Baby’s ‘inconsolable’ crying ‘proved’ that nurse Lucy Letby had injected air into the infant

An expert paediatrician told the Lucy Letby trial today how a baby’s ‘inconsolable’ crying had helped reinforce her view that the infant had been injected with air.

Dr Sandie Bohin said Baby I had been crying in a way that neonatal nurses at the Countess of Chester Hospital felt was unusual.

‘Parents and experienced nurses get a sense of why babies are crying,’ she told the jury at Manchester Crown Court.

‘This was inconsolable crying. I think she must have been in severe pain to be this upset. It was over and above what is normal’.

Dr Bohin, who was called in by Cheshire Police to peer review the findings of another expert witness, Dr Dewi Evans, said she could think of no innocent explanation for mottling on the infant’s trunk and her subsequent death.

‘That, to me, is a baby in pain’.

Ben Myers KC, defending, suggested that if the court had wanted her independent views it would have been better for her not to have seen the numerous reports produced by Dr Evans.

Dr Bohin replied: ‘If I’m understanding you correctly, you’re saying I’ve just rubber-stamped Dr Evans’ findings, and that is less than discourteous.

‘I was asked whether I agreed with his findings after reviewing the notes myself, or whether I found a different cause. I have disagreed with some of his findings and added my own evidence.

‘I’m not backing up what he said. I’m reviewing the case and coming to my own conclusions. If that’s in alignment with Dr Evans’ view, that’s in alignment with his view’.

Mr Myers persisted, asking: ‘I suggest you would never have come up with air embolism if you had not been exposed to his view’.

Dr Bohin replied: ‘I disagree’.

She told the court she had seen two examples of air embolus in her career. In one of these a bypass machine was being used to try to help a critically ill baby, and she had seen air bubbles in the system that had caused an immediate cardiac arrest.

The clinical presentation of air embolus was wide and varied. In some cases a baby might be resuscitated and recover, in others he or she might die.

If a sufficiently large amount of air was pumped in it could fill the chamber of the heart, ‘in which case the heart stops’. Additionally, if the air went through a small hole in the right hand side of the heart it could pass to the left hand side and be pumped around the body and into the coronary arteries.

‘In this case I think as well as air being distributed around the body, it’s likely that air went in down the coronary arteries’.

Mr Myers, whose client denies causing any harm to Baby I, put it to her that she was ‘just reaching for air embolism as a general catch-all’ to explain the infant’s death.

The paediatrician replied: ‘No, that’s not the case’.

Letby, 33, originally from Hereford, denies killing seven babies in the year June 2015 to June 2016 and attempting to murder a further 10. She denies all the charges.

A nursing colleague of Lucy Letby has previously told the court how the alleged killer alerted her to Baby I looking pale – even though she was standing six feet away and the infant’s cot was in a darkened room with her top half covered by a canopy.

When the nurse, Ashleigh Hudson, went over to the previously stable infant she found her in ‘quite poor condition’ and needing urgent care.(Then) she said she thought

She told the court: ‘Lucy was in the doorway. We were talking. I don’t remember the content of the conversation. (Then) she said she thought (Baby) I looked pale’.

She estimated that Letby was standing five or six feet away. She was in the doorway and said something along the lines of ‘(Baby) I looks pale’ or ‘Don’t you think (Baby) I looks pale?’

Simon Driver, prosecuting, asked: ‘Was there anything about the layout or lighting that would have afforded her a better view of the baby than the one you had?’

Nurse Hudson replied: ‘No’.

Today the jury was told that during an interview Letby told police she could not recall whether the light went on before or after she and her colleague had seen Baby I.

But she thought they had been in the doorway together, and that one of them put the light on as they went into the room.

The alleged killer told the interviewing detective she wondered whether she had seen something in the baby’s colour that Nurse Hudson hadn’t ‘as she was more experienced’.

There was always a level of light in the nursery, and a degree of natural light. Despite the presence of the canopy, they were still able to see the infant in the cot below.

