THE METHODS Hereford nurse Lucy Letby is alleged to have used to harm babies in her care have been revealed in her trial.
The 32-year-old nurse, who is of Arran Avenue, Hereford, grew up in Hereford before studying nursing at the University of Chester.
She is accused of murdering seven babies and 15 charges of attempted murder, involving 10 babies, while working at the Countess of Chester Hospital between June 2015 and June 2016.
She is currently on trial at Manchester Crown Court.
Letby denies all the allegations, while defence barrister Ben Myers has said the defence does not accept she is responsible for the deaths and collapses of babies being cared for in the unit, calling her a "dedicated nurse".
Here are all the alleged murders and attempted murders she is accused of committing:
Child A
Child A was the first alleged murder, at just one day old, on June 8 2015, prosecutor Nicholas Johnson KC said.
Delivered by Caesarean section at 31 weeks, he was admitted to the intensive care room in the neonatal unit of the hospital, but was in good condition and did well and by the following morning was breathing “in air” without extra oxygen help and was given expressed breast milk.
An hour after starting her shift, Letby called a doctor to the baby’s incubator and the on-call consultant was also alerted.
Both doctor and consultant noted an “odd discolouration” on the boy’s skin, patches of pink over blue skin that appeared and disappeared. Mr Johnson said this became a “hallmark” of some of the cases in which Letby had injected air into the bloodstream of a victim.
Despite resuscitation attempts, child A was pronounced dead at 8.58pm.
A pathologist concluded that air in child A’s circulation was most likely caused by air administration through one of two tubes already attached to the baby’s body.
Child B
Child A's twin, child B required some resuscitation at birth on June 7 but recovered quickly and stabilised but shortly before midnight, it was noted her blood/oxygen levels had fallen and that nasal prongs had been dislodged.
At about 12.30am on June 9 she was blue in colour, was not breathing and was limp. An on-call registrar was alerted and the child recovered quickly once resuscitated.
Mr Johnson said an expert paediatrician concluded child B was subjected to “some form of sabotage” and may have been injected with a dose of air.
Child B does not have appear to have suffered any adverse consequences.
Child C
Letby allegedly murdered a five-day-old baby on June 14, 2015, by injecting air into his stomach through a nose tube, a court has heard.
Child C died because the air injected into his stomach made him unable to breath and he suffered a cardiac arrest, the prosecutor said.
Born prematurely, he was in intensive care but in good condition. Letby was looking after another baby but was the only person in the room when he suddenly collapsed.
Child D
Prosecutor Nick Johnson KC said child D was allegedly murdered by Lucy Letby with an intentional injection of air into the bloodstream.
She had been responding well to treatment after losing colour and becoming floppy after birth, but collapsed three times in the early hours of June 22, 2015.
On the third collapse, she could not be revived.
Letby searched for her parents on Facebook after her death.
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Child E
Child E, a twin boy, was also murdered by an injection of air into the bloodstream, said prosecutor Nick Johnson KC.
He said that on the evening of August 3 2015 Child E’s mother visited her son in the neo-natal unit, finding him “distressed” and bleeding from the mouth.
The mother recalled Letby tried to reassure her, he said, and told her a registrar would review the youngster’s condition and she should leave the unit.
Child E went on to suffer significant blood loss later in the evening. Following Child E’s death in the early hours of August 4, the Crown said Letby made “fraudulent” nursing notes which were “false, misleading and designed to cover her tracks”.
She repeatedly searched for the family on social media after his death.
Child F
The day after allegedly murdering child E, Lucy Letby allegedly used insulin for the first time to poison a baby, the court heard, by trying to murder child E’s twin brother, child F.
Child G
Lucy Letby was said to have attempted to murder child G on three separate occasions in September 2015, the court heard.
September 6 was a “significant date” with 100 days passing since the youngster’s birth, but in the early hours of the following day the Crown says Letby fed an excessive amount of milk to child G through a nasogastric tube and also, probably, injected air.
Child G vomited out of her cot and on to a nearby chair and the floor. She had suffered a collapse and was not breathing. She was moved back to the hospital where she was born and quickly recovered before she returned to the Countess of Chester on September 16.
Child G had two projectile vomits and stopped breathing briefly on September 21 after she was earlier fed milk via a nasogastric tube, allegedly by Lucy Letby, the court heard.
