A CONSULTANT paediatrician at the Countess of Chester Hospital walked in on neonatal nurse Lucy Letby 'trying to kill' a 1lb 8oz baby that had been born only 97 minutes earlier, a court has heard.

Nicholas Johnson KC continued his opening of the prosecution case at Manchester Crown Court on Wednesday, October 12 against nurse Lucy Letby, 32, who denies murdering seven babies and attempting to murder 10 others.

The offences are said to have taken place between June 2015 and June 2016. none of the children or their parents can be named due to reporting restrictions.

Mr Johnson said it was the prosecution's case Letby was trying to kill 'Child K' when consultant paediatrician Dr Ravi Jayaram walked into the nursery room, as Child K was awaiting transfer to Arrowe Park Hospital.

Child K had been born in February 2016, very premature. The court heard births of this type would normally be delivered at Arrowe Park or Liverpool Women's Hospital, but there was not enough time for this to be possible, so Dr Jayaram was present for the birth at the Countess of Chester Hospital.

It was just 98 minutes later, Mr Johnson said, that Dr Jayaram was standing at the nurses’ station compiling his notes.

Although he did not have a view into Nursery 1 - where the most vulnerable babies are treated - Dr Jayaram was aware the designated nurse was not there, a fact backed up by door swipe data. Lucy Letby was the only nurse in room 1, alone with Child K.

Mr Johnson said: "Feeling uncomfortable with this because he was beginning to notice the coincidence between the unexplained deaths and serious collapses and the presence of Lucy Letby, Dr Jayaram decided to check on where Lucy Letby was and where [Child K] was.

"As he walked in, he could see Letby standing over Child K's incubator. He could see Child K's oxygen levels were falling. However, the alarm was not sounding and Lucy Letby was making no effort to help.

"Dr Jayaram went straight to treat Child K and found her chest was not moving, he asked Letby if anything had happened to which she replied, 'she’s just started deteriorating now'."

Dr Jayaram found Child K's breathing tube had been dislodged.

Child K was very premature, and had been sedated and inactive. The tube had been secured by tape and attached to Child K's headgear.

Mr Johnson: "It's well recognised if you handle a child you can dislodge the tube accidentally, but any experienced staff member would recognise that.

"Dr Jayaram was troubled as the levels were falling and Nurse Letby had been the only person in the room."

The prosecution added: "On these monitors, all readings are set to default values in the neonatal unit.

"Saturation levels falling to the 80s, is a serious issue and if the machine is working properly, it would have an alarm if the saturation levels fell to the 80s, as Dr Jayaram noticed.

"There is an alarm pause button on the screen of the monitor - if you want to treat the child, you don't want the alarm going away. It will pause for one minute.

"Bearing in mind the rate displayed on the monitor, Dr Jayaram estimates the tube would have been dislodged between 30-60 seconds, and that is on the assumption the alarm had been cancelled once."

The court heard Dr Jayaram did not make a contemporaneous note of his suspicions or the alarm failing to activate.

Attempts were made to stabilise Child K and Arrowe Park Hospital but she remained unwell, and died three days later.

In police interview, Letby denied dislodging the tube and did not recall seeing any significant fall in saturations.

Letby could not explain to police why she had researched Child K's parents on Facebook in April 2018 - over two years after Child K had died.

Earlier, Mr Johnson said Letby twice attempted to murder Child H on two successive night shifts in September 2015, for two "unexplained" collapses.

Mr Johnson said: "We say this has to be looked in the context of everything else.

"We say it is more than an innocent coincidence that once Child H was moved out of the Countess of Chester Hospital she had no further problems."

Mr Johnson said for Child I, born in Liverpool Women's Hospital in August 2015, Letby made four attempts to kill her, succeeding on the fourth attempt.

On the final occasion, Mr Johnson said it was at 1.06am when a nurse, having left the nursery temporarily, responded to Child I's alarm and saw Lucy Letby at the incubator. Child I was very distressed and wanted to intervene, but Letby assured her that they would be able to settle the baby.

Child I then collapsed.

The on-call doctor arrived and resuscitation attempts were made. Purple and white mottling were noted on Child I's skin.

All resuscitative efforts were unsuccessful and treatment was withdrawn at 2.10am, and Child I was pronounced dead at 2.30am.

In the immediate aftermath, Child I's parents were taken to a private room.

As the mum bathed her recently deceased child, Lucy Letby came into the room and, in the words of the mum, "was smiling and kept going on about how she was present at [Child I']s first bath and how much [Child I] had loved it.”

The prosecution said Child I "was doing well by the time Lucy Letby got her hands on her.

"What happened...followed the pattern of what happened to others before and what has yet to happen to others.

"All of a sudden out of nowhere came vomiting, breathing problems and critical desaturations.

"It was persistent, it was calculated, and it was cold-blooded."

Child J had required a stoma bag shortly after birth due to the gastro-intestinal disease NEC.

The doctor could not explain Child J's collapse, or symptoms of a seizure.

The prosecution said medical expert Dr Dewi Evans described the collapse at 7.11am as unexpected without any straightforward explanation.

He said that it was “of concern and consistent with some form of obstruction of her airways, such as smothering”.

The symptoms of a seizure suggested oxygen deprived to the brain.

Child J had not suffered a seizure since.

The prosecution said: "It is remarkable that on many occasions, when children who had suffered unexpected spectacular and life-threatening collapses were removed from her [Lucy Letby's] orbit, they had exceptional recoveries."

The trial continues. Follow updates here: https://www.chesterstandard.co.uk/news/23042657.live-prosecution-continues-opening-lucy-letby-trial/