am:
Dr Jayaram says the checking process is 'almost a reflex, like doing an emergency stop in your car', and takes "about 20 seconds".
He says there wasn't any 'obvious' evidence Letby had interfered with the tube.
He says Child K picked up extremely quickly, within a few breaths, after the baby girl was disconnected from the ventilator and given breathing support.
Mr Johnson asks how long was it there had been a significant ventilation problem for Child K.
Dr Jayaram says it would have been longer than 30 seconds, "probably 30-60 seconds" given the saturation levels were in the 80s.
He adds the heart rate was normal.
He says that would be before he came into the room.
11:21am:
He says Letby was saying words along the lines of 'She's desaturating'.
He says it was clearly an airway issue, and what he found suggested was an issue with the tube. He says the "suddenness" of the desaturation would "go against the tube blockage", but there was not a huge blockage he could recall.
He says it is a "possibility", but he "has never seen" a baby of Child K's gestation dislodge their own tube.
He says it "would take quite a lot of movement" for the tube to be dislodged. He adds the diameter of the tube would "have no bearing" of how the tube could be dislodged.
Asked about the high leak reading, Dr Jayaram says he does not believe the leak is "significant at all" in connection with the deterioration.
He does not recall any call for help, and was "surprised" the alarm was not going off.
He says in retrospect, he is surprised no call for help was made, considering a baby of Child K's gestation.
11:24am:
He says he could not say for sure when nurse Joanne Williams returned to the unit.
Dr Jayaram is asked to look at his clinical notes.
He wrote 'at 330 [3.30am] sudden deterioration' for Child K. He says the desaturation was potentially life-threatening if not treated.
11:27am:
The clinical notes add Child K was 'reintubated by Dr [James] Smith after bolus of...morphine.'
Dr Jayaram says Child K would have been hand ventilated at this time.
He says they took the opportunity to put in a larger, 2.5mm diameter tube. 'Good air entry' is noted.
11:31am:
Dr Jayaram says the next issue was to establish UVC and UAC lines for Child K. He says they are things that help, but do not cause trouble if they are not achieved.
11:34am:
A morphine infusion chart for Child K is shown, with the time of the infusion noted as 3.50am. Dr Jayaram has signed it.
He says he cannot remember which began first, the morphine infusion or the morphine bolus.
11:37am: Dr Jayaram said he would have then gone to see Child K's parents in the labour ward to relay events and update them on the plan. Door swipe data is shown to the court indicating this. He says he does not remember any other babies/parents that required his focus that night.
11:40am:
A note on the transport team recorded Dr Jayaram was 'keen not to miss window of opportunity whilst baby stable'.
Dr Jayaram says he was "keen" for Child K to be transported "sooner rather than later".
The transport team was recorded as 'happy for day team to go first thing'.
11:43am:
A record from the transport team: '0555 call received from Dr Jayaram baby dislodged the tube and had to be reintubated...'
Dr Jayaram says: "I probably framed it as the tube was dislodged."
The note adds 'okay for the day team to do the transfer'.
Mr Johnson notes it also says 'still no x-ray'.
11:50am:
Dr Jayaram says he does not have as clear a memory of the second desaturation. He recalls there was one, and says there was a concern the ET Tube had gone too far down.
A clinical note written retrospectively at 7.50am by Dr Jayaram is shown to the court.
The UAC 'would not pass' so was "not done", Dr Jayaram tells the court.
'@0615 began to have lower sats'. The line before that refers to 'left lung hazy'.
Mr Johnson asks how Dr Jayaram knows about that. He replies he would have had to look at an x-ray beforehand [ie before 6.15am].
An x-ray of Child K with a timestamp of 6.07am and 23 seconds is shown to the court.
Dr Jayaram says the left lung shown on the x-ray 'looks slightly more hazy'. He adds the baby girl is slightly rotated.
The significance of that is potentially either infection, or surfactant lung disease, he says.
He points, using a mouse pointer on the screen, to where the end of the ET Tube is.
Also shown is the positioning of the UVC.
11:56am:
Dr Jayaram says the saturations for Child K dropped 'quite suddenly' at 6.15am. He cannot recall if he was in the room. He recalled he pulled back the ET Tube slightly to see if that helped, but it did not.
A blood gas reading recorded a higher level of carbon dioxide.
He says the readings indicated a problem with ventilation.
A fluid bolus was given to increase the 'low' blood pressure. He says "in spite of this, saturations continued to drop".
He says the positioning of the ET Tube looked correct from the x-ray. After removing the ET Tube, Child K was given 'bagging' breathing support and reintubated.
Dr Jayaram says at the time, this desaturation was "clinically explainable" with the 'hazy left lung' noted.
12:08pm: The trial resumes after a 10-minute break.
12:16pm:
At 7.19am, door swipe data shows Dr Jayaram is shown heading towards the office part of the hospital. He says at this point, he believed everything was stable, and he would be preparing for the day ahead without going home.
A couple of minutes later, Dr Jayaram is shown returning to the neonatal unit.
He says he has no recollection of the third desaturation. His clinical notes of the desaturation, timed at 7.25am, are shown to the court.
The notes record a 'sudden' drop in oxygen saturation levels and a drop in the heart rate to under 100. He says it was noted the ET Tube had migrated 1.5cm further in to Child K than had been sited at intubation.
He says this time they did not withdraw the tube, it was moved back, and the heart rate 'picked up immediately'. The note adds 'Now stable'.
12:26pm:
Dr Jayaram explains the notes recorded on 'current situation' for Child K, on ventilator settings, medicine, fluids, lines and results following the third desaturation.
He says a CRP reading for Child K of less than 1 did not rule out infection, but would not indicate it either. He says a higher reading would be more indicative of infection.
The heart rate was a 'regular' 130. Abdomen was 'soft' - "a positive sign". Left lung noted hazy. The transport team was due for 8.30am.
Door swipe data shows Dr Jayaram leaving the neonatal unit at 8.29am. A face-to-face discussion was held between Dr Jayaram and the transport team.
A further dose to support Child K's blood pressure was added to the plan, along with more lung surfactant.
12:27pm: Benjamin Myers KC, for Letby's defence, rises to ask Dr Jayaram questions.
12:30pm:
Dr Jayaram confirms he held a lead clinician role at the hospital, "a managerial role", between 2009 and 2018, including the times of 2015 and 2016.
He says it involves discussions with management.
He said he worked together with Dr Stephen Brearey on the neonatal unit, and agrees that role involved discussions on funding and risk management.
He says ultimately, at departmental level, "the buck stops with me".
12:35pm:
Dr Jayaram confirms Dr Smith was under his guidance when intubating Child K, and the 2.5mm diameter tube was used first.
He says it was more ideal, as the guidance is to use as wide a tube as possible. When the 2.5mm tube was not possible, the 2mm was used, which "should be adequate" for a baby such as Child K's size.
He says there is more likely to be the risk of a leak, but it is a calculated value, and Child K's ventilator requirements were "not excessive".
Asked why he did not take over the intubation process, Dr Jayaram says Dr Smith was an experienced trainee, Child K had a successful resuscitation and the procedure was not urgent.
He says with a 2.5mm tube, at that time, it may not have been possible to intubate Child K, due to it not passing through the cords. He says he may have had the same issue if he had taken over.
He says it's important to note that, with a size 2mm tube, Child K was able to be ventilated.
12:38pm:
Dr Jayaram agrees there is a potential risk of trauma during intubation, but there was no bleeding noted, and repeat intubations were carried out "without difficulty".
Mr Myers asks about surfactant. Dr Jayaram says surfactant should be administered quickly, within 30 minutes. He disagrees with Mr Myers' suggestion it should be within 5 minutes of birth.
Dr Jayaram says the resuscitation process was carried out first.
12:43pm:
Mr Myers says in the first trial, Dr Jayaram said 'Ideally, yes.' in relation to surfactant being given within the first 5 minutes after birth.
Dr Jayaram emphasises the 'ideally' and says that is not always possible.
Mr Myers says the surfactant is given at 2.45am, up to 20 minutes after intubation.
Dr Jayaram says it is "not ideal", but before that, they were not needing high pressure ventilation. He said if there was difficulty with ventilation, with 100% oxygen requirement, the surfactant would have been administered sooner.
He adds: "I wouldn't disagree it could have been given sooner."
He adds he would disagree is that it would have made a difference.
12:50pm:
Mr Myers refers to the intensive care chart with the '94' air leak reading at 3.30am.
Dr Jayaram says it is a 'high leak', and if there was a difficulty with ventilation, then consideration would be to put a wider tube in, but the other readings showed Child K was 'ventilating well'.
He says, "even now", he believes it would not have been appropriate, given the wider clinical picture, to electively reintubate based on that reading.
He says the baby was stable, the ventilator settings were where they were, and there "was nothing to suggest anything of concern".
He says if he was aware of the leak reading, he would "not have considered it important...as the baby was stable".
He says "we don't treat numbers, we treat the whole baby."
12:52pm:
He adds he would not refer to it as an 'air leak', but a 'leak around the tube'.
He says it would have been flagged up to him if there had been concerns by nurses.
He says the size 2 tube was "good enough to get air in her lungs" as the subsequent size 2.5mm tube was with the same ventilator settings used as the 2mm tube.
He accepts there is no leak with the larger tube, but does not believe it is "clinically relevant".
12:54pm:
Mr Myers says the acute deterioration happened with the 2mm tube.
Dr Jayaram says the issue is it was an 'acute' deterioration. This situation, up to the point of desaturation, there had not been anything flagged up, and the nurse Joanne Williams had felt Child K was stable enough for the nurse to leave the room. A leak would have led to gradual deteriorations with gradually increased oxygen requirements, he adds.
12:55pm: Dr Jayaram says Child K would have had the potential for some breathing for herself, but for a poorly 25-weeker [gestation], that would have been limited, and that was why she was on the ventilator.
12:59pm:
Mr Myers asks about the timing of the morphine infusion.
Dr Jayaram says looking at the notes, he believes it was 3.50am.
Mr Myers says in a 2018 police interview, Dr Jayaram had told them Child K was already sedated on the infusion. Dr Jayaram says that was the case he had told police that, and having looked at records since, he says the morphine was applied later, as the morphine was taken out of storage at 3.30am.
He tells the court the tube was in a "very good position" and the chances of a baby dislodging the tube "spontaneously", especially 'small, fragile' 25-weekers, was "minimal". He says that would have been further minimised if Child K was sedated.
1:04pm:
Dr Jayaram says it is correct the baby is not given medication on initial resuscitation and intubation. Subsequent intubation would be 'best practice' to administer medication.
He agrees a morphine infusion chart, timed for 3.50am, would be the correct time.
He says the only reason to cast doubt on it was there was a 3.30am time mentioned, but he believed that was when it was signed out from the storage.
1:05pm: The court is now adjourning for a lunch break.
2:15pm: The trial will resume shortly.
2:16pm: Benjamin Myers KC continues to question Dr Ravi Jayaram.
2:21pm:
Mr Myers suggests it is an exaggeration that it can take up to 2 minutes for a baby to desaturate to the extent Child K was presenting. Dr Jayaram had said in police interview had said "at least 30, at least 60 seconds".
Dr Jayaram says it would usually be 30-60 seconds, and up to 2 minutes would be a maximum.
Mr Myers says that two minutes was suggested as an exaggeration in order to discredit Lucy Letby. Dr Jayaram replies that would be Mr Myers' view.
Dr Jayaram said when he walked into the room and saturations were down, he says there must have been a period of at least 30 seconds when oxygen was not being ventilated properly. He says the tube 'must have been out for a longer period'.
2:24pm:
Dr Jayaram says surfactant deficiency would not cause a rapid desaturation.
He says respiratory distress syndrome will cause lower saturations, but it would be "unlikely and very unusual" for it, as it is evolving, to cause a "sudden drop in saturations in isolation".
Mr Myers says infection is another possible cause, but does not say this was the case here. Dr Jayaram agrees it could be a cause of many issues, including desaturation.
Mr Myers says a blockage of the tube, or a tube not fitted properly can cause issues.
Dr Jayaram says in this situation, up to this point, oxygenation had taken place and there was chest movement for Child K.
2:32pm:
A nursing note for Joanne Williams, Child K's designated nurse, is shown to the court.
'...began to desat to 80s, Dr Jayaram in attendance and on examination colour loss visible and no colour change on CO2 detector. ETT dislodged, removed and reintubated on second attempt by Reg Smith with 2.5ETT...large amount blood-stained oral secretions'.
Dr Jayaram says it depends on where the secretions are coming from. He says it could be from some trauma during intubation, but it did not follow that the secretions would block the tube. He says it is not uncommon for there to be a little blood trauma. He adds the comment is made after the second intubation, and there is no comment about bleeding on the initial intubation.
He says if a blockage is suspected, you look at the baby, look for chest movement, check for CO2 coming out. An x-ray can be carried out, but is not viable in an acute deterioration.
He says if there is a blockage, "you notice it", and they "don't happen acutely".
2:38pm:
Mr Johnson rises to ask where in the nursing note there is a reference to a 'blockage'.
Dr Jayaram says there was no evidence of any pulmonary haemorrhage during this process, and said if there had been anything that needed a closer look, he would have done so.
Mr Myers says Dr Jayaram did not check the tube. Dr Jayaram had earlier said he had had 'a glance' at it.
Mr Myers says there were blood-stained secretions. Dr Jayaram says that was post reintubation.
Asked if Dr Jayaram had contradicted what he had said in a witness statement, Dr Jayaram replies says it is "nuance" and he did not 'formally' look at the ET Tube.
2:39pm: Dr Jayaram says it would take a big effort and "quite a lot of strength" for a baby to dislodge the ET tube, and had never known a baby of Child K's gestation to have done so. He says it is not impossible for it to happen.
2:41pm: Mr Myers says it is Letby's case she does not recall this incident, and he says whatever did or did not happen, Dr Jayaram has added details to make it sound suspicious.
2:46pm:
Dr Jayaram agrees that by this time on the neonatal unit in February 2016, there had been a number of unexplained deaths.
Mr Myers says a review was conducted into this. Dr Jayaram says Dr Brearey had been involved with the review, he was aware of it, and it was "noted" that Lucy Letby had been present for all the deaths.
Dr Jayaram said he, Dr Brearey and other clinical colleagues were aware Letby had been associated. He said the "unthinkable thought" Letby was deliberately harming the babies was made.
He said he wanted to "reassure myself" when he went into the room, to 'give my head a wobble' and then sit down afterwards.
He said the thought of deliberate harm was 'something we had started to consider'.
My Myers said that possibility included 'killing them'. Dr Jayaram: "Yes."
2:53pm:
Mr Myers says it is known Dr Jayaram was on the telephone at 3.41am to the transport team, as shown by a transport team record.
Mr Myers says it is also known Joanne Williams returns to the neonatal unit at 3.47am.
Mr Myers suggests it was about 3.30am when she had left the neonatal unit. Dr Jayaram: "I don't think it was as long as that."
Dr Jayaram says his recollection was that it was a short period of time before he went into room 1, after Joanne Williams had left the unit.
Mr Myers: "Why didn't you check all the nurseries Letby was in, if you were worried?"
Dr Jayaram says it is a good question. He said by this stage of the review, they could not think of natural causes.
