Baby allegedly murdered by nurse Lucy Letby 'injected with air'

The infant was said to have been attacked by the defendant during her day shift at the Countess of Chester Hospital’s neo-natal unit in June 2016.

Giving evidence on Wednesday, March 15, expert witness Dr Dewi Evans told Manchester Crown Court he believed Child O was the victim of an “air embolus” – in which gas bubbles block blood supply.

The retired consultant paediatrician said a “small discoloured purpuric rash” had been noted on the youngster’s chest during his rapid deterioration on the afternoon of June 23.

Dr Evans said: “I considered that the rash was consistent with (Child O) having received a injection of air into his circulation, his blood circulation.

“My opinion was that (Child O’s) terminal collapse was him being the victim of an air embolus.

“I couldn’t find any evidence where this could have occurred accidentally.”

Dr Evans said it “repeated the pattern” seen in the case of Child B, a twin girl, who also had a noticeable rash during her collapse – which she survived.

Jurors were told Dr Evans had concluded in an earlier report, in June 2018, that the cause for Child O’s collapse was trauma to the liver.

A haematoma – bleeding – had been found in the liver during a post-mortem examination.

Dr Evans said: “If there was a purpuric rash – little blood spots under the skin – there had to be a cause. It was indicative of direct trauma.”

He later learned from the police that the doctor who observed the rash had further explained it disappeared a short time after.

Dr Evans said: “This made a big difference to the interpretation of the rash. If it’s a purpuric rash it will last quite some time – days, hours.”

Letby is also accused of murdering Child O’s newborn brother, Child P, on the following day.

The surviving triplet was later discharged from another hospital after their parents “begged” a doctor to remove him from the Countess of Chester.

Letby, originally from Hereford, denies the murders of seven babies and the attempted murders of 10 others between June 2015 and June 2016.

Yesterday, the court heard that in June 2015, senior paediatrician at the Countess of Chester Hospital Dr Stephen Brearey conducted a review into the circumstances of the death of Child D that month.

An “association” with Letby and her presence at a number of collapses up to that point were noted, the court heard.

Dr Brearey told the court a meeting followed with director of nursing Alison Kelly in late June or early July 2015.

He said: “I think my comment at the time during the meeting was ‘it can’t be Lucy, not nice Lucy’.

Ben Myers KC, defending, said: “I would suggest that once Ms Letby had been identified as someone, or a factor, that caused concern there was naturally a bias against her in the way she behaved and the way it was interpreted, do you agree?”

Dr Brearey replied: “I disagree.”

A further review of collapses at the unit from a neonatologist based at Liverpool Women’s Hospital took place in February 2016, the court was told.

Dr Brearey said he sent a report of those findings to the director of nursing and the hospital’s medical director as he asked for another meeting.

He confirmed that during this period there was no formal complaint made to the police.

Mr Myers asked: “If somebody hurt a baby on your unit and you believed you had the identity of the person responsible, you’d report it to the police wouldn’t you?”

Dr Brearey said: “I think you are making it a bit more simplistic than it was. It was not something that anyone wanted to consider, that a member of staff is harming babies.

“Actually, the senior nursing staff on the unit didn’t believe this could be true up until the point and beyond when the triplets (Child O and P) died.

“None of us (the consultants) wanted to believe it either.

“This all became very exceptional and it took a step back to think about it. The nature of these collapses, the unexpected nature of them, the lack of response to resuscitation, the unusual rash noted on a number of occasions and each time the association with Nurse Letby.”

He said he wanted to “escalate” concerns within the hospital management rather than go directly to the police.

He said: “I needed executive support and that was what we were after.”

Dr Brearey said there were “no more events” after Letby left the neo-natal unit.

He said: “It was the same staff doing the same job and there were no sudden collapses.”

The consultant told Simon Driver, prosecuting, that between the deaths of Child D and Child O he was unaware that two other babies had returned blood results which showed abnormally high insulin levels.

The trial continues.