Neonatal nurse Lucy Letby tried to smother a premature baby girl on a day the infant was on the verge of being allowed home, a jury heard today.

Baby J appeared perfectly healthy when she was born by Caesarean section on October 31, 2015.

But medics at the Countess of Chester Hospital quickly diagnosed that she had a perforated bowel and had her transferred to Alder Hey in Liverpool for surgery.

When she returned to Chester she was cascaded down through the nurseries from the high dependency Room 1 to Room 4 where babies were expected to go home within a short space of time.

Baby J collapsed in the early hours of November 27, just as her mother was preparing for ‘a dry run’ to take her home.

‘We were really excited about her coming home,’ she told the jury at Manchester Crown Court. ‘She was doing really well.

‘They’d taken her off all the monitoring systems and I’d been staying at night-time to see if I could manage the daytime cares’.

The mother was rung at around 7.10am to say her baby had collapsed and she needed to come to the hospital immediately.

She and her husband rushed to the unit. ‘When we got to the hospital J was in a hot cot in the high-dependency room. She was connected back up to a monitor. She looked floppy, very pale, yellowy in colour and not very responsive.

‘We were totally and utterly shocked because prior to this she was extremely well. She was coming home. We were preparing for her to come home. Other than (an issue of) weight gain she was fine’.

The infant recovered so quickly that by the afternoon of the next day she was back up to full feeds. She was given no indication of what had caused her baby’s collapse, aside from a doctor telling her there was no infection.

The mother recalled being asked at one point whether she wanted her daughter to be christened, but that was not needed.

Baby J underwent two bowel operations at Alder Hey – one to insert two stomas, the second to remove them and restore her normal function.

The infant’s mother contrasted the ‘extremely professional’ way that staff at the Liverpool hospital approached the procedure required by the use of stomas with an apparent lack of ability at Chester.

‘At Alder Hey they were extremely professional in the way they approached the procedure. They seemed to be organised in what they were doing with it. Everything ran smoothly with the stomas’.

Mr Myers asked whether there was a similar level of confidence and ability at Chester. She replied: ‘I would say no’.

She added: ‘Staff didn’t seem to be geared up or prepared for the level of care she needed so far as stomas.

‘Alder Hey had contacted Chester to ask whether they would be able to perform the procedure and they said they could. If they couldn’t we would not have been able to go (back) to Chester.

‘But they didn’t have the resources or the expertise or the time to commit to J’s needs. They relied on me to deal with the stomas’.

She acknowledged that anyone – ‘even nurses’ – would have trouble with positioning the stomas correctly. ‘If we raised concerns I didn’t feel they were taken very seriously. They didn’t take it to the correct levels or didn’t liaise with Alder Hey.

The mother said that on occasion her husband had to prompt staff to give their daughter medication.

She recalled calling in to see her daughter one morning at 8am and finding her lying ‘with her bottom wrapped in a towel covered in faeces. I said to one of the nurses ‘What would you do in my situation?’ We called a meeting with a consultant’.

A series of WhatsApp messages sent on the day of Baby J’s birth reveal Letby’s claim that the unit was in ‘chaos’.

She had had a row with a colleague and felt that some of her colleagues ‘want the easy life’.

On November 26 – the night of Baby J’s collapse – she tells a colleague that ‘staffing really needs looking at’ and that the situation ‘is just not manageable’.

In his opening address to the jury, Nick Johnson KC, said Baby J’s case ‘is one where we suggest that its parallels with other cases tell you what happened and who was responsible’.

He added: ‘We suggest that it is highly significant that children within the orbit of Lucy Letby persistently and consistently suffered unexplained collapses.

‘Sometimes the evidence of her hand at work is more obvious than others and it is remarkable that on many occasions, when children who had suffered unexpected spectacular and life-threatening collapses were removed from her orbit, they had exceptional recoveries’.

She denies the charges and the trial resumes on Monday.