It's an uncomfortable thought, you don't want to think it, you want to bury your head in the sand, and...the only reason I wanted to walk in [to the room] was to prove I was being ridiculous.
He adds that at this stage, discussions had been taking place with Letby's managers, and it was "impractical" for him to follow Letby around, and it wasn't his job to do so.
2:56pm:
Mr Myers says at this stage, 'you've got her'?
Dr Jayaram says at the moment he walked in, Child K was desaturating, and that could be due to a dislodged tube, or a tube blockage. Up to that point, she had been stable, and the alarms had not sounded, and no-one had called for help.
He said at the time, the important thing was to deal with the baby.
BM: "You were presented with the fact the tube had been dislodged deliberately?"
Dr Jayaram: "That was one of the possibilities..."
Dr Jayaram: "I was extremely uncomfortable... I didn't see the tube being dislodged."
3:03pm:
An ITV interview with Dr Jayaram is shown to the court concerning the case of Child K.
In it, he says the event is 'etched on my mind' and the 'only possibility' is the tube had been dislodged.
Dr Jayaram says the interview is a long time after the event and after Letby was convicted of murders and several attempted murders.
Mr Myers: "You caught her red-handed, didn't you?"
Dr Jayaram says the culture of the NHS with clinicians, by this time, there was a strategy to 'keep us quiet' - 'people didn't really want to listen to us to acknowledge our problems'.
He says if he had rung police, they would have spoken to bosses and they would have replied to 'ignore them [the clinicians]'.
He said "We spent a long time trying to raise concerns...and running into walls."
He adds: "Had I had more courage, maybe I would've picked up the phone and called police."
Mr Myers: "What stopped you from doing that?"
Dr Jayaram said adherence to procedure, in terms of raising concerns with bosses. He says he had faith in the system at the time, but a meeting was not held for three months.
I guess we put faith in our medical leaders at executive level.
He says the police would have got in touch with hospital executives and they would have said it was already in hand, it had already been raised internally.
3:06pm:
Mr Myers says Dr Jayaram didn't contact police because things didn't happen as they said he had.
Dr Jayaram: "I disagree. There was an element of denial, I didn't want to believe what I had seen.
"There was a fear of retribution - we were told it would have been inappropriate to contact police [by hospital bosses].
We were advised from the start contacting the police would be the wrong thing [to do]."
He says in retrospect, it would have been the right thing to do.
3:11pm:
Dr Jayaram says he found it "beyond coincidence" that with the alarms not going off and seeing Letby standing there [as Child K was desaturating].
He says no matter what else they could've done better, it "still strikes me at that moment in time".
Mr Myers says the issue of Child K was not raised with police until June 2017. Dr Jayaram says that is when the police investigation started.
Dr Jayaram says there was no precedent for [Letby] and knowing now, he would challenge the hierarchy.
He says at the time, the tube being dislodged was 'one of the possibilities'.
Dr Jayaram said he had discussions with Dr Brearey a few weeks later about the neonatal unit.
3:14pm:
Dr Jayaram says at the time, he cannot go throwing around accusations about Letby.
He says: "We don't believe that people who work in healthcare go to cause harm, and I think I was a victim of my cognitive dissonance."
Mr Myers said he didn't engage in such a conversation with Letby, and she continued to work the remainder of her shift without informing anyone else.
Dr Jayaram: "What am I going to say?...Hey everybody, this is what's going on."
3:18pm:
Dr Jayaram's clinical notes are shown to the court, which Mr Myers says does not record the tube being dislodged.
Dr Jayaram says the thing at the forefront of his mind was the stabilisation of Child K.
He added he had mentioned it to the transport team. He accepts it is not in his written notes.
3:32pm:
The trial is resuming after a short break.
Mr Myers is continuing to question Dr Ravi Jayaram.
3:34pm:
Mr Myers asks about the alarm system. Dr Jayaram says he is "absolutely certain" it was not sounding.
He is asked to look at a 2018 police interview at Blacon Police Station and at the time, he said he couldn't remember.
Dr Jayaram: "I don't know why I said that." He says if the alarm was sounding, he would have been alerted into the room.
3:36pm:
Mr Myers says Dr Jayaram said for a second and third time, later that interview, he couldn't remember if the alarm had gone off or not.
Dr Jayaram says, 'with absolute certainty' it was not an alarm sounding that prompted him to go in the room.
3:39pm:
The ITV interview had Dr Jayaram saying of the night February 16/17, 2016: 'That night is etched in my memory, it will be in my nightmares forever'
Dr Jayaram says he wished he had the courage to escalate it in a different way, and that is why the night will be in his nightmares.
3:46pm:
The transport team note of '0555 call received from Dr Jayaram baby dislodged the tube and had to be reintubated'.
Dr Jayaram said he framed it was the tube was dislodged.
Mr Myers says Dr Jayaram does not have a problem with the accuracy of the transport team's earlier note on Child K's information. The transport team were relayed information by Dr Jayaram. He adds there is no criticism of a subsequent note made by them.
Dr Jayaram says the 0555 note is their interpretation of what he had said.
He says it comes back to the denial that there had been deliberate harm. "I didn't want to believe it."
Mr Myers: "This is you proposing a reason. This is what you believed happened?"
Dr Jayaram: "It is what I would have liked to have believed."
It is...very difficult to discuss the discomfort on thinking the unthinkable.
3:54pm:
The jury are coming back in after a 'matter of law' was raised and a short adjournment held.
Dr Ravi Jayaram continues to give evidence.
4:00pm:
Nicholas Johnson KC says one of the reasons Dr Jayaram didn't ring police was the lack of confidence he had in the hospital system. Dr Jayaram says that is correct.
Dr Jayaram says the cluster of events in June 2015 were noted. Letby was later convicted of the murders of babies that month.
The death of a baby in August 2015 is mentioned, for which Letby was convicted of murder. Letby was also convicted of murder of a baby in October 2015 and twice attempting to murder a baby in September 2015.
Dr Jayaram said by October 2015, Dr Brearey had escalated concerns. Senior management's response was "wait and see", Dr Jayaram said.
We wondered - should we be ringing the police? We knew that might get turned back against us. We escalated these things to senior management level...it was frustrating that - and by this stage, the association of Lucy Letby had been noted, no-one was really thinking the unthinkable - we were frustrated that it was being put down as bad luck, pure and simple, at this stage.
4:03pm:
Further events are noted in April and June 2016, including brothers in June 23 and June 24, 2016.
Dr Jayaram said after a thematic review, Dr Brearey had called for an urgent review, and there was a group of consultants who had concerns about deliberate harm. He said there was no response from that until late May, and there was no action needed.
He said after June 24, 2016, there were serious concerns and they should be raised with the executive board. One of the suggestions was to reduce the level of the unit. Another was to register "discomfort" about Lucy Letby working on the unit.
That meeting took place 'about 10 days after' the death of one of the brothers on June 24.
Mr Johnson: "Did you receive support from management?"
Dr Jayaram: "We were told explicitly it would be the wrong thing to contact police" as it would damage the reputation of the trust.
4:06pm:
Dr Jayaram is asked about the 0555 note. He says he does not know if the person is medically qualified.
Mr Johnson asks about how he would phrase it.
Dr Jayaram says the tube could be dislodged during handling of the baby, which would be spotted quickly. The baby could be very active or agitated, and if spotted it would have been documented. He says those two would be "the common causes".
He says it "should raise a question" on how a 25-week gestation baby could dislodge a tube spontaneously.
4:09pm:
Nurse Joanne Williams' note for Child K is shown to the court.
Mr Johnson refers to '?ETT dislodged'. "There is no mention of blood, is there?"
Dr Jayaram: "No."
Mr Johnson asks where she would know the tube was dislodged.
Dr Jayaram says Joanne Williams would have been more likely to look at the tube, as he was busy resuscitating Child K.
4:12pm: Mr Johnson refers to Dr Jayaram's police interviews about the ET Tube. He says in a 2018 police interview, Dr Jayaram had said 'the tube was not blocked'.
4:13pm:
The judge says that completes Dr Jayaram's evidence.
The judge says that completes the case for today, and it will resume on Thursday at 10.30am.
He reminds jurors not to discuss the case or conduct independent research.
Chester Standard Live Reporting
10:40am: Trial judge Mr Justice James Goss and the jury have entered the courtroom, and the trial resumes.
10:44am: Nicholas Johnson KC is asking questions of nurse Joanne Williams, neonatal practitioner, who worked at the Countess of Chester Hospital in February 2016.
10:50am:
The court hears Joanne Williams was the designated nurse on February 17 for Child K.
Child K was her "sole responsibility" that night, with other children being reallocated to other nurses after Child K's birth.
10:55am: Ms Williams says the security of the ET Tube is checked upon Child K's arrival at the neonatal unit nursery room.
11:17am:
Ms Williams is asked to look at the intensive care chart, the readings are in her writing for 3.30am. Writing for an event timed at 3.50am at the bottom of the chart, for the morphine administration, is in another person's writing.
Mr Johnson asks about a few readings on the 3.30am chart, the 'leak 94' reading, the 'VTE 0.4' and the oxygen saturations of 94. Ms Williams says she cannot remember recording them. She said she noted the 94 leak reading at the time, and her job was "to escalate that".
She adds that clinically, Child K looked well, but she would escalate that reading to Dr James Smith or Dr Ravi Jayaram.
11:19am:
Ms Williams says it was "very important" to keep the parents updated.
She says at 3.30am she did "a lot of things" in relation to observation. She said in her statement she had left the unit at 'approximately 3.30am'. She adds the readings taken for 3.30am would not necessarily be recorded at 3.30am exactly.
11:26am:
Mr Johnson asks about the time Joanne Williams went to see Child K's parents. She says the labour ward was next to the neonatal unit.
Door swipe data is shown for Joanne Williams at 3.47am, which the court hears is her going from the labour ward to the neonatal unit.
Mr Johnson asks how long, to her recollection, had she been with Child K's mother. Joanne Williams says it is difficult to say, given it was eight years ago, but she says she would not have been gone for long knowing the condition of Child K, and that it was important to update the mother.
11:30am:
Ms Williams says she wouldn't know, at the time she planned to leave the neonatal unit, which other nurses were available to look after Child K in her temporary absence.
She adds that she was aware Dr Jayaram was on the unit. She does not recall speaking to him as she left, from memory, but said it would be normal practice to do so.
She adds Child K would be stable. She says she had "important information" to relay to parents.
She says she would have checked the ET Tube was in position as part of the 3.30am checks.
11:33am:
Ms Williams says she would have been "very conscious" to come back to Child K, knowing of her condition.
On her return to the neonatal unit, she recalls "alarms going off" from nursery 1, adding "we are trained to respond to them".
She says people were in the room, including Lucy Letby and Dr Ravi Jayaram being there.
NJ: "Was this an emergency?"
JW: "Yes, we were responding to alarms." Ms Williams says she cannot recall the saturation levels, or what Lucy Letby or Dr Ravi Jayaram were doing at the time. She does not recall being part of the resuscitation efforts, but believes she would have been.
11:37am:
Nursing notes by Joanne Williams, written retrospectively, are shown to the court.
The note '?ETT dislodged' is read out. Ms Williams agrees that was the working theory at the time.
About the 'large amount blood-stained oral secretions', Ms Williams says she would have seen it, so recorded it.
11:41am: Ms Williams says she recalls that night, from her notes, Child K desaturated a number of times. She does not recall why the desaturations happened a second and third time, or have any memory of those events outside of her nursing notes from that night.
11:54am:
The trial is resuming after a short break.
Benjamin Myers KC, for Letby's defence, will now ask Joanne Williams questions.
11:57am: Ms Williams agrees the neonatal unit work is a "team effort". She agrees that although nurses have designated babies, they can - for example - write observations for other nurses' designated babies.
12:07pm:
A stock book for the morphine dose was kept on top of a locked fridge in a store room, that room being located near one of the nursing stations in the neonatal unit.
The morphine was recorded as being taken out of the fridge at 3.30am. Joanne Williams is one of the two co-signers. Ms Williams says that morphine would not be applied to the baby instantly as, coming out of the fridge, it is cold.
12:11pm: Ms Williams says she does not remember the specific time she had been gone from the neonatal unit [to see Child K's parents], but from her notes at the time she says she would have left the unit at about 3.30am.
12:20pm: Ms Williams says the morphine infusion would have been prepared as Child K was already intubated. The time of infusion started is noted as 3.50am.
12:22pm: Ms Williams is asked about tubes dislodging. She says 'certain babies' can dislodge tubes. She adds pre-term babies can be active, and dislodging a tube "can happen". She adds she did not have much experience with 25-week gestation babies.
12:23pm: Ms Williams is asked about her return to the nursery room 1. She says she remembers Dr Jayaram asking her 'What's happened?' and who was in the room at the time. Ms Williams agrees that in her statement from 2018 she had said she wasn't there, she had been speaking to the parents.
12:29pm:
The judge asks a question about a 25-week gestation baby being active.
Ms Williams says at the time she had little experience of dealing with 25-week gestation babies.
12:42pm:
The trial is resuming after a short break, with Simon Driver now prosecuting.
Giving evidence next is a nurse who cannot be named due to reporting restrictions. She was a neonatal nurse shift leader at the Countess of Chester Hospital in February 2016.
She says she has some independent memory of events that day. She was part of the day team which began the shift at 7.30am.
12:50pm:
The nurse recalls there was a handover 'huddle' which took place at about 7.25am. At that point Lucy Letby gave a 'call for help' from nursery 1 and all nursing staff and Dr Jayaram went into the room.
She says Lucy Letby had her hands in the incubator, 'Neopuffing' Child K. The nurse said she didn't know the baby at all, and the handover had not taken place at this stage. She recalls other nursing staff and Dr Jayaram went to help, and had noted the ET tube had moved in Child K further than it should have gone, so the tube was removed.
Child K was placed back on the ventilator and the handover continued.
The nurse said she pre-empted that she and nurse Melanie Taylor - Child K's designated nurse - would both be looking after Child K, knowing the gestation and clinical picture for Child K at that point.
The nurse remembers drawing up medication and writing notes for observations and transfer for Child K. Charts are shown to the court showing observation readings initialled by the nurse.
12:55pm: Mr Myers says there are no questions on behalf of Lucy Letby for the nurse, and her evidence is completed.
12:57pm: The court is now adjourning for its lunch break.
2:05pm: The trial is now resuming following the lunch break, with the jury back in.
2:18pm:
Analyst Kate Tyndall is recalled to give evidence.
Nicholas Johnson KC refers to a line in the neonatal review, regarding a self-extubation for a baby [not Child K] during February 17 at 3.20am.
Ms Tyndall says, in light of the questioning and from reviewing the chart, she says this event happened 24 hours earlier, on February 16.
2:32pm:
Amendments to the neonatal schedule in respect of this baby are being relayed to the court.
The jury is told they will receive a hard copy of these amendments by tomorrow.
The court hears the source of the misunderstanding was from undated charts and readings which looked like they referred to the morning of February 17, but when checked with relevant nursing notes, were found to relate to readings made on February 16 and February 18.
2:38pm:
Mr Myers rises to clarify how these amendments came about.
He says a page of readings for February 16 ended up in the February 17 order.
He says Ms Tyndall went back to check, and then found that page out of sequence in the order of documents she had been provided by the hospital. Ms Tyndall says that was how the assumption was made.
