Lucy Letby: Medics could find no reason why baby ‘suddenly collapsed’

It is alleged the defendant, 33, attempted to murder the premature-born girl on successive shifts in the early hours of September 26 and 27, 2015.

Child H, who cannot be identified for legal reasons, needed full resuscitation from both incidents at the hospital’s neo-natal unit before she recovered.

Giving evidence at Manchester Crown Court on Thursday, January 19, registrar Dr Alison Ventress said she received an urgent bleep call from nurses in the early hours of September 25.

She said she was informed Child H had breathing difficulties, poor chest movement and poor colour.

Child H’s oxygen levels plummeted shortly after her arrival and she called for a consultant to assist, Dr Ventress told the court.

More desaturations followed as Child H received a series of invasive needle treatments for a tension pneumothorax – an emergency situation where air accumulates between the chest wall and lung which causes it to collapse.

Dr Ventress agreed with Simon Driver, prosecuting, that it had been a “rocky night” for Child H.

Mr Driver asked: “Were the causes for those problems identified?”

Dr Ventress replied: “Yes, a tension pneumothorax is something that does happen. You never find an exact cause but for a premature baby needing breathing support it is a known complication of that.”

On the following night shift, she noted a “cluster” of desaturations in a two-hour period.

She said she later found a chest drain – a tube inserted to drain air – was in a sub-optimal position and it had “almost fallen out”.

Dr Ventress noted at 1am on September 26 that a combination of Child H needing more respiratory support and a drop in her blood pressure led her to think she may have another tension pneumothorax.

At 3.24am, she received a crash call from the nurses in the neo-natal unit, the court heard.

Child H had desaturated to a “level of real concern”, she said, and her heart rate had fallen below 100 beats per minute.

She said she was informed that “no trigger was identified”.

Chest compressions commenced at 3.26am when her oxygen levels and heart rate continued to drop, the court was told.

Child H was given several doses of adrenaline before compressions stopped at 3.46am when her heart rate rose to a safe level.

Dr Ventress said: “We followed the cardiac arrest protocol and she recovered, but we never found a reason why she got into that state.”

The court heard that three chest drains were put into Child H over several days before her first sudden collapse.

Benjamin Myers KC, defending, asked Dr Ventress: “Do you agree there are numerous reasons why a baby on a chest drain may desaturate?”

“Yes,” said the doctor.

Mr Myers said: “If we look at the days leading up to the event on September 26, over those days there have been multiple desaturations with this little girl.”

Dr Ventress said: “Yes.”

Mr Myers went on: “Indeed in the hours leading up the event we are looking at, there was a series of desaturations over the night, weren’t they?”

“Yes,” repeated Dr Ventress.

She also agreed Child H had been suffering for a prolonged period of time from tension pneumothorax and “the reality is she had been through an awful lot of medical activity”.

Dr Ventress conceded it was “conceivable” that babies under that much intervention could suffer “quite a significant collapse”.

Mr Driver asked the witness: “You confirmed desaturations are not uncommon with babies experiencing the sort of problems Child H was experiencing. Are arrests as common as desaturations?”

Dr Ventress said: “No. Arrests are not all that common. I’m not saying they are impossible, but they are not all that common.”

Child H was discharged in October 2015 after she continued to improve.

The court heard that 13 children were in the unit in the early hours of September 26, with four nurses allocated to their care.

Letby was tasked with looking after a sole baby, Child H, in intensive care nursery room 1.

The evening’s nursing shift leader, who cannot be identified for legal reasons, agreed with Mr Myers that caring one-to-one for a baby such as Child H was “potentially quite a demanding job” for a nurse of Letby’s experience.

But she added: “Lucy was qualified in specialist neo-natal nursing at this time and very competent. She was not a totally inexperienced nurse … and I would trust that she would ask me if she had any problems.”

Mr Myers asked the witness: “Was there an issue with Lucy Letby being relatively junior compared to others and some debate about her going into Nursery One to look after more poorly babies?”

“Sometimes, yes,” she replied.

Mr Myers said: “And sometimes a bit of an under-the-surface dispute about that, is that correct?”

The witness said: “Yes.”

Letby, originally from Hereford, denies murdering seven babies and attempting to murder 10 others on the unit between June 2015 and June 2016.

The trial continues on Friday, January 20.