In the mid-afternoon a nurse responded to Letby’s shout for ‘help’, said Mr Johnson, and noticed the monitor had been switched off, while the child was struggling to breathe.
Child G was left “severely disabled” as a result of the first two episodes.
Child H
Letby is accused of attempting to murder child H on two successive night shifts in September 2015. The child suffered two "profound collapses" and required resuscitation with the use of adrenaline. No clear cause for either incident was identified at the time.
Child H was transferred to another hospital, where she dramatically improved.
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Child I
Child I collapsed and required chest compressions in the early hours of October 23 2015 but was successfully resuscitated and recovered to the extent she was showing signs of hunger, the court heard.
She later collapsed and died, with attempts to revive her unsuccessful.
An expert paediatrician who reviewed child I’s case had concluded the youngster’s deteriorations were consistent with the deliberate administration of a large amount of air into her stomach via a nasogastric tube.
Mr Johnson said child I’s mother was allowed to bathe her “recently departed” daughter.
He said: “Lucy Letby came into the room and in the words of (the mother) ‘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’.”
Letby later sent a sympathy card to the parents and made Facebook searches for the family.
Child J
Born prematurely at 32 weeks and two days, child J had an operation for a bowel disorder, but was doing well and was healthy, the jury at Chester Crown Court heard.
But she suffered an unexplained collapse overnight on November 26/27 when Lucy Letby was one of the six nurses working the night shift.
Child J suffered two serious problems with her breathing in the night and was moved to a high-dependency room.
At 6.56am on the 27th, her oxygen level dropped so low it was unrecordable and she went into seizure.
At 7.20am Letby gave the baby a glucose infusion, then minutes later child J collapsed again with a seizure and had to be resuscitated, with the help of a doctor.
An independent medical expert who reviewed child J’s case said it was “of concern and consistent with some form of obstruction of her airways, such as smothering”.
Letby searched for the child's family on Facebook the next month.
Child K
A suspicious doctor walked in on Lucy Letby as she allegedly attempted to kill one baby, Chester Crown Court heard.
Dr Ravi Jayaram, the prosecutor said, walked in to child K's room to find Letby alone with her.
Child K's chest was not breathing and her breathing tube was found to be dislodged, he said.
Later the same morning at 7.30 Lucy Letby was again at child K’s cot calling for help, the court heard.
She was assisting the baby with her breathing and it was found child K’s breathing tube had this time slipped too far into her throat.
Child K was transferred to another hospital later that day but remained unwell and died two days later. Letby is not accused of her murder.
Child L
On April 9 2016, Letby is said to have attempted to murder child L by giving them an unauthorised dose of insulin and while that attack was under way she turned her attentions to child M by administering air into his circulation.
Mr Johnson said the defendant went on to agree the insulin could not have been given accidentally but said she was not responsible.
Her only explanation was it must have already been in one of the bags he was receiving but the Crown say that was “not a credible possibility”, he added.
Child M
Mr Johnson said child M came “close to death” after his heart rate and breathing dropped dramatically without warning but improved on the night-shift that followed and went on to make a speedy recovery.
When Lucy Letby’s home in Chester was searched two years later, a number of medical notes were found which detailed how many doses of adrenaline were given to child M during his collapse.
A note of his collapse was also recorded in her diary, the court heard.
Child N
Child N was born at 34 weeks in June 2016. His clinical condition was described as “excellent” although he did have mild haemophilia, a blood disorder.
Mr Johnson said this meant Letby believed, wrongly, that his haemophilia gave her “cover” to attack him and allegedly went on to attack him three times.
At 1.05am the day-old baby suffered a sudden lowering of his blood oxygen levels to life-threatening levels.
Twelve days later, on June 15, Letby is alleged to have made two more attempts to murder child N.
Child N was almost ready to go home when Letby entered his room. When a second nurse had her back turned Letby told her the baby had lost oxygen and immediately assisted with his breathing.
A doctor was unable to put a breathing tube into the child after discovering fresh blood inside his mouth. The medic could not see the back of the child’s throat as it was so swollen.
Around 3pm that day there was a further collapse of child N with his oxygen levels falling to life-threatening levels and a further attempt to insert a breathing tube again found blood in his throat.
Independent medical experts suggested the blood in child N’s mouth was a result of the “thrusting” of a tube into the back of his throat to inflict injury, the court heard.
He was later transferred to a specialist children’s hospital in Liverpool where he recovered quickly.
Child O