Mr Myers says there is no criticism to be made.
2:39pm: Simon Driver, prosecuting, is now reading a witness statement on behalf of Anne Kember, a now-retired consultant radiographer who at the time was working at the Countess of Chester Hospital.
2:48pm:
Ms Kember describes the process of the portable x-ray machine being used. She confirms she took Child K's x-ray.
The timing of the x-ray on the machine - at 6:07 and 23 seconds - is known to be wrong, Ms Kember says. She adds staff did not know how to change the machine's internal clock.
A statement by Shawn Anderson is also read out. He says the date and time on the x-ray machine was not calibrated.
The judge says, to clarify, the time on the machine was not accurate, but the door swipe data by Anne Kember into the neonatal unit at 6.09am is accurate. The x-ray process took several minutes.
2:49pm:
A witness statement by a doctor who cannot be named due to reporting restrictions is read out by Mr Driver.
He said he was working the day shift on February 17, and inserted an arterial line for Child K.
2:54pm:
A statement by nurse Caroline Oakley, who was on the night shift at the neonatal unit, is now read out. She says she has no memory of the night shift or Child K, and her recollection is based on medical notes from that night.
The statement says she has no memory of the first desaturation. She says she knows of occasions in the past where an ET Tube has slipped, and of occasions in the past where a tube has been faulty, but cannot say if that was the case here.
2:58pm:
A statement by nurse Melanie Taylor is read out. She recalls throughout the morning of February 17, on the daytime shift, Child K's ventilation requirements increased ahead of the transport team's arrival.
A series of medication doses was given to try and raise Child K's low blood pressure, which eventually saw some effect.
At 12.40pm, the transport team took Child K to Arrowe Park Hospital.
3:04pm:
A statement by clinical engineering manager Stuart Eccles is read out. His statement is in relation to ventilator system monitors.
He says the hospital's touch-screen monitors are stand-alone, and not networked. He adds nurses will get their observations from the monitor readings and observing of the babies. He adds when monitors record readings which are outside of a preset range, the alarm will sound. The alarm system can be paused with a one-minute countdown, with a visual countdown to the alarm going off. The user can press it again after that minute to pause it for a further minute.
He adds it is possible to pause the alarm in advance of treatment.
It is also possible to silence the alarm with the 'silence alarm' button. In this instance, the alarm will present as a visual indicator.
3:06pm: A seven-minute video demonstrating what an incubator is and how it works is shown to the court.
3:13pm: That concludes the hearing for today. Jurors are told the case will resume at 10.30am tomorrow, and not to discuss it or conduct independent research.
Chester Standard Live Reporting
10:28am: The courtroom is filling up with press, public and lawyers. Lucy Letby, the defendant, is also present in court.
10:34am:
The judge and jury have come into court.
The trial is now resuming, with jurors presented with pages of 'agreed facts'.
10:36am: Simon Driver, prosecting, reads out agreed facts in relation to how the neonatal unit at the Countess of Chester Hospital was accessed, through swipe cards.
10:43am:
The jury hears the Countess of Chester Hospital was reclassed as a level 1 unit in July 2016. The decision was made by the hospital trust itself.
The court also hears no post-mortem examination was carried out for Child K.
Mr Driver says another agreed fact is Lucy Letby was arrested on three occasions, listing when and where they happened - once in Chester, and twice at her parents' home in Hereford.
10:47am: Mr Driver explains when Lucy Letby was interviewed by police. A total of 13 interviews took place in July 2018 over three days. In June 2019, she was interviewed 14 times over three days. In November 2020, there were three interviews.
10:52am:
Mr Driver says items seized from Letby's Chester address included a smartphone, the digital contents of which were extracted and are the source of the messages presented as part of the trial.
A digital forensic investigator later accessed her Facebook and email accounts, which included Facebook searches.
Walkthrough videos at the Countess of Chester Hospital, showing the layout and equipment, were presented by staff not involved with the case.
10:54am: Mr Driver reads out an agreed fact in relation to Letby's murder and attempted murder convictions. Letby was convicted last year of the murders of seven babies and the attempted murders of six other infants at the Countess of Chester Hospital between June 2015 and June 2016.
11:02am: More videos are played to the courtroom, the first demonstrating how a Neopuff breathing device works, which is used during resuscitation, stabilisation and pre- and post-intubation.
11:15am:
The other video is also related to the Neopuff device.
Mr Driver reads out further agreed facts to the court in relation to definitions of trained medical staff, and how many of each staff were employed at the relevant hospital departments.
A further video is shown to the court, demonstrating a 'Neo Wrap' - used for extreme pre-term babies. Special padding is placed under the baby and the baby is placed in a type of plastic bag, with their head staying out, for extra protection and insulation.
11:26am:
A witness statement is read out from Dr Arnand Kamalanathan, who was at Arrowe Park Hospital.
He had a role in transferring Child K to the hospital. He was made aware of Child K's gestational age and birth weight of 692 grammes. He said he and the transport team would have arrived at the Countess of Chester Hospital just before 9am, in an ambulance with blue lights active.
He says there were "some episodes" where Child K's oxygen saturations dropped. He says he introduced himself to the parents, and examined Child K, including the positioning of the ET Tube.
Fluids were increased for Child K, and the oxygen requirement had gone up to "high amounts".
He shared his "concerns" about Child K with the parents, in relation to high oxygen requirements and low blood pressure.
An x-ray was requested to check the ET Tube positioning, and that there was no leak.
11:32am:
A plan was made to transfer Child K at 1pm. He adds that when they arrived, Child K was "unwell", and it was "not uncommon" for a 25-week gestational age baby to require high oxygen.
He adds the team would have used blue-light ambulance to transfer to Arrowe Park. Dr Kamalanathan notes he had a conversation with the Arrowe Park team to prepare them for Child K's arrival. The transfer itself was "uneventful".
Child K was "still unwell" upon arrival at Arrowe Park.
A second statement from the doctor reaffirms that he did not have to reintubate Child K during the transfer.
11:33am:
Another statement from Dr Danielle Gardner, now a paediatric cardiologist at Alder Hey Children's Hospital but at the time working at Arrowe Park Hospital, is read out by Mr Driver.
She explains what facilities Arrowe Park has to offer for babies born from 23-week gestational age.
11:41am:
Dr Gardner refers to the care of Child K for February 19-20, 2016, where the baby girl's condition was deteriorating.
Child K's parents were updated, and Child K was baptised.
The baby girl was on 100% oxygen requirement and her blood pressure had worsened. The parents were informed that Child K was unlikely to recover.
The parents asked Dr Gardner if now was 'the right time' to withdraw treatment for Child K. Dr Gardner advised it was.
Child K was taken to her parents for cuddles.
The baby girl died at 5.28am. The cause of death was noted at severe respiratory distress and extreme prematurity.
11:44am: The court is adjourning for a short break.
11:59am:
The trial is now resuming.
Detective Sergeant Danielle Stonier, of Cheshire Constabulary, is called to the courtroom. She confirms to Mr Driver she conducted some of the interviews with Lucy Letby.
12:03pm:
Members of the jury have a transcript of some of the police interviews in their jury bundle.
The court hears the interviews overall covered other babies than Child K, while the jury will hear and read about interviews only concerning Child K.
The relevant parts of the 2018 video interviews are now played as a compilation to the court.
12:11pm:
Lucy Letby, in the 2018 police interview, is asked about Child K. She says she does not remember the '3.50am event' on February 17 'with any clarity', and her memory of Child K was it "she was a tiny baby".
She says she can read from the notes that Child K's ET Tube had slipped, from reading Melanie Taylor's notes. She says she "does not remember" being present when that happened.
12:13pm: Letby says she does not remember the other events for Child K that night.
12:26pm:
A video from Letby's 2019 police interviews is now played to the court, with Letby asked questions about Child K.
Asked about whether she was stood by Child K's incubator at the time, she says she does not remember. Asked if she agrees she was standing there 'doing nothing' while Child K's saturation levels were dropping and alarms were switched off, Letby says she does not agree.
12:38pm: A short adjournment is taking place while a technical issue with the video is resolved.
12:46pm: The adjournment will be longer than first thought, and the trial will instead resume at 2.15pm.
2:14pm: The courtroom is filling up once more, following the lunch break, with Lucy Letby present.
2:16pm: The judge, Mr Justice James Goss, and the jury have also returned, so the trial resumes.
2:21pm:
The remainder of the relevant parts of Letby's 2019 police interview is played to the court. The jury has access to the transcript so members are able to follow as footage is played.
The November 2020 interview is now played. Due to Covid restrictions in place at the time, all in the interview room are wearing some form of face masks.
2:28pm: The judge says it was "difficult to hear" the footage on the video, particularly if you didn't have the transcript.
2:33pm:
Letby was asked about why she might not react to a baby's saturation levels dropping. She replied she might have been waiting to see if she self-corrected.
A written statement by nurse Elizabeth Morgan, nursing advisory consultant, is read out by Mr Driver. She gives her 'professional opinion' on the situation. She says it is "very unlikely" that a nurse would leave the incubator unless they were confident the baby was stable and the ET Tube was in place, and would alert a nursing colleague to tend to that baby if an alarm should sound in their absence.
She adds in her professional experience, in a poorly saturating baby of Child K's gestational age, it would be 'standard good nursing practice' to observe the baby, ascertain any cause in changes and take any corrective action, calling for help from staffing members if necessary. A series of checks would be carried out, including if the ET Tube had been dislodged.
She added: "I do not believe it would be normal nursing practice to wait and see if the baby self-corrected."
2:34pm: That concludes the case for the prosecution.
2:37pm:
Mr Myers says it would be preferable for the defence case to begin on Monday, with the defendant expected to be giving evidence.
The judge says he has regard to timetabling and the appropriate course would be to start the defence case on Monday, with a view to seeing the defence case end on Tuesday.
The judge says the week after next (as the court is not sitting on Wednesday, Thursday, Friday), he will give legal directions and sum up the case.
He adds it is likely, at this stage, the jury will begin their deliberations that week (week commencing July 1).
2:38pm: That concludes the case for this week, and the trial will resume on Monday, June 24, at 10.30am.
Chester Standard Live Reporting
10:44am:
The trial judge has entered the courtroom, which has a packed public gallery, and members of the jury are coming in.
The trial will resume, with the defence case beginning.
Lucy Letby will be giving evidence.
10:47am:
The judge apologises for the late start.
Nicholas Johnson KC, prosecuting, says there are minor amendments to be made to their jury bundle, which include adding page numbers to the interview transcript. Those are being presented for the jury first.
10:51am: Lucy Letby is called to give evidence.
10:52am:
Benjamin Myers KC, for Letby's defence, is asking questions.
Letby denies attempting to kill Child K. She denies intending to do the baby girl any harm at all.
Mr Myers raises the issue of previous convictions.
Letby denies she has ever harmed, or attempted to harm, any baby in her care.
10:55am:
Mr Myers refers to the events of 3.45-3.50am on February 17, 2016. Letby says she has no recollection of that event.
She says she does have a memory of seeing Child K in nursery 1 at some point, but "cannot be specific with timings".
Mr Myers raises Dr Jayaram's evidence.
Letby says she does not recall anything like that happening, or of the consultant doctor coming in when she was present. She does not recall saying 'she has just begin to desaturate'. She says she does not remember being there in those circumstances.
10:56am:
Asked to clarify, Letby denies accepting that it happened.
Asked about Letby's Facebook search in April 2018 for Child K's surname, Letby says: "I'm not sure, I don't have any recollection of why I did it."
She denies it was linked in any way to do her harm.
11:01am:
Mr Myers raises the police interviews that Letby was in.
In one of them, Letby was asked about the 3.50am event, and what contact Letby had with Child K.
She said at the time she did not recall why she was in the nursery.
Mr Myers asks about the co-signing of morphine at 3.50am. Letby was asked if that helped her memory, and she said she did not.
Letby says for the police interview, she had a selection of charts and nursing notes, to assist in her memory.
She says she does not have an independent memory for that.
She says the 3.50am time would have come from the prescription charts, and not from her memory.
11:06am:
The police interview asked how Letby knew the ET Tube had slipped.
Letby had said in the interview it was from reading nurse Melanie Taylor's notes. She says "she was relying on documentation that was in front of her".
The notes are shown to the court, and are from the day shift, written retrospectively at 4.06pm.
'Written for care handed over from 0730...'
'As commencing shift, ETT ? slipped, loss of colour...saturations dropped...Dr Jayaram resecured ETT...'
Mr Myers asks if Letby was referring to any event around 3.50am.
Letby: "No, I was just relying on these notes."
11:07am:
Letby said she remembered Child K: "She was a 25-week gestation baby, which was unusual on the unit.
I do remember her being on the unit at some point.
Letby has no recollection of any events associated with Child K on the unit.
11:08am:
The 2019 police interview is referred to, which includes Dr Jayaram's recollection of the event.
Asked by Mr Myers, Letby says she does not agree that anything like Dr Jayaram's account happened.
11:11am:
Mr Myers asks about the sedation for Child K. Letby had agreed Child K was sedated, which she had seen from Melanie Taylor's notes.
Mr Myers asks why Letby was agreeing. Letby says she was relying with what she had in front of her. She says she did not have notes from the time of the event.
Asked if she agreed that she was present in room 1 when Dr Jayaram came in, Letby says: "No."
Letby had also said in interview: "I didn't dislodge her tube."
Asked about that: "Because I didn't dislodge her tube and that is what I thought I was being asked at the time."
11:13am:
Mr Myers asks if Child K was 'paralysed' at the time of the first event. Letby says: "No."
Asked why she had agreed, in police interview, with Dr Jayaram's account that Child K was paralysed at 3.50am, Letby says: "I took Dr Jayaram's word to be the truth."
11:16am:
Mr Myers asks about an 'earlier' moment where the ET Tube slipped. Letby says it was referred to in Melanie Taylor's notes.
Letby says Child K was not paralysed as she has not seen any medication notes prior to 3.50am for Child K which would effect that.
Letby adds there is a difference between sedation and being paralysed, in terms of the medication administered to effect that.
11:19am:
Letby denies being the person present to call for help in room 1. She had said in police interview she would not know why the alarm would be silenced.
Asked about it, she said she could have been "possibly waiting to see if she [Child K] self-corrected" when Child K's saturation levels dropped.
Letby says she was "trying to be helpful" to police and "think of reasons why" she would be in the nursery at the time.
She denies accepting she was in the nursery at that time.
11:25am:
The police interview asked Letby about telephone messaging in connection with Child K.
Letby says "it happens frequently" that nursing colleagues message each other about babies. The court is shown an example of that messaging between Letby and a nursing colleague. The colleague is the first to bring up Child K, and Letby responds with details about the baby girl's potential arrival.
11:27am: A message conversation with another colleague, Ailsa Simpson, is relayed to the court. Ms Simpson refers to a '24wkr', which Letby confirms to the court is Child K.
11:29am:
Letby is asked about her shift that night on February 16/17. She says she was in room 2, but would go to other rooms to assist other nurses with their babies, or collect medications. She adds room 1 is where most of the medications are kept, for use for the whole unit.
It was a busy [room], people would be in and out of the nursery [that night].
11:32am:
Letby confirms she was designated nurse for two babies in room 2 that night. A colleague, Sophie Ellis, assists with co-signing of medication that night. Mr Myers says from the chart, Sophie Ellis is designated nurse for babies in rooms 3 and 4.
Letby says it is not a problem that colleagues from other nurseries come to help co-sign, as two nurses are required for such tasks. Asked what would happen to babies in those other nurseries, Letby says a nurse would be asked to look out for those babies while the designated nurse was away from them.
11:35am:
Letby says it was "common practice" for her and colleagues to assist other nurses, and she would not have an independent recollection of such assistance.
Mr Myers refers to events and duties from that night, and asks Letby to explain what they were. One of them is a feed via a naso-gastric tube for a baby in room 2 at 12.30am. Letby explains the process.
Mr Myers asks if the feed starts at exactly 12.30am. Letby: "No." Mr Myers says if that time noted gives an idea of how long the process takes. Letby says it does not, and the process of an NGT feed would take approximately 15-20 minutes.
11:37am: Letby says the nursing notes of entries such as '1am' are "an approximation", such as taking observation readings, and would not necessarily be at 1am exactly.
11:40am:
Mr Myers refers to the 3.30am readings. Letby is noted as carrying out a feed and observations for a baby that is not Child K.
Letby is also recorded, at 3.30am, as being a co-signer on a log book for getting a 50ml morphine syringe out of a storage fridge. Letby says that was the time when it was withdrawn from the fridge. She adds it would take time for that morphine syringe to warm up to room temperature, and would not be used immediately.
She adds that time it was taken out would be "as accurate" as they could.
11:49am:
An observation chart for a baby which Letby was caring for that night (not Child K) is shown to the court.
Letby has signed observation readings for the baby at 9.30pm, 12.30am, 3.30am and 6.30am.
A feed chart is shown for the baby. One of the readings is for 3.30am. She says "this would take a period of time". Asked about an 'average' of time, she says "about 10-15 minutes", which would be longer if there was also a nappy change. She adds the feed would not necessarily be commenced at 3.30am exactly.
11:51am: Letby says she can see from the notes, she had changed this baby's nappy at the 3.30am feed.
11:53am:
Mr Myers asks if Letby has any memory of the 3.50am desaturation for Child K.
Letby says she does not, and has no memory of being asked to look after Child K by Joanne Williams.
11:59am:
Letby says she has no memory of the circumstances which led her to being involved in the morphine administration for Child K at that time. She is listed as a co-signer for it.
Asked about the 3.30am 'morphine commenced' reading on the fluid chart, Letby says that time would be an 'approximation'.
The chart also shows, in Letby's writing, '0350 100mg kg morphine'. Letby says she does not remember writing that note.
An infusion chart for the prescription of the morphine syringe is shown. Dr Jayaram has signed for the prescription at 3.50am as the doctor's signature. Letby and Joanne Williams have signed for the nurses' signatures. The '3.50am' time is in Dr Jayaram's writing, Letby says.
Letby says the time could not have been before 3.50am.
12:02pm:
Letby is noted, on the schedule, as co-signer for a baby (not Child K) that Caroline Oakley was designated nurse for a baby in nursery 1.
Later that night, Caroline Oakley and Lucy Letby are co-signers for medication for Child K. Mr Myers asks if either of them were the designated nurse for Child K. Letby says they were not. Mr Myers asks if there was any significance to that. Letby says there is not.
Letby later adds admission records for Child K on a computer shortly after 6am. The timing on the computer system is accurate, the court hears. She says she does not recall writing the records.
Letby denies interfering with Child K's ET Tube moments later.
12:05pm: A chart for a saline bolus is prescribed for Child K, signed for by Dr Jayaram and administered by Caroline Oakley and Lucy Letby at 6.25am. That timing would be accurate, Letby says.
12:06pm:
Letby is asked about the third desaturation. She says has no recollection of it.
Letby's last involvement with Child K recorded is around that time. The court hears her night shift finished around 8am, and she had no further involvement with Child K after that point.
Letby denies trying to hurt Child K, or trying to interfere with her to give the impression she was more unwell.
Letby: "No, absolutely not."
12:07pm:
That concludes the questions by Mr Myers.
The court will take a 20-minute break.
12:33pm:
The trial is now resuming.
Nicholas Johnson KC, prosecuting, will be cross-examining Lucy Letby.
12:36pm:
Mr Johnson says having a 25-week neonate at Chester was 'very unusual'. Letby: "Yes."
Letby says she had seen quite a few before at Liverpool Women's Hospital, but not at Chester.
She says she remembered seeing Child K.
Mr Johnson says when police came to see her in 2018, she recalled Child K.
Letby says she cannot recall much of her police interview.
Letby is asked about her April 2018 Facebook search for Child K. 11 weeks later, she was arrested by police.
Letby says she does not recall why she was searching for the child's surname.
12:38pm:
Mr Johnson says if a nurse deliberately displaced the ET Tube on a child of Child K's gestation, what would likely happen?
That's a hypothetical question.
Mr Johnson says why wouldn't you?
LL: "You would cause harm to the baby... they can't breathe without that tube."
Mr Johnson says if action isn't taken to correct it quickly, it would be likely to severely compromise their prospects of survival.
Letby agrees.
That is what you did, isn't it?
No.
You actually did it three times.
No.
12:39pm:
Mr Johnson refers to the first event of about 3.50am.
Letby says she is not sure of the precise timing.
It had happened by the time Joanne Williams came back into the unit [at 3.47am]?
Yes.
Letby adds: "I know my actions and I know I did not displace that tube."
12:40pm:
Mr Johnson refers to Dr Jayaram's account, asking if he is not telling the truth.
LL: "I don't think I can comment if he is telling the truth, all I know is that did not happen."
Mr Johnson refers again to the doctor's account of events.
NJ: "You're saying that cannot be true?"
LL: "Yes."
12:41pm:
Mr Johnson refers to the second event, just after an x-ray, when the tube was 'in the correct place'.
Letby says she cannot remember the event.
The third event had come after the day shift nurse came in. Letby says she cannot remember that event.
She says she cannot comment on that nurse's account of events [whether it was true or not].
12:44pm:
Letby: "I don't believe I stood there while that tube was dislodged." [re: the first event]
Letby says for the third event, the nurse 'might be right' of her account of events, when the day shift nurse described Letby Neopuffing Child K.
NJ: "You are just that sort of person [who kills babies]."
LL: "No."
NJ: "You have killed seven babies and tried to kill six others, one on two separate occasions."
LL: "No, I haven't."
12:47pm:
Mr Johnson refers to Letby's 2022 defence statement. At the beginning, Letby dealt with general issues, then by the cases on a baby-by-baby basis. Letby agrees.
Mr Johnson refers to the section involving Child K. He asks whether, when she signed it, she made sure what was said in there was true. Letby agrees.
12:52pm:
Mr Johnson says he wants to clarify two paragraphs in the statement, which refer to allegations raised her, and her grievance procedure against the hospital.
She adds she 'does not accept the good faith of Dr Jayaram...during this [grievance] process or generally'
What did you mean by that?
That I didn't accept any of the things that had been raised by that point.
Mr Johnson says after being removed from the unit in July 2016, Letby raised a grievance procedure.
Letby agrees she did not accept the good faith of Dr Jayaram during that procedure.
Asked why, LL: "Because of the comments he has made and things that came to light [during that procedure]...and the way he was conducting himself [in those allegations.]"
The statement adds: 'The grievance was resolved in my favour...but it is apparent they [Dr Ravi Jayaram and Dr Stephen Brearey] have been set against me for some time.
That is obvious from their witness statements and for some of their conduct towards me [from 2015].
NJ: Are you saying to the court that Dr Jayaram's conduct towards you in 2015-16 gave you a justifiable cynicism to his good faith?
LL: Yes, when I found out his actions, yes.
NJ: At the grievance procedure was resolved in your favour, you were vindicated, weren't you?
LL: Yes.
12:53pm:
Mr Johnson says he wants to clarify two paragraphs in the statement, which refer to allegations raised her, and her grievance procedure against the hospital.
She adds she 'does not accept the good faith of Dr Jayaram...during this [grievance] process or generally'
What did you mean by that?
That I didn't accept any of the things that had been raised by that point.
Mr Johnson says after being removed from the unit in July 2016, Letby raised a grievance procedure.
Letby agrees she did not accept the good faith of Dr Jayaram during that procedure.
Asked why, LL: "Because of the comments he has made and things that came to light [during that procedure]...and the way he was conducting himself [in those allegations.]"
The statement adds: 'The grievance was resolved in my favour...but it is apparent they [Dr Ravi Jayaram and Dr Stephen Brearey] have been set against me for some time.
That is obvious from their witness statements and for some of their conduct towards me [from 2015].
NJ: Are you saying to the court that Dr Jayaram's conduct towards you in 2015-16 gave you a justifiable cynicism to his good faith?
LL: Yes, when I found out his actions, yes.
NJ: At the grievance procedure was resolved in your favour, you were vindicated, weren't you?
LL: Yes.
12:58pm:
Mr Johnson says in police interview, Letby had gone on the basis that what Dr Jayaram had said was true.
Letby says she had assumed that police had established fact from what was being put to her, potentially from other people's accounts.
Letby agrees that the allegation depends on what Dr Jayaram had said.
She says when interviewed by police [in 2018], she had assumed what had been said to her could be factually backed up.
Letby says at the time, she was looking at ways that could have factually happened.
Mr Johnson says that was also the case in the 2019 interview.
Letby says she has never accepted his version of events. She said she was not remembering.
Mr Johnson says what Letby is saying now is not what she was saying in police interview, that she did not accept Dr Jayaram's account of events.
I think it's difficult to look at the context of the interview.
Letby is asked what she means by that.
At the time I had a lot of different notes I was looking at...but I don't think I ever accepted [that version of events].
Mr Johnson says there was no shift in Letby's position over the police interviews.
12:59pm: Letby says she had made it clear at police interview that she had not dislodged the ET Tube.
1:03pm:
Letby says it is still her case that Child K was not properly intubated, with problems relating to the size of the ET Tube used, and there were other 'issues' with her care.
NJ: "Maybe someone dislodged her tube?"
LL: "Well it wasn't me."
NJ: "Maybe somebody else, if not you?"
LL: "...Yes."
Mr Johnson asks about the potential tube blockage, as Letby said in interview. He asks if that is still her case. Letby: "Yes."
Letby agrees it is her case that Child K received sub-optimal care, and that nursing staff were not experienced with dealing with babies of Child K's gestational age.
Mr Johnson asks where in the statement there is anything that says Dr Jayaram could not be correct as she was not in the nursery room at the time of Child K's desaturation.
LL: "It doesn't, but I have made it quite clear I have done nothing to hurt [Child K]."
2:13pm: The courtroom is filling up following the lunch break, with Mr Johnson due to continue cross-examination of Lucy Letby.
2:17pm:
Mr Johnson asks Letby about Child K's mother's statement. Letby says she remembers it.
A photo was taken of Child K in nursery 1 at 4.31am on the morning of February 17.
Letby is asked if she remembers seeing the parents with the baby girl. She says she cannot remember.
2:19pm:
The neonatal schedule for that night is shown to Letby.
Letby had earlier said she was involved in the administration of medication to a baby who was in room 1.
The time of that medication was 4.34am. Mr Johnson says the medication would have also come from room 1.
You saw [them] with their daughter, didn't you?
Letby says she cannot be sure, she was concentrating on medication for the baby who was in room 1.
How did you remember their surname? [the surname of Child K and parents]
I don't know.
2:20pm:
The agreed facts are presented to Letby.
Nothing was found at Letby's address search in relation to the surname of Child K.
Mr Johnson refers to the April 2018 Facebook search for Child K's surname, at nearly midnight.
Letby is asked why: "I can't answer that. I don't know why."
2:23pm:
NJ: "You knew on April 20, 2018, that police were asking questions about you and your dealings at the Countess of Chester Hospital?"
LL: "I thought the police were involved from May, but I could be wrong."
Letby is asked if Joanne Williams is a friend of hers. "No."
I was not aware of what the police were doing or with who.
NJ: "It's just a coincidence that after Joanne Williams had spoken to police about [Child K] that [you searched her name?]"
Yes, I had no contact with Joanne at this point.
And you cannot remember why?
No.
2:24pm:
Letby is asked to agree that she has searched of Facebook for the names of babies that she has been convicted of murdering and attempting to murder. Letby agrees that is the case.
LL: "I am not guilty of what I have been found guilty of."
2:26pm:
Asked if it was an "innocent coincidence" that she had searched the names of babies (and parents of babies) that she had been convicted of murdering and attempting to murder, Letby says "yes".
She adds that she has searched for many other parents and babies on Facebook.
Letby says she would have been on her phone, 'day and night', sometimes at work, when conducting these searches, many of which are recorded late at night.
2:28pm:
NJ: "This was your habit, wasn't it?"
LL: "I looked at many parents, not just the babies here."
Asked about what her fascination was in looking at these names, Letby replies: "It wasn't a fascination," adding she regularly looked at the names of parents.
Letby: "[Child K] was on the unit very briefly."
2:30pm:
Letby: "If I remembered any details, I would say; I cannot remember."
NJ: "Because you are not the sort of person who does this thing?
LL: "No."
NJ: "Were you looking for grief? [Names of] Parents on Facebook sites, were you searching for evidence of grief?"
LL: "No."
2:34pm:
Text messages between Letby and a nursing colleague early on February 16 are shown to the court.
Letby: 'Unit is a hive of activity in preparation for the big bods lol x'
The court hears this was at the end of Letby's previous night shift.
Letby sent in a message at 5.26pm that day: "No it [Child K] didn't come but 6cm [dilated] so wouldn't transfer out, imagine it'll have delivered today."
Letby is asked if she had a recollection of the other baby from the February 15/16 shift, when that baby was extubated. She replies she does not. She adds she does remember that baby.
2:37pm:
The court is shown a nursing note written between 12.51am and 1.07am by Caroline Oakley for that child.
The note includes 'Longline pressures increasing and then occluding ? positional. Site appears satisfactory. Cares attended to by SN [senior nurse] Letby."
'At 0015 longline pressures observed to have dropped...longline snapped from cannula hub ?? cause.'
Letby denies she had anything to do with the longline snapping.
2:47pm: After a short break, Mr Johnson refers to the birth of Child K as part of the cross-examination.
2:51pm:
Letby denies wanting to be part of the care for Child K, as she says she was not the most senior member of nursing staff, and would not be suitable for a baby of Child K's gestational age.
A nursing observational chart for Child K is shown. Letby confirms the 2.45am readings are hers. Asked why she has not signed for it, Letby says: "That is an oversight on my part."
Letby says it would be a "team approach" when Child K arrived on the unit.
Asked again why she did not sign on the chart, LL: "Sometimes things do get missed."
Letby denies she did not sign the 2.45am observation so she could avoid being tied to Child K in the event of any events for her.
2:53pm:
The court is shown swipe data for Dr Laura Lo coming into the neonatal unit from maternity at 2.43am, which Mr Johnson says would presumably be with Child K and others.
Mr Johnson says moments later, Letby fills in the data on the chart in the 2.45am column.
He asks Letby if she can remember what else she was doing at this time. She replies she cannot.
2:56pm:
A nursing note is shown for a baby Letby was caring for, and the admin note is timed as being opened at 2.36am and being closed at 2.50am.
Letby is asked why she had that open while Child K was admitted. Letby says it would be a team effort for a baby's arrival and it was not unusual for people to leave the computer at the time when such an arrival on the unit happened.
Letby is asked if that was to give the impression she was otherwise engaged when Child K arrived. Letby replies it was not.
3:01pm:
Letby is asked about feeding time for a baby she was caring for. She says the times vary on how long a feed takes.
Mr Johnson refers to the 3.30am feed for the nursery 2 baby, and when she "actually" did that.
Letby says there is no way to say exactly, as the times are all "approximations".
Also at 3.30am are the observation readings for a baby and a morphine medication. Letby says the latter would be a precise timing [when the morphine syringe was taken out of the fridge].
Letby says the process takes "seconds" and the morphine could have been taken by Joanne Williams and the prescription taken to a cotside for Letby to cosign.
Letby says the administration would not be given until it had been prescribed.
A reading for '0330 commenced' is shown. Letby says the note is in Joanne Williams' handwriting, and, asked about if that means the morphine infusion commenced at that time, says: 'that is how it presents'.
3:03pm: Letby says the chart has been prescribed at 3.50am [from a prescription note]. She adds while the morphine can be administered before the prescription time of 3.50am, it is 'not good practice'.
3:08pm:
NJ: "Did you wait for Joanne Williams to leave the unit before you decided to go into nursery 1?"
LL: "No." Letby adds she does not remember going into room 1.
Mr Johnson refers to the 3.41am transport team note from a conversation with Dr Ravi Jayaram. Letby agrees there are telephones at a nursing station outside the room, as well as one inside room 1.
Letby is asked if she accepts Joanne Williams coming into the neonatal unit at 3.47am. She replies she does.
Mr Johnson asks if the event must have happened before 3.47am. Letby says it does, given Joanne Williams' statement.
Letby says she will agree Dr Jayaram was on the phone, but not sure which one.
3:09pm: Letby says she cannot recall the situation, so she could not say what she would or would not have done.
3:13pm:
Mr Johnson refers to the police interviews with Letby. A short video extract of one of them is played to the court.
He says Letby does not say she does not recall why she was in the nursery.
He asks why Letby went along with Dr Jayaram's version of events. Letby denies she did so.
She adds: "This was a highly stressful situation, I was being interviewed about multiple babies on multiple days."
Letby denies a suggestion from Mr Johnson that she is pretending not to remember [the events] so she doesn't have to answer difficult questions.
3:15pm: Letby, asked for clarification by the judge about her referring to say shift nurse Melanie Taylor's nursing notes in relation to Child K's desaturation, says she 'was not clear on the times'. The nursing note refers to a later desaturation Child K had.
3:21pm:
Letby is asked about Child K's ET Tube 'slipping'.
Letby is asked why she did not rule out being in the nursery room at the time.
She replies she is trying to be helpful and "try to fill in the gaps".
NJ: "You were hedging your bets, weren't you?"
LL: "No."
NJ: "You were trying to cover for all sorts of unforeseeable eventualities, weren't you?
LL: "No, I was telling the truth."
NJ: "You were prepared to go along with an account of a doctor who you say had it in for you?"
LL: "No, I don't think I have ever accepted his account."
Letby says it was "very intimidating" in the police interview situation.
NJ: "Who were you helping?"
LL: "I don't know. Not me."
LL: "I was trying to be compliant with police in an intimidating, stressful situation."
3:22pm:
That concludes the trial for today. The cross-examination will continue on Tuesday.
The trial judge reminds the jury they will not be sitting on Wednesday, Thursday or Friday this week.
Chester Standard Live Reporting
10:30am: The courtroom is filling up with lawyers, press and public, as Lucy Letby is present for the continued cross-examination.
10:31am: Trial judge Mr Justice James Goss and the jury have now also come into the courtroom.
10:32am:
Nicholas Johnson KC, prosecuting, continues the cross-examination he began yesterday.
He asks if Letby has said anything from yesterday which she wants to correct or clarify. Letby: "No."
10:39am:
Mr Johnson refers to Letby's police interviews, and a nursing record made for Child K. The first notes are by Joanne Williams, with Letby adding an admission note between 6.04am and 6.10am.
Letby says in police interview, she was not given all the notes, such as this one. Mr Johnson says she was given all the nursing notes for that interview. Letby: "I don't know...I would have to check."
Mr Johnson refers to the nursing note made by Joanne Williams documenting the baby girl's arrival on the unit and the 'desaturation to 80s' event. '? ETT dislodged'.
Mr Johnson says 'not a blocked ETT, a dislodged one'. Letby says it's queried.
Letby says she has no memory of the event, in response to a question whether she saw 'large blood-stained oral secretions', as noted by Joanne Williams.
10:44am:
Joanne Williams notes '2 further episodes of apnoea and desaturation with loss of colour'. Letby agrees those would be the two further events.
There is an additional 'family communication note' by Joanne Williams made.
Letby 'booked Child K in' to the unit between 6.04am and 6.10am. The record of it lasts several pages. At the end of it is Melanie Taylor's note, 'written for care from 0730...as commencing shift, ETT ? slipped, loss of colour, HR [heart rate] and saturations dropped. Dr Jayaram resecured ETT...'
Mr Johnson says that Letby had access to all these notes.
Letby: "I can't say for definite what I had at my interview." Letby yesterday said in police interview she had been relying her recollection of the events for Child K on Melanie Taylor's notes.
I had many many interviews and I can't say what documents I had for each baby.
I have no memory of what notes I was given.
Mr Johnson: "You knew very well what you were being asked."
LL: "I can't say that I had the notes for definite."
10:48am:
A section of Letby's 2019 police interview is played to the court.
Mr Johnson says Letby was agreeing she was there at 3.50am.
Letby: "No, I was looking at possible options and assuming that Mr Jayaram had been right."
What do you mean by that?
I do not remember that event, I was relying on what Mr Jayaram was saying, and trying to fill in the gaps.
Mr Johnson says 10 weeks before the first interview, Letby had searched for Child K's surname.
NJ: "A child you had remembered very well."
LL: "I disagree."
10:51am:
Letby says she stands by the practice of waiting to see if a baby would self-correct when a desaturation began.
Mr Johnson raises the agreed evidence of Elizabeth Morgan, who says it would not be good practice, as the lungs were so immature, and the risks of unplanned extubation.
NJ: "Do you agree?"
LL: "No, because I know what the standard practice was in Chester. I know what our policy was."
NJ: "For 25-week gestation babies?"
LL: "For any baby."
LL: "From my experience at Liverpool Women's is that you would not put your hands in the incubator [you would wait to self-correct]."
NJ: "For a 25-week gestation baby? You are lying, aren't you?"
LL: "No."
NJ: "And you are lying because you know you were caught by Dr Jayaram."
LL: "No."
10:52am:
Letby is asked to say where in her defence statement where she disagrees with Dr Jayaram's account. Letby says there is not in so many words.
LL: "I know I did nothing to interfere with [Child K]."
10:54am:
Letby agrees she accepts Child K was sedated after 4am with morphine.
LL: "She would have been relaxed, but she could have moved if she wanted to."
Asked if she saw Child K move, Letby says she did not.
10:56am:
Letby says nurses would not write about how a baby was behaving in the incubator.
Mr Johnson says if a baby was active when not being handled, and apparently self-extubating, then it would be 'highly relevant'.
Letby agrees.
Mr Johnson says there is no record of Child K being active in the nursing notes before or after 4am.
Mr Johnson says there was no handling of Child K before 4am - other than Letby moving the tube.
LL: "No."
10:59am:
Mr Johnson refers to two babies in room 2 that Letby was the designated nurse for. Letby agrees she was in that room around 6am.
Letby is asked if she went from nursery 2 to 1 to input Child K's admission records on the computer. Letby says the records for it would be kept at Child K's cotside.
Letby is asked if she recalls child K having an x-ray. "No. I don't recall."
NJ: "Which is it? 'No', or 'I don't recall?'"
LL: "I can't recall anything from that night."
11:01am:
A record is shown of Anne Kember coming into the neonatal unit at 6.09am with the portable x-ray machine.
Letby agrees the ET Tube was in the correct position at the time of the x-ray.
Mr Johnson says by 6.24am, Child K had desaturated again. Letby: "Yes."
NJ: "Between those times, you would have taken the [admission record] notes to her cotside?
LL: "Yes. That would be best practice."
11:04am:
Mr Johnson asks Letby if she accepts other staff members' accounts of her being present at the third desaturation?
LL: "I have no recollection."
Mr Johnson asks her if they are telling the truth.
LL: "That sounds like actions that I would be taking [in that event].
NJ: "So you do accept?"
LL: "I don't think I can comment on whether someone is telling the truth or not, I only know what I know."
11:13am:
A feed chart is shown for a baby in nurse 2, which Letby was the designated nurse for, at 6.30am. Letby says she cannot be specific on how long it took - "10-15 minutes".
A medication prescription is made for a baby in room 1, administered at 6.37am, with Letby cosigner.
Letby says the feed time of 6.30am is "an approximate time".
Mr Johnson says the medication prescription is an exact time. He asks how the bottle feed could be warmed and fed within 10 minutes. Letby says there are ways to ensure the milk is prepared and warmed in advance of the scheduled feed.
NJ: "Were you keeping accurate records?"
LL: "Yes."
Mr Johnson asks if that baby could easily be fed within 10 minutes.
Letby: "I don't have recollection [of that baby]."
Letby says those times are approximations.
Mr Johnson says the feed was started after 6.25am as the infusion for Child K was administered at that time.
Letby says she may have started the feed then gone out [of nursery 2] and come back.
11:16am:
Mr Johnson asks about the third desaturation, and how Letby came to be in nursery 1 at the time. Letby says she cannot recall. She adds the morning handover [to the day shift] had not happened yet.
Letby denies 'taking the opportunity' to interfere with Child K.
I don't recall this event.
Mr Johnson says it wasn't an alarm, but it was Letby calling for help, that alerted a nursing colleague to the third desaturation.
I don't know how I can accept... I don't have a direct memory.
11:17am:
Mr Johnson says Child K's ET Tube had slipped in, relatively speaking, 'a long way', while she was 'well sedated'.
NJ: "That was because you pushed it in, didn't you?"
LL: "No."
11:18am:
Mr Johnson says Letby did not want a written record of her being present in the third extubation. Letby says she disagrees.
You tried to kill [Child K], didn't you?
No.
Letby again denies she killed and attempted to kill other babies.
11:24am:
That concludes the cross-examination.
Mr Myers rises to clarify a couple of points. He refers to Letby's defence statement.
He says the defence statement referred to 22 allegations, of which Child K was one of them.
Letby is asked to say how many paragraphs there are in the defence statement. Mr Myers has a full copy, and says there are 213 paragraphs.
He adds there are 30 paragraphs on general issues.
Letby is asked to read out a couple of paragraphs about that. It includes that there is more information to receive, and the defence case 'continues to be prepared'.
Mr Myers asks about the issue of Dr Jayaram's credibility.
Letby reads out the part of her statement which questioned that, not accepting the 'good faith' part during her grievance procedure or generally.
Mr Myers asks about the 'generally' words, and asks Letby to explain.
Letby says "in all ways". Asked further, Letby replies that involved 'The grievance procedure and the police statements.'
11:27am:
Mr Myers asks Letby to read out another part of her statement.
Letby reads out her defence statement in which she said she had no recollection of being in room 1 when Dr Jayaram walked in [as was stated in his account].
Mr Myers asks, in the 213-paragraph statement, if Letby gave accounts of where she was on other instances, including on cases where she was convicted. Letby agrees.
11:31am:
Mr Myers refers to Letby's 2018 police interview, in which Letby said she did not recall why she was there in room 1.
BM: "Is that you accepting you were there?"
LL: "No."
The morphine prescription is presented in that police interview and Letby was asked if that helped her remember. LL: "Not really, no."
Mr Myers asks if that was Letby accepting she was there. LL: "No."
11:35am:
The judge asks Letby about what documents she had at the time of the police interview.
The judge says the interview referred to 'pages 9 and 10' of documents. He asks if there were also pages 1-8, or an idea of what documents she had.
Letby says she couldn't comment on how many documents she had, and cannot remember if they were presented chronologically or as pages.
Letby is also asked, by the judge, if she was informed about Child K dying. Letby replies she was, but cannot say how or when. She adds the hospital would have been informed 'within days' [of Child K passing away on February 20, 2016].
11:38am: That concludes the case for the defence.
11:42am: The court is adjourning for a short break.
11:48am:
The trial is now resuming.
Trial judge Mr Justice James Goss says that completes the evidence in the case, and it is up to the jury to deliberate.
He says there are to be discussions with counsel on matters of law for him to provide legal directions.
He says he will provide a summing up of the case, which will focus on what he believes to be the 'salient points', it is not for him to says which parts are relevant and which are not.
He says the closing speeches will take place next Monday, and the jury will go out 'possibly Monday', but likely Tuesday, to consider their verdict.
He reminds jurors of their responsibilities, and to return at 10.30am on Monday.
Chester Standard Live Reporting
10:29am: The courtroom is filling up with lawyers, press and members of the public. Lucy Letby is also present.
10:31am: The trial judge has now entered the courtroom, with members of the jury now also filing in.
10:33am:
Members of the jury are provided with a 'fuller index' to their jury bundle.
The judge, Mr Justice James Goss, is now delivering the directions of law. Members of the jury are given them in writing, but they will also hear them read out. The judge says this is the first part of his summing up and won't take long.
10:38am:
Jurors are told to judge the case on the evidence that has been heard before them, and not to "speculate" on other factors.
He says it is natural for jurors to fell sympathy to Child K's parents, and it is normal to react with "horror" at the allegation of someone causing deliberate harm to a premature baby.
He urges jurors to go through the evidence in a "fair, calm, objective and analytical way".
10:44am:
The judge adds that jurors do not have to find a motive in the case. He says: "Motives for criminal behaviour are sometimes complex, and not always clear."
He adds that the passage of time is likely to have affected the memory of each witness, including the defendant, given that events happened eight years ago, and weight has been applied for the contemporaneous notes made at the time in February 2016.
10:49am:
The judge says Letby's previous convictions can support the prosecution's case, but they do not prove she attempted to murder Child K. He adds it is up to the jury to decide how much weight they want to apply to those previous convictions.
He adds jurors are to give a verdict on which they are all agreed.
10:52am:
Prosecutor Nicholas Johnson KC begins his closing speech by saying Lucy Letby is "an extraordinary person - and not in a good way."
He points towards a "terrible list" of the babies Letby was convicted of murdering, and how old they were when they died.
He adds the names of the babies Letby was convicted of attempting to murder. "Thirteen separate children."
That is the shocking and dreadful context to this case.
10:53am:
He says Letby was "cunning and devious" and committed a "campaign of murder and attempted murder" while remaining "undetected" for all those months.
He says jurors should take that "devious" behaviour into account when considering the case.
10:55am:
He says Child K can be considered to be the "epitome of fragility" due to her prematurity and her weight of being 'seven tenths of a bag of sugar'.
He says Child K was a "source of great interest" to nurses on the unit, including, "importantly, to Lucy Letby".
10:58am:
He refers to Letby's recollection, which he paraphrases as 'I don't remember, it's not the sort of thing I would do'.
He says Letby referred, nine times in her evidence, to 'best/common/good practice'.
He says it was common practice for her to sabotage infants in her care.
10:59am:
He says the staff at the Countess of Chester Hospital, with one exception - the one who is sitting in the dock - did their best to care for Child K that morning.
He adds the "difficult but humane" decision was later made at Arrowe Park Hospital to withdraw care for Child K.
11:01am:
Mr Johnson refers to Letby's defence statement and the "red herring" that Child K should not have been born in the Chester hospital.
He says that is nothing to do with why Child K's "ET Tube kept dislodging."
11:09am:
He says the risks of Child K's mother being transported to Preston, the only available level 3 centre in the area at the time, outweighed the risks of Child K being born in Chester.
He says Dr Jayaram was doing his best to transfer Child K to a tertiary centre. "He could have done no more."
He adds that Lucy Letby had accepted that moving an ET Tube would be "likely to kill the baby".
He says that with Dr John Gibbs, the simplest thing to do if a baby is desaturating is "turn up the oxygen on the wall" and the appropriate intervention depended on what help the baby was receiving at the time.
Dr Gibbs had said the whole point of the ventilator was to prevent desaturations in the first place. He says the oxygen would be turned up and to call for help, or simply to call for help.
He says the reasonable option was not "to do nothing".
He refers to Elizabeth Morgan's agreed evidence, which said from her "professional experience", it would be "standard and good practice" to immediately tend to the bedside the assess the baby and take any corrective action, calling for help if necessary. A series of checks would be carried out "immediately" [eg if the tube has become blocked, or equipment failure]. She had said it would not be good practice to wait.
Mr Johnson says Letby had said, in evidence: "That's her opinion." Mr Johnson says that's agreed evidence and "what should have happened."
11:12am: Mr Johnson refers to the evidence of obstetrician Dr Sara Brigham, where she was challenged on where Child K should have been born. He says the evidence given was the risk of Child K's mother giving birth in the back of the ambulance "on the M6 [motorway towards Preston]".
11:23am:
Mr Johnson says it was the defence case there was a shortcoming in care after Child K was born.
He says there are distractions from the central issue of Child K's ET Tube being dislodged.
He refers to the 'leak 94' reading from the ventilator being a snapshot taken at that moment in time, and witnesses had given accounts to say Child K was "optimally oxygenated".
He says questions were asked about Dr Srinvasaro Babarao's panel board meeting which had concluded Child K's care was sub-optimal. He says the decision to have the delivery in Chester and the delay in transfer could not be helped, and the delay in inserting a line for Child K was "a distraction". He adds the conclusion was not based on all the evidence.
He says Dr Babarao was "surprised" when he heard Child K's alternate delivery location was "Preston", and he had said "That's a long way".
He says none of those issues had anything to do with the competence of the staff at the Countess.
He refers to the delay in inserting a UVC line for Child K. The plan for it had been confirmed at 3.41am. He asks the jury what happened immediately after. He says Letby had interfered with Child K's ET Tube and Child K desaturated.
He says the defence are relying on the destabilisations of Child K from the defendant's "acts of sabotage" for the staff's competence of the care for Child K.
He says the care of Child K was "criminal, not sub-optimal" as a result of Lucy Letby's actions.
11:27am:
Mr Johnson refers to a 2.45am reading for Child K on nursing notes, in Letby's handwriting but not initialled by her. He says Letby had called the lack of writing in initials an "oversight".
Mr Johnson says jurors should look at the context, and it shows that "Lucy was very keen to get her hands on [Child K]" and "wanted to reduce the audit trail" from what "she knew was going to happen".
11:29am: He refers to a nursing note started by Letby at 2.36am and ending at 2.50am for one of her designated babies who was in room 2. He says during that time, Letby was in room 1. He says that is a reflection of Letby's "sly" behaviour.
11:37am:
Mr Johnson refers to further nursing notes about the room 2 baby's 3.30am feed by Letby. He says the words 'bottle offered' on the note were written afterwards, and was "devious".
He says Child K's designated nurse, Joanne Williams, would only have left Child K after ensuring the baby girl was stable. He says there is no dispute about that.
He says it cannot be known, given how long ago the events were, what order Ms Williams did her nursing duties noted at 3.30am, documented as getting a morphine syringe out of the storage fridge, for noting intensive care readings and for noting observations for Child K.
He says according to the contemporaneous notes, the morphine was "commenced" at 3.30am. He says the hourly rate was 0.34, and the total administered by 4.30am was 0.35.
He says the idea that Joanne Williams was out of the unit by 3.30am was "unrealistic".
He says the door swipe data of 3.47am, of the nurse entering the unit, is accurate.
He asks if jurors "believe for a minute" that Child K would have been left "abandoned" for 20 minutes in room 1, in her 'fragile state'.
11:40am:
He says nurse Caroline Oakley returned to the unit at 3.40am, so was out of the unit. Valerie Thomas also re-entered the unit at 3.40am.
He says it was after this time that Joanne Williams left the unit, and "we know that for a very good reason".
He refers to the 3.41am transport team note with Dr Ravi Jayaram being called.
He says Dr Jayaram was at the nursing station on the phone when Joanne Williams left, and the transport team's note is accurate, as they have no reason to be inaccurate.
He says Joanne Williams was gone from the unit for "six minutes", and at that time, "somebody had to be looking after [Child K]."
He says Dr Jayaram had said that was Lucy Letby.
11:44am:
He says when Joanne Williams returned, she said she saw Dr Jayaram and Lucy Letby.
He says Dr Jayaram is "right" when he says it was not an alarm that alerted him to room 1, as if it was, other staff would have been alerted to it.
He says the only explanation for Child K's saturations to be in the 80s and for there to be no alarm is that the alarm had been muted.
You sabotage the child, you mute the alarm. It's bad luck for Lucy Letby that Dr Jayaram walks in. He says after that point, the alarm is then sounding that alerts Joanne Williams on her return to the unit.
He says Dr Jayaram had said it would take "at least 30 seconds" for Child K to desaturate 'to the 80s'. Mr Johnson counts up to 30 to demonstrate how long that is, using the court's digital clock.
11:47am:
Mr Johnson says when Dr Jayaram walked in, Lucy Letby was "doing nothing".
He says the ET Tube had "moved". He says it had been suggested to Caroline Oakley that the tube had been blocked. He says that is not what happened, it had been queried as moved.
He says Dr Jayaram had said a tube blockage would not happen immediately, but over time, and the saturations would drop gradually.
Mr Johnson says a simple thing to do would be to turn up the oxygen on the ventilator.
11:52am:
Mr Johnson says there is evidence to suggest Child K was sedated at the time of the desaturation, referring to the '3.30am commenced morphine' note, which would support the prosecution case, but "even if she wasn't", he says there is important context.
He refers to "an extraordinary performance" by Lucy Letby as she "tip-toed through the minefield" of her interviews. He says when giving evidence to counsel, she was asked questions to 'explain away' the "concessions" she had made in interviews. He says Letby, in police interview, had accepted she was in room 1.
He says Letby, "a devious murderer", had said she was "trying to be helpful".
He says the question was asked "Who are you trying to help?"
He says with "all the skill of a politician", she "tried to avoid answering".
He says "she didn't help herself" because her case is now that Dr Jayaram is a "liar who made it all up", but what she had said in police interview undermined that.
He asks why Dr Jayaram would 'make it all up'. He asks "to stitch up Lucy Letby?" That's not credible. What has he got to gain?"
11:56am:
Mr Johnson refers to Letby's April 2018 Facebook search for the surname of Child K at 11.56pm, made two years after Child K had been admitted to the Countess of Chester Hospital.
He says their "paths had crossed" for "five-and-a-half hours at most". He asks why Letby was thinking about the family, and why they were "so memorable" to her.
He says the answer "can only be" because she had tried to kill Child K.
He asks what alternative is the jury being asked to consider.
He says Letby never offered any alternative to her pattern of searches. He says Letby 'simply says': "I don't remember."
11:58am:
Mr Johnson refers to two babies Letby was convicted of murdering in June 2016. Letby had searched for the surname of those two a year later, in June 2017.
He says Letby had said: "I carry a lot of babies around in my head."
Mr Johnson: "That's a pattern."
He adds the 2018 Facebook search came 11 weeks before Letby was interviewed by police.
12:05pm: The court has adjourned for a short break.
12:14pm:
The trial is now resuming.
Mr Johnson apologises to the jury in saying this is taking some time, adding it is necessary to go over the points they need to hear. He says he will refer to police interviews and the second and third desaturations.
12:20pm:
He says, in Letby's 2018 police interview, 11 weeks after the Facebook search, Letby did not say she 'did not recall' being in room 1 at the time. She had said she might have been covering for someone who was 'on a break'. The section of video interview is played to the court.
He says that was what Dr Jayaram had said. He says Letby, at the time of the police interviews, was 'hedging her bets' - "What have they got on me?"
The 2019 police interview is referred to in the court. He says Letby could not recall "why" she had been in room 1, not that she could recall being in there.
He adds there is "all sorts of material" in the police interview that "undermines" her account.
A section of the 2019 police interview is played, which Mr Johnson says has Letby "accepting" she was there in room 1.
12:34pm:
Mr Johnson says the bits of police interview "show" that the "attack on Dr Jayaram and his integrity" are to "distract you from the issues".
He says the second and third desaturations are important in their context as Letby was there.
He says the circumstances of the second desaturation for Child K are 'not entirely clear', but the prosecution points to the "incontrovertible fact" it happened within a few minutes of Letby being at Child K's incubator, as she had obtained handwritten notes from there to input admission records on the computer. The computer times the record as being begun at 6.04am and ending at 6.10am.
He says the x-ray for Child K at that time would have taken 10-15 minutes, and a blood gas reading was taken at 6.24am. He says that was taken in response to the desaturation.
He says in between those times, the x-ray had shown the ET Tube was in the right place. He says within moments of that time, the ET Tube had been displaced. He adds Letby would have had to have placed the written records for Child K back at the incubator.
He refers to Joanne Williams, who was questioned about the desaturations. She had said Dr Jayaram had asked her who was in the room at the time the alarm went off at the time of the first desaturation.
Mr Johnson says there is a 'red herring' here. He says Joanne Williams could have confused elements of the second desaturation with the first. He says Dr Jayaram's words to her would "make perfect sense" if that was after the second desaturation. He says it would suit Dr Jayaram's words, with his "suspicious mind" at that point.
12:39pm:
Mr Johnson says, less than six hours after birth, Letby was seen to "save the day" at about 7.30am when alerting other staff to Child K's ET Tube having slipped too far down, when the baby girl was "sedated with morphine". "How on earth did that [tube slippage] happen?" asks Mr Johnson.
He adds Child K's ET Tube did not slip after that time.
He says Letby was making it look like Child K was 'a habitual tube self-mover' to "cover her tracks from earlier".
A nursing colleague's evidence was "unchallenged". Mr Johnson says that evidence was "accepted" by the defence.
He says that proves a couple of points - that Letby was back in room 1 when she should have been in room 2. He says that was when "she had no reason to be in nursery room 1", and she had not been alerted there by an alarm.
He adds that the tube had dislodged again, and that it happened when Child K was sedated, and it had happened three hours and 45 minutes after the first desaturation.
He says on this occasion, Letby had called for help and took action to assist Child K.
12:41pm:
Mr Johnson says the jury heard from Letby, and her "demeanour", and she was "clearly lying", "like she has done on so many things".
He adds Dr Jayaram was telling the truth, and if the jury agrees with that, then the verdict to be given is one of guilty.
12:42pm: That concludes the prosecution closing speech.
12:43pm:
Benjamin Myers KC, giving the defence closing statement, says he will be about an hour and a half in total for his speech (not including the lunch break).
He begins that the jury is the only body responsible for deciding they are sure of a verdict. Not the prosecution, not the judge, not himself, but the jurors.
Anyone who thinks this is a done deal is wrong, he adds.
12:48pm:
Mr Myers says he will say what is credible and what is incredible, adding Dr Jayaram's evidence is "incredible".
He refers to the prosecution's opening statement on the case ultimately coming to a single issue relying on Dr Jayaram's account, where he caught Letby 'almost red-handed'.
He asks the jury what they would do in that situation, if they believed someone was on the unit and trying to kill babies.
He says they would call the police, raise it with management. He says his account included the words: "We didn't have the training," which he labels "pathetic", adding "A child would have known what to do."
He says the "only sensible reason" for that not happening is events differed from what he said happened.
12:52pm:
Mr Myers says he and his defence team will stand up and defend Lucy Letby, when no-one else will, for it to be a fair trial.
He says Dr Jayaram 'didn't have a clue' what he saw, and the prosecution have been "inventing" in this case.
He says it is an "insult to the collective intelligence of the courtroom" that Dr Jayaram had said what he saw, and did nothing. He says it is "ridiculous and unbelievable".
12:54pm:
Mr Myers refers to a baby in the unit, not Child K, which had self-extubated. A long line had snapped.
He says "out of nowhere, on the basis of no evidence", the prosecution had accused Letby whether she had done that.
He says there was "no evidential basis" for that, and says it was "unfair" and "deeply prejudicial".
Extraordinary, he adds.
12:59pm:
Mr Myers says it is known that nurses move from nursery room to room to help each other, that it is not unusual, but was portrayed as "suspicious" when Lucy Letby did so.
He refers to the unsigned Letby initialling for a nursing note at 2.45am. He says it is obvious the rest of the note is in her handwriting. He refers to another chart where three entries are not signed, including at least one by Melanie Taylor.
Mr Myers refers to the 'bottle offered' 'doctored note [as the prosecution had said]'. He says "sometimes things are added, they change". He says Dr Jayaram had, in another note, scribbled out '0330' and replaced it with '0350', and says it would have been classed by the prosecution as suspicious if Letby had done that.
1:10pm:
Mr Myers says only Letby is expected to have the memory from that night.
He said Caroline Oakley, who designated babies in room 1, had no memory of that night at all. He says it is fine for Caroline Oakley not to have a memory of the night, but not Letby.
He refers to the morphine prescription signed at 3.30am, and the evidence is a "long way" from implying Child K was sedated at 3.45am.
He says it "suits their case to nudge it that way".
He adds that Dr Jayaram had said, in police interview, that Child K was sedated.
Mr Myers refers to the drugs log book, when the morphine syringe is noted as being taken out of the storage fridge at 3.30am. He says that needs time to warm up, "for obvious reasons".
He says the infusion chart of hourly readings at the half hour mark are "not precise". He says the prosecution will not accept even when their witness says otherwise. He says the prosecution has then relied on calculations, and the witness was invited to calculate it "on the hoof", referring to the '0.35 total' reading for 4.30am.
He says it is "not a safe process" to treat those as fixed times, as the rate is not increasing by the same rate each time. "Some of them are bigger, some are smaller", and it cannot be known what times the readings were taken.
He adds the note is made '0350 100mg/kg morphine' elsewhere on the sheet, and refers to a prescription of the morphine 'time started 0350', which he said Dr Jayaram had accepted.
The administration history for the drug records 'administered 0350'.
Nurse Joanne Williams' note is shown to the court. The note of the desaturation is made, followed by 'commenced morphine'. Mr Myers says this is chronologically what happened, and is consistent with what Dr James Smith had said, that morphine would not have been administered before intubation, with which Dr Jayaram had agreed.
