A nurse sat crying in the witness box today after telling the trial of neonatal nurse Lucy Letby how she felt the final heartbeat of a baby she was trying to resuscitate.
The shift leader at the Countess of Chester Hospital, who cannot be named for legal reasons, was carrying out CPR on Baby A after he suddenly deteriorated in the neonatal unit.
In order to give the infant CPR, she was reaching in through a flap at the back of his incubator. Her hands were around the tiny infant’s chest, her thumbs near his sternum.
All the time she was holding him, nurses and doctors were crowded around the incubator in the final attempts to revive him.
Nurse A recalled Baby A, who weighed 3lb 12oz at birth, being given tiny amounts of adrenalin one by one. After each dose, they listened for a response.
‘There was nothing…just one more heartbeat’, she told the court.
The nurse was giving evidence from behind a screen at Letby’s murder trial.
Letby, 32, denies murdering seven babies and attempting to murder 10 more at the Countess of Chester Hospital in Cheshire between 2015 and 2016.
A colleague of neonatal nurse Lucy Letby (pictured) could not recall the alleged killer going to comfort a baby’s family as he collapsed, a jury heard today
John and Susan Letby, parents of Lucy Letby, arriving at Manchester Crown Court today for their daughter’s murder trial
At times, the nurses voice dropped to a whisper. Finally, as her evidence concluded for the day, she could be heard crying.
At the start of her evidence the nurse was asked how Baby A had looked as he went into a rapid collapse.
‘I’ve never seen a baby look that way before,’ she told Simon Driver, prosecuting. ‘He looked very ill. He had a discolouration pattern I’ve never seen before.
‘He was white with sort of purply blotches. He looked cyanotic. It was these purple blotches with white that I’d not seen before, all over his body’.
Asked where in particular on his body, she replied: ‘Everywhere. Maybe more torso…no, I can’t remember clearly. I just knew it was very unusual. It had come on very suddenly. It was just so unusual’.
She had remained in Nursery 1 following the baby’s death. ‘It was sudden and very unexpected,’ she said.
The nurse recalled a decision being taken to leave the lines being used to treat him ‘because we didn’t know if the coroner would need them’.
Dr Owen Arthurs (pictured arriving at Manchester Crown Court), professor of radiology at Great Ormond Street Hospital, gave evidence at Lucy Letby’s murder trial today
Earlier in the day, the court heard that an X-ray taken the day after Baby A died while in the care of neonatal nurse Lucy Letby revealed an ‘unusual’ line of gas not normally seen in infants.
On day 10 of her murder trial, Dr Owen Arthurs, professor of radiology at Great Ormond Street Hospital, guided the jury through an image displayed on a screen at Manchester Crown Court.
He showed them pockets of gas in the infant’s stomach and heart. Both were normal.
But the doctor then pointed out a third accumulation of gas – in a line just in front of the spine, running from the stomach to just beyond the heart.
‘That is an unusual find,’ said Dr Arthurs.
His conclusion after carrying out a review of cases of infant mortality was that the line of gas was consistent with ‘air being administered’ to Baby A.
Dr Arthurs said that after initially noticing the gas near the spine he carried out a large-scale review of past cases at Great Ormond Street, organising them into a list of possible circumstances for that type of image to appear in deaths attributed to natural causes.
A court sketch of Lucy Letby at Manchester Crown Court on Thursday, October 20, where she stands charged with the murder of seven babies and the attempted murder of another ten
Letby, 32, of Hereford, is on trial for the murders of seven babies at the Countess of Chester Hospital, Cheshire, and the attempted murder of 10 more between 2015 and 2016. She denies all charges
Such accumulations of trapped air could be found in cases such as serious road traffic accidents, overwhelming infections of sepsis, or ‘very occasionally’ in cases of ‘sudden unexpected death in infancy (SUDI).
Before studying the X-ray of Baby A’s body he had never previously seen such an accumulation in an infant.
Nick Johnson, KC, prosecuting, asked: ‘Have you ever seen this in a baby before?’
The radiologist replied: ‘Only in one other case, which I think we’ll discuss later on’.
Mr Johnson: ‘One of the other children in this case?’
Dr Arthurs: ‘That’s right’.
He added: ‘My opinion was that this was an unusual experience, not typical of what you would normally see. In the absence of any other explanation, it is consistent with, but not diagnostic of, air being administered’.
The court heard that Dr Arthurs had also studied X-ray images of Baby A’s surviving twin sister, Baby B, taken on June 8, the day he had died, and on June 10.