1:12pm:
Mr Myers says Joanne Williams had earlier given an account to say her recollection was she had gone to see the family to update them on Child K, for 'about 20 minutes'.
He says Joanne Williams leaves the neonatal unit at about 3.30am.
2:05pm: The defence closing speech is due to resume at about 2.15pm following the lunch break.
2:20pm: The trial judge and the jury have returned to the courtroom, and Mr Myers continues his closing speech.
2:22pm:
Mr Myers says an "obvious feature" of the case is Letby's previous convictions. He says the jury cannot ignore them.
He says it is "equally obvious" that those stem from different cases and do not make her guilty of this one.
He says those convictions should "not be used as a shortcut to guilt".
He says the evidence should be looked at separately to them, and labels the evidence as "weak".
2:29pm:
Mr Myers says the jury understands what Letby says in her defence, that she said she did not intend to harm Child K, and that she does not believe Dr Jayaram is a credible witness.
He says the prosecution has been in "forensic word games", adding there is "no mystery" in Letby saying she did not remember.
He says the total defence statement was over 200 paragraphs representing 22 cases, and Letby had given details on cases where she remembered them.
He asks the jury to look at the police interviews "in a fair and balanced way".
He says the 2018 police interviews ran for nine hours and 26 minutes, on a range of cases, with the 2019 police interviews lasting nine hours and 12 minutes, plus the 2020 interviews lasting 32 minutes. He says that totals about 20 hours.
He says of that, the interviews concerning Child K totalled about half an hour's worth of interviews. He says there was a "massive amount of material", and that police had asked questions on the basis that Dr Jayaram's account was "an established fact".
He says Letby answered the questions on the basis that she was already there, "not necessarily" that that was what happened.
2:33pm:
Mr Myers says Letby, in her Facebook searches, searched for many parents of babies, including many not on the original case, and that is not disputed.
He says the 2018 Facebook search for Child K's surname is 'random'. He says it "doesn't fit any pattern at all".
He says the possible explanation comes from the prosecution, when they asked if Letby knew the police were investigating at that time, as Joanne Williams had been interviewed in March 2018. Letby said she could not remember.
Mr Myers says it does 'not fit any pattern of guilt.'
2:35pm:
Mr Myers says Letby does not have to prove anything at all in this case.
He says one issue is to look at the "clinically fragile position" of Child K and the difficulties of intubation.
He says Child K was a "very unwell baby...right from the start", and it was a "fact" she was not in an optimal place for care, regardless of what happened.
2:45pm:
Mr Myers refers to "an expert in the care of babies like [Child K]", Dr Srinvasaro Babarao, and says Dr James Smith could not accept that Child K was unwell. Mr Myers says "there is nothing stable about a baby like [Child K]."
He adds Child K was "incredibly fragile and unwell", and extremely pre-term. He refers the jury to the video demonstrations which use a mannequin the size of a toddler, and not one that weighed as much as a bag of sugar, with low blood pressure "difficult to manage", according to Dr Babarao.
He said Child K "struggled to saturate", and there were "blood clotting problems".
He says the picture of Child K being settled at the Countess of Chester Hospital was "a million miles away" from the reality.
He adds nurse Joanne Williams had "not very much" experience of managing 25-week gestation babies. He adds it is not a criticism of her, but "how is she to know what is stable or not?"
He asks the jury which doctors gave straight answers in evidence, and which had "an agenda".
He adds evidence was heard that a baby can desaturate from high 90s to 80s "in seconds".
He adds the conclusion of Arrowe Park's review panel was the care for Child K was 'sub-optimal', which was "a fact".
He says the prosecution had said that conclusion was reached without the panel knowing about the three desaturations at Chester. He says that means from what the panel knew, that makes it "even worse".
2:48pm:
He adds that Preston [the alternative level 3 centre Child K's mother could have been transferred] was "not in Aberdeen...it's up the road".
He adds that lung surfactant was given "too late" for Child K - "minutes delay is bad". He says there was a delay in administering IV fluids for Child K.
2:57pm:
Mr Myers refers to the second and third desaturations first. He says the prosecution need the allegation of Letby's interference on both their occasions to support their narrative that Child K's desaturations were because of that and Letby was covering her tracks.
He says that was "utterly daft", as if Letby had been caught "red-handed" first time around, she would not be returning to the incubator, and Dr Jayaram would not have allowed her to be there.
He adds for the second desaturation, there is no note recorded of the ET Tube having "moved", only that Dr Smith pulled the tube back from 6.5cm to 6cm after Child K desaturated. He says there is "not a jot of evidence" that Letby moved it, other than she was "nearby".
He says for the third desaturation, it was "unrealistic" there would be an attempt at this time, as this was during the handover when there would be double the staff members on the unit. He says the only evidence was the call for help, as the tube had slipped, and "on that basis", Letby was "at fault".
Mr Myers refers to a note made for 9.15am: 'Baby is ventilated - not very secure - ties tightened with effect.' He says this is after Letby has left the unit and has nothing to do with it, and Child K was sedated.
3:04pm:
Mr Myers refers to the system of checking in the event of a desaturation, which was labelled 'DOPE', which included 'Obstruction'. He says that possibility was "not properly considered at the time".
He says it is "extraordinary" that Dr Smith did not see 'large blood-stained oral secretions', as was noted by a nurse.
He says it was "doubtful" the tube was checked, adding Dr Jayaram had said in a 2021 police interview he had not checked, but in evidence had said he had 'had a glance'.
He adds the 'Equipment' included a '94 leak' reading, saying when the ET Tube was changed to a larger 2.5mm tube from a 2mm one that had been used at the time of that reading, the reading changed to '5 leak'.
He says the prosecution and witnesses had pointed to higher oxygen saturations that Child K had at the time. Mr Myers says Dr Babarao had agreed it was a theoretical possibility that Child K was doing the breathing for herself at that time.
3:08pm:
Mr Myers refers to the 'D' for 'Dislodgement'. He says in agreed evidence, an ET Tube could become dislodged in an active or, less likely, in a sedated baby.
He adds it is "hard listening" for the jury to listen to this, but it is important. He adds he has about half an hour more left of his speech.
3:11pm:
Mr Myers says Child K was "prone to desaturation", saying the first one could have been down to a tube blockage or a problem with the leak that was noted.
He says "the reason why we're here" is what Dr Jayaram is what had said to police about a year after the event.
3:21pm:
Mr Myers says Dr Jayaram has given a "lurid description", a "powerful description", of what happened that night. A section of his ITV News interview is played to the court.
Mr Myers emphasises Dr Jayaram's account: "This is a night that is etched on my memory and will be in my nightmares forever.
The only possibility is that the tube had been dislodged deliberately.
Mr Myers says Dr Jayaram "wriggled" in his evidence.
He says in the consultant's position, 'you would call the police' and get her out of the unit if the prosecution say he caught her 'red-handed'. He says "you would say something to somebody, act on it."
"The whole point is if he said what he saw, he would go to management and say 'I have caught her red-handed, get her out,' and not have her work for another four months on the unit.
He says Dr Jayaram not contacting police as he said police would not listen to him is utter rubbish", asking if police would respond: "You are wasting your time, mate" in response to Dr Jayaram, a lead consultant at the Countess of Chester Hospital, calling them to say he had caught a nurse trying to kill a baby."
He asks the jury to reflect on the comment that the defence make, and ask whether it is reasonable based on the evidence.
3:26pm:
Mr Myers says Joanne Williams, in her 2018 statement, said when she returned to the unit at 3.47am, the alarms were sounding, and that did not match with Dr Jayaram's account, and Dr Jayaram had said in police interview he could not remember if there was an alarm.
Mr Myers says there is nothing to say in Joanne Williams' account about whether she was referring to a later desaturation, adding it is clear the nurse was referring to the first desaturation when Dr Jayaram was asking her who was in the room at the time.
Mr Myers says Ms Williams was not questioned about this. He says if Dr Jayaram was correct in his account, he would not be asking her about who was there.
He says Joanne Williams is a "clear and neutral" witness, and the prosecution have literally 'conjured up' an explanation.
3:31pm:
Mr Myers refers to the transport team's 5.55am note 'Call received from Dr Jayaram baby dislodged the tube and had to be reintubated'.
Mr Myers said the prosecution had earlier said the transport team's notes were 'very precise'.
Mr Myers says it gives "a record and an explanation", and Dr Jayaram "told them this".
He says this was why there were no calls to the police.
3:33pm:
Mr Myers says if Letby was not convicted of the cases, "would we be here now?". He adds they would not be.
He says whatever Letby has been convicted of, the jury must be sure of Dr Jayaram's evidence, which he says is "unbelievable".
He adds the jury have "very good reason" "not to be sure", and asks the jurors to give a verdict of 'not guilty'.
3:34pm: The judge says there will be a short, 10-minute break, before he will begin his summing up.
3:46pm: The trial is now resuming.
3:49pm:
The judge is now beginning his summing up of the case, setting out the background, including on Letby's previous convictions which are "part of the context".
He says it is the jury's view of what is significant in the evidence.
3:59pm:
Judge Goss gives the background to level 2 units, such as the Countess of Chester Hospital at the time, and level 3 units such as Arrowe Park, and the respective levels of care and experience available to premature babies.
He explains the layout of the neonatal unit at the Countess as it operated at the time in February 2016, with room 1 being the intensive care nursery room, room 2 being the high dependency room, and 3 and 4 being special care, ordered in decreasing levels of intensive care required [rooms 3 and 4 being where babies were cared for before going home].
He adds the staff rota, which had a half-hour handover system, one of them at 7.30am-8am. The handover would see nurses assigned designated babies for their skillset.
He adds there was "fluidity" between nurses in nursery rooms during their respective shifts.
4:06pm:
Judge Goss says it had been heard that, if Child K could not be delivered at a level 3 unit, "the next best thing" was for the delivery to be at a level 2 unit. He says Preston, the only level 3 unit available for transfer at the time, was 'not one of the closer ones', and the decision was made that Child K's mother was "too unstable" to be transferred and there was a risk the delivery could have happened in an ambulance.
The evidence had heard it was 'not uncommon at all' for a planned transfer to be cancelled. The court heard it 'may have been better' if Child K could have been born in a tertiary unit, but the decision not to transfer, in the circumstances, was, the court heard, the right one.
4:09pm:
The judge says that concludes the background to the case.
He says he will conclude the summing up at 10.30am on Tuesday, with the jury then to go out and deliberate.
He repeats it is ever more important for them not to discuss the case until they deliberate, or conduct independent research.
Chester Standard Live Reporting
10:29am:
The courtroom is filling up at Manchester Crown Court with lawyers, members of the public and press, and defendant Lucy Letby is in the dock.
The trial is expected to resume shortly.
10:35am:
The judge and jury have now entered the courtroom.
Mr Justice James Goss will resume his summing up.
10:42am:
The judge recaps the events leading up to Child K's birth, where Child K was born at 2.12am and weighed 692g.
The baby girl's condition was "not unexpected" for someone of her gestation, with 'good' oxygen saturation levels, and she was considered to be stable.
The ET Tube was inserted at the third attempt, using a 2mm tube, having unsuccessfully tried with a 2.5mm tube.
The general clinical picture was positive, Dr James Smith had said. The judge said Benjamin Myers, for Letby's defence, had been critical of the care for Child K given up to this point.
10:48am:
The judge adds Child K did not have any infection present [as shown from a blood test].
The court had previously heard evidence from Dr John Gibbs that babies have many episodes of apnoea, where they temporarily stop breathing. He had added that apnoea episodes on ventilated babies are of more concern.
10:52am:
The judge tells the jury of nurse Joanne Williams' evidence, and the checks she would have done to ensure Child K was stable before she left the unit.
She had noted the '94 leak' reading on the ventilator, and said she would escalate that to a doctor. She had noted the oxygen saturation levels were good.
Dr Srinvasaro Babarao had said the leak reading was high, but a 2mm tube would not have caused that, and the cause would be something else. It should be investigated, although the reading was a snapshot reading.
10:56am:
The judge says the Dr Ravi Jayaram had said Joanne Williams had left Lucy Letby to 'babysit' Child K in room 1 of the unit.
He said Dr Jayaram, about 2.5-3 minutes later, went into the room, and saw Child K's oxygen saturation levels were dropping, and Lucy Letby was standing by the incubator. Her hands were not in the incubator. He said to her 'what's happening?'
The judge says Dr Jayaram recalled Letby responding: "Oh, it looks like she's desaturating" - or words to that effect.
Dr Jayaram said the saturation levels were continuing to go down.
He said, in evidence, what he could say was it was not an alarm sounding that caused him to go into the room.
11:02am:
Dr Jayaram said Child K's ventilation problem had lasted at least 30 seconds, likely 30-60 seconds, and not longer than two minutes.
He says Mr Myers referred to an inconsistency in Dr Jayaram's evidence on whether Child K's ET tube had been checked.
The judge says evidence heard in court was that, given the way the ET tube was secured, it would take "quite a lot of movement" from a baby for the tube to be dislodged.
Child K's saturation levels dropped to the 40s, which the judge says was a "life-threatening level".
The judge says Dr Jayaram was feeling 'uncomfortable' and "didn't want to think the unthinkable". He was cross-examined at length about this, with the defence critical of his lack of action. Dr Jayaram had said he wanted to follow procedure, and "in retrospect", he would have taken action sooner. He added he didn't want to engage in conversation with the defendant about it.
11:07am:
The judge says Child K was x-rayed and the ET Tube was in a satisfactory position.
Child K desaturated at about 6.15am, with her saturation levels dropping quite quickly. The baby girl was reintubated and she picked up quickly. He says Dr Jayaram had said at the time he believed there was a clinical explanation for the desaturation, and there is no evidence of the tube having been moved.
The third desaturation had seen the ET Tube move in from 6.5cm to 8cm in Child K - further than it should have gone in. A nurse on the day shift had heard Lucy Letby call for help. When the nurse went into the room, Letby was seen with her hands in the incubator, using a Neopuff breathing device for Child K.
11:11am:
The judge says the prosecution refers to the second and third desaturations as 'part of the whole picture' with Letby interfering with the ET tube, but are not charges.
He adds that Child K was taken to Arrowe Park Hospital on February 17, where sadly she died a few days later.
Dr Srinvasaro Babarao, a doctor at Arrowe Park, had said Child K's death could have been prevented if she had been born at a level 3 centre [such as Arrowe Park]. He added he had not seen medical notes from the Countess of Chester Hospital from that night, and knew more than he did back then. He also did not know that the only level 3 centre available for transfer at the time was Preston.
11:20am:
The judge refers to Letby's Facebook search for the surname of Child K in 2018, and which the defendant has no recollection or explanation for doing so.
He adds Letby said she has no recollection of being asked to look after Child K by Joanne Williams, and denied doing anything to harm Child K. She had said it was common for nurses to assist other nurses in looking after babies.
He says Letby was cross-examined about the police interviews, on the comment 'I believe her ET tube had slipped'. She had said that was based on the documentation by day nurse Melanie Taylor, for the final desaturation.
Letby had said if she had noted the ET tube had slipped, she would have summoned help. She said she didn't recall any event, did not know why the alarm would be silenced. She had said she was 'trying to be helpful' and 'trying to fill in the gaps'.
She "remained steadfast" that she had no recollection, the judge adds.
Letby had suggested in interview the ET tube 'may not have been secured correctly'.
Elizabeth Morgan, a nursing advisory consultant, had said in agreed evidence, that it was possible for an ET tube to become unsecured in an active baby. It was less likely in a sedated baby.
She added she would expect, for a baby of Child K's gestational age, it would be standard good practice to actively observe the baby and take corrective action, calling for help if necessary, if there was a drop in oxygen levels. She had said it would not be normal practice to wait for the baby to self-correct.
Cross-examined about this, Letby had said that was Elizabeth Morgan's opinion, and said from her experience at Liverpool Women's Hospital, you would not automatically put your hands in the incubator, and babies even of 25-week gestation can self-correct.
11:23am:
The judge says he will not repeat the respective arguments from the prosecution and defence.
He says jurors should respect each others' opinions and allow each of them to speak, and they "are under no pressure of time".
He urges jurors not to make their own enquiries with anyone about the case, and only to deliberate together, as a group, and not conduct independent research.
He adds there will be two smoke breaks per day, and a jury bailiff will escort them to a designated smoking area, with the other jury bailiff overseeing the remaining jurors. He says no deliberation can take place in the absence of other jurors.
11:29am:
The judge reminds jurors to take with them their bundles and their iPads, the latter containing all the relevant documents and videos they have been supplied.
Upon a question by Mr Myers, the judge says he has not referred to questioning by Nicholas Johnson KC to Lucy Letby on a baby [not Child K] whose long line had snapped. The judge says Letby had disagreed with the questioning and the jury should not rely upon that questioning as evidence.
The court ushers have now been sworn as jury bailiffs, and the jury will now go to consider a verdict.
3:05pm:
The court has been called back in, with Lucy Letby present, lawyers, press and members of the public.
The jury has a verdict.
3:06pm: Members of the jury are coming into court now.
3:07pm:
The verdict: Guilty.
The verdict is unanimous.
3:08pm:
The judge says the sentencing will not take place today.
The sentencing is planned to take place on Friday.
3:09pm:
The judge tells Letby the sentencing will take place on Friday, adding: "You will be here for that."
The judge thanks members of the jury, who had been deliberating for a little under three and a half hours before giving a verdict.
3:11pm: The judge adds it is not an experience the jury will likely forget, and informs them the sentencing will take place at 10.30am on Friday.
3:12pm: Giving reaction to the verdict, senior crown prosecutor Nicola Wyn Williams, of CPS Mersey-Cheshire's Complex Casework Unit, said: "Lucy Letby has continually denied that she tried to kill this baby or any of the babies that she has been convicted of murdering or attempting to murder. The jury has heard all of the detailed evidence including from her in her own defence and formed its own view.
"Our case included direct evidence from a doctor who walked into the nursery to find a very premature baby desaturating with Letby standing by, taking no action to help or to raise the alarm. She had deliberately dislodged the breathing tube in an attempt to kill her.
"Staff at the unit had to think the unthinkable - that one of their own was deliberately harming and killing babies in their care.
"Letby dislodged the tube a further two times over the following few hours in an attempt to cover her tracks and suggest that the first dislodgment was accidental. These were the actions of a cold-blooded, calculated killer.
"The grief that the family of Baby K have felt is unimaginable. Our thoughts remain with them and all those affected by this case at this time."
3:18pm:
It can now be revealed child serial killer Lucy Letby was compelled to hear part of the sentencing remarks she refused to listen to last year as they were read out ahead of her latest trial.
Former neo-natal nurse Letby, 34, refused to attend her sentencing at Manchester Crown Court after she was convicted in August of murdering seven babies and attempting to murder six others - with two attempts on one victim - at the Countess of Chester Hospital between June 2015 and June 2016.
The mother of two of her victims said her absence was "one final act of wickedness" while Prime Minister Rishi Sunak branded Letby "cowardly" as he said the Government was looking at changing the law to force criminals to attend sentencing hearings.
Letby received 14 whole life terms of imprisonment - one for each offence she committed.
In June, Letby returned to the same courtroom to face a retrial on an allegation that the previous jury could not reach a verdict on - that she attempted to murder a baby girl during a night shift at the hospital's neo-natal unit in February 2016.
Her legal team tried, unsuccessfully, to throw out the case before it started as they argued she could not have a fair trial due in part to a "tsunami of prejudicial comment" in the aftermath of her convictions.
But prosecutor Nick Johnson KC countered that what followed in media coverage was "nothing more than a fair reflection of the facts of this case", which included the sentencing remarks of Mr Justice Goss.
Referring to Letby, who he said "of course was not there", he reminded the high court judge of what he said on sentencing.
Letby looked largely to the floor in the courtroom dock as Mr Johnson took seven minutes to read a section of the remarks while a packed public gallery watched on in silence.
He said: "My lord, you said ‘you acted in a way that was completely contrary to the normal human instincts of nurturing and caring for babies and in gross breach of the trust that all citizens place in those who work in the medical and caring professions … the lives of newborn or relatively newborn babies were ended almost as soon as they began and lifelong harm has been caused, all in horrific circumstances.
"‘Loving parents have been robbed of their cherished children and others have to live with the physical and mental consequences of your actions. Siblings have been deprived of brothers and sisters.
"‘You have caused deep psychological trauma, brought enduring grief and feelings of guilt, caused strains in relationships and disruption to the lives of all the families of all your victims'."
3:19pm:
It can also be revealed, as the Press Association have reported, a bid to throw out the attempted murder charge against Lucy Letby was refused by the judge ahead of her retrial.
Ben Myers KC, defending, argued there had been "overwhelming and irremediable prejudice" to Letby because of the extent and detail of coverage and comment across all forms of media in the aftermath of the verdicts from her first trial, including from witnesses set to give evidence at the retrial.
In legal argument ahead of the retrial, Mr Myers said there was also "highly prejudicial and emotive public comment" last August from senior police officers who investigated Letby, plus the Crown Prosecution Service, and that public statements from detectives about a probe into potential further crimes by the defendant were also prejudicial.
Mr Myers told Mr Justice Goss that the comments all came at a point when a retrial was still under consideration.
He said: "This is not a question about inaccurate reporting.
"The problem in this case is that because of the fact of the previous trial and we have those convictions, they provide a glue by which irrelevant, inadmissible and deeply prejudicial comment and reporting will attach to this trial.
"There has been an outpouring - deeply hostile and deeply prejudicial at every level, at a political level.
"For a juror to attempt to expunge from his or her thoughts about what they have heard about this case, or what they thought they have heard, is an impossible task."
Prosecutor Nick Johnson KC responded: "We submit nothing that has been said about Lucy Letby by anyone comes close to eclipsing the truly dreadful catalogue of murders and attempted murders of which Lucy Letby is responsible.
"Everything which was reported in the aftermath of those verdicts was fair and accurate. If it was shocking, that was a natural consequence of the unprecedented dreadful offending of this defendant.
"The convictions themselves and the notoriety of the defendant are not susceptible to the fade factor but the convictions are admissible in these proceedings. The material, the reporting that is complained about is susceptible to the fade factor because it is utterly eclipsed by the dreadful offending.
"There used to be a saying in this part of the world - today's front page, tomorrow's fish and chip paper.
"It is the crimes themselves that will live long in the memory. It is not the relatively obscure detail of various commentators in various mediums that can possibly eclipse the crimes.
"Her crimes will always eclipse any comment made about them or about her by lawyers, police officers or journalists."
Explaining his decision to refuse the application to stay the proceedings as an abuse of process, Mr Justice Goss said: "I am satisfied that any prejudice to the defendant from the publicity in the media is not such as to preclude the defendant from having a fair trial.
"The evidence of her convictions will be in evidence before the jury. It will be subject to the necessary directions to the jury as to the use to which they may and may not put this evidence; they will also receive a direction as to the importance of reaching their verdict on, and only on, the evidence placed before them and nothing else.
"Experience has shown that juries can be relied upon faithfully to follow such directions. The media coverage will, in any event, have been diluted by the ‘fade factor' since the verdicts in the original trial were reported.
"The fairness of the trial is not compromised, nor could the court's sense of justice and propriety be offended or public confidence in the criminal justice system be undermined by the trial proceeding."
3:36pm:
Dr Nigel Scawn, Medical Director at the Countess of Chester Hospital NHS Foundation Trust, said: "Our thoughts are with the family and loved ones of Baby K.
"We are extremely sorry that these awful crimes happened at our hospital.
Since Lucy Letby worked at our hospital, we have made significant changes to our services and remain committed to providing high quality safe care to our local communities."
"We want to acknowledge the impact this continues to have on everyone involved in this case and restate our commitment to do everything we can to help families get the answers they deserve.
"We remain grateful for the unwavering cooperation and professionalism of our staff, some of whom returned to court to repeat evidence and relive events.
We will continue to ensure our staff receive the care and support they need and we remain committed to fully and openly supporting the ongoing legal processes."
3:39pm: We'll have further reaction soon - a statement is due to be read out from Cheshire Police, which has had Operation Hummingbird resources dedicated to the Letby case.
4:15pm: Speaking after the verdict today, Detective Chief Inspector Nicola Evans, who is the Deputy Senior Investigating Officer, said: "This has been a long and painful journey for the parents of Baby K - having to face continual denials and sitting through very personal and upsetting evidence in the original trial and again at the re-trial.
"Their courage, strength and resilience is absolutely remarkable.
"I would like to thank them for continuing to put their faith in us and I hope that the conclusion today provides them with some peace of mind and some of the answers they have been searching for.
"Once again, there are no winners in this case. Today is not a time for celebration - it is a time for reflection and a time for the family of Baby K.
"My thoughts - and those of the whole prosecution team - remain with them at this incredibly difficult time."
4:16pm: DCI Evans added: "A trained nurse responsible for caring and protecting a tiny, premature baby abused that position of trust in the most unthinkable way.
"The continued denials have caused significant upset for Baby K's family as they have had to endure a trial and subsequent re-trial. No-one should ever have to go through what they experienced."
Detective Superintendent Simon Blackwell, who is strategic lead for the investigation, said: "This has been a highly complex and extremely sensitive investigation over the past seven years and I want to say thank you to the whole investigation team in recognition of all of their dedication and hard work.
"I want to acknowledge each and every person who has been involved - from our dedicated officers and staff who built a detailed case that resulted in a charge, to the witnesses who were integral in giving their evidence at court, to the prosecution team who devoted their time to this case and finally to the jury who have had to sit through complex and, at times, very distressing and upsetting evidence before delivering their verdict.
"Our case has also been strongly supported by a number of key partners to which we are also very grateful including the Crown Prosecution Service, Prosecution Counsel, The National Crime Agency and colleagues from other forces.
"Everyone has had a part to play and we owe a debt of gratitude to you all."
4:53pm: Further to the news that Cheshire Police's Operation Hummingbird remains ongoing, here is a statement from Detective Superintendent Paul Hughes, who is the senior investigating officer.
He said: "The Operation Hummingbird team remains committed to a complete and thorough investigation into the full period of time that Lucy Letby was employed as a nurse, either while at the Countess of Chester Hospital or on placement at the Liverpool Women's Hospital.
"The investigation covers the period from 2012 to 2016 and includes a review of 4,000 admissions of babies into the neo-natal units of both the Countess of Chester Hospital and the Liverpool Women's Hospital for us to work through.
"This does not mean that we are investigating all 4,000, it just means that we are committed to a thorough review of every admission from a medical perspective. Only those cases highlighting any medical concern will be subject of further detailed review.
"Whilst our investigation remains ongoing, we are unable to confirm any further specific information relating to individual babies or families.
Out of respect of everyone involved we will not be commenting further at this stage. Further updates will follow at the appropriate time. The families of all the relevant babies, who are part of this investigation, have been informed and continue to be supported."
The ongoing operation had previously confirmed it had launched an investigation into corporate manslaughter at the hospital.
Detective Superintendent Simon Blackwell, who is strategic lead for Operation Hummingbird, said: "In October 2023, following the lengthy trial and subsequent conviction of Lucy Letby, Cheshire Constabulary launched an investigation into corporate manslaughter at the Countess of Chester Hospital.
"The investigation, which is ongoing, focuses on the indictment period of the charges for Lucy Letby, from June 2015 to June 2016, and is considering areas including senior leadership and decision making to determine whether any criminality has taken place.
The investigation is complex and sensitive and specific updates regarding progress will be issued at the appropriate time. At this stage we are not investigating any individuals in relation to gross negligence manslaughter."
"We recognise that this investigation has a significant impact on a number of different stakeholders including the families in this case and we want to reassure that we are committed to carrying out a thorough investigation.
"Since Letby's original convictions in August 2023 it has been a very busy period for the investigation team. This has included a subsequent appeal, the re-trial for one count of attempted murder and the launch of the statutory public inquiry that Cheshire Constabulary is assisting with."
4:17pm:
Cheshire Police's Operation Hummingbird remains ongoing.
A spokesperson for Cheshire Constabulary said: If you have any information that you would like to pass onto the investigation team please get in touch via the Operation Hummingbird mailbox at Operation.Hummingbird.Public.Contact@cheshire.police.uk"
Information can also be passed on by calling 101 and asking for Cheshire Constabulary or anonymously, via Crimestoppers, on 0800 555 111.
4:50pm:
The parents of Child K gasped and then cried as the foreman read out the verdict after the jury deliberated for three-and-a-half hours.
Lucy Letby showed no emotion in the dock.
Sentencing will take place on Friday at 10.30am.
5:37pm:Detective Inspector Andrea Price of Cheshire Constabulary, representing the family liaison team, was outside court earlier, where she read out a statement on behalf of Child K's family in the case.
The statement reads as follows:
"Words cannot effectively explain how we are feeling at this moment in time.
To lose a baby is a heart-breaking experience that no parent should ever have to go through. But to lose a baby and then learn of the harm that was inflicted under these circumstances is unimaginable."
"Over the past seven to eight years we have had to go through a long, torturous and emotional journey, twice.
From losing our precious new-born and grieving her loss, to being told years later that her death or collapse might be suspicious. Nothing can prepare you for that news."
"Today, justice has been served and a nurse who should have been caring for our daughter has been found guilty of harming her. But this justice will not take away the extreme hurt, anger and distress that we have all had to experience.
It also does not provide us with an explanation as to why these crimes have taken place."
"We are heartbroken, devastated, angry and feel numb. We may never truly know why this happened.
Words cannot express our gratitude to the jury. We recognise that this has not been an easy task for them and we will forever be grateful for their patience and resilience throughout this incredibly difficult process."
"The police investigation began in 2017 and we have been supported from the very beginning by a team of experienced and dedicated Family Liaison Officers. We want to thank these officers for everything they have done for us not only once but twice.
Medical experts, consultants, doctors and nursing staff have all given evidence at court, which at times has been extremely hard for us to listen to."
"However, we recognise the determination and commitment that each witness has shown in ensuring that the truth was told. We acknowledge that the evidence given by each of them has been key in securing today's verdict.
Finally we would like to acknowledge and thank the investigation team and, more recently, the prosecution team who have led the trial to a successful conclusion. The search for the truth has remained at the forefront of everyone's minds and we will forever be grateful for this."
"We would now ask for time in peace to process what has happened as we come to terms with today's verdict."