None of these had shown an accumulation of air similar to the one he had seen in her brother’s X-rays.
Full indictment against Lucy Letby
Lucy Letby is charged as follows:
Count 1 – Charged with murder of Baby A on June 8, 2015
Count 2 – Charged with attempted murder of Baby B between the June 8, 2015 and June 11, 2015
Count 3 – Charged with murder of Baby C on June 14, 2015
Count 4 – Charged with murder of Baby D on June 22, 2015
Count 5 – Charged with murder of Baby E on August 4, 2015
Count 6 – Charged with attempted murder of Baby F on August 5, 2015
Count 7 – Charged with attempted murder of Baby G on September 7, 2015
Count 8 – Charged with attempted murder of Baby G on September 21, 2015
Count 9 – Charged with attempted murder of Baby G on September 21, 2015
Count 10 – Charged with attempted murder of Baby H on September 26, 2015
Count 11 – Charged with attempted murder of Baby H on September 27, 2015
Count 12 – Charged with murder of Baby I on October 23, 2015
Count 13 – Charged with attempted murder of Baby J on November 27, 2015
Count 14 – Charged with attempted murder of Baby K on February 17, 2015
Count 15 – Charged with attempted murder of Baby L on April 9, 2016
Count 16 – Charged with attempted murder of Baby M on April 9, 2016
Count 17 – Charged with attempted murder of Baby N on June 3, 2016
Count 18 – Charged with attempted murder of Baby N on June 15, 2016
Count 19 – Charged with attempted murder of Baby N on June 15, 2016
Count 20 – Charged with murder of Baby O on June 23, 2016
Count 21 – Charged with murder of Baby P on June 24, 2016
Count 22 – Charged with attempted murder of Baby Q on June 25, 2016
They neither pointed towards a possible diagnosis of air embolism in Baby B, nor against it.
But he added: ‘The absence of air doesn’t mean that didn’t happen’.
Cross-examined by Ben Myers, KC, defending, Dr Arthurs said his case review had been the largest available at the time.
When the barrister asked whether any of the cases had involved neonatal babies in the first three or four days of life, he replied: ‘The vast majority of those don’t die’.
Dr Arthurs agreed he had looked initially at 500 cases at Great Ormond Street. After narrowing down the criteria, the review amounted to the cases of 38 babies aged under two months. Of those, eight had gases in the greater vessels of their bodies.
The causes of death had included trauma, a road traffic accident, congenital heart disease and sudden expected death in infants.
He agreed with Mr Myers that ‘one possibility’ that would explain the line of gas shown in the image would have been air administration. Other possible causes could have been attempts made at resuscitation or post-mortem changes.
The barrister then asked about an X-ray taken of Baby B on June 10, about 40 minutes after her non-fatal collapse.
‘On that image there are no features which support an air embolus diagnosis?’
Dr Arthurs agreed.
Later, another nurse recalled the moment Lucy Letby called her over to help with the collapse of Baby A.
Senior nurse Caroline Bennion was looking after the infant’s twin sister, Baby B, a few feet from the alleged killer in Nursery 1.
The room was ‘quite full’ because there was a crossover between the day and night shift.
There was no need for a crash call because there were doctors already present – David Harkness and Christopher Wood, a trainee. The consultant, Ravi Jayaram, came a short time later.
‘I remember Lucy asking for some assistance,’ said Mrs Bennion, a Band 6 nurse in the unit. ‘When it became obvious there was a problem I moved over to help with A’.
She helped her colleague deliver some ventilator breaths over the Neopuff via a face mask.
As the infant deteriorated she took on the role of drawing up the emergency drugs needed to resuscitate him.
She was still there when Baby A was declared dead. By then she had returned to care for his sister.
Nurse Bennion told Ben Myers, KC, defending that there were times when nationally recommended staffing levels could not be achieved.
She agreed that in a neonatal unit there was ‘an awful lot’ to observe and monitor, and it was quite possible for a neonate who appeared well to suddenly deteriorate.
‘These babies are very vulnerable and there’s always the potential for them to deteriorate very rapidly’.
Over 30 years she had experienced occasional deaths in neonatal units.
Asked by Simon Driver, prosecuting, whether the speed and nature of A’s deterioration was typical of those experiences, she replied: ‘It was very rapid. Very sudden. And sometimes there’s an indication that you are going to have a deterioration.
‘There was no evidence that he was going to deteriorate. However, it can happen and it has happened’.
Letby’s parents, John and Susan Letby, have been supporting their daughter throughout the trial and were seen arriving at Manchester Crown Court earlier today.
The trial continues on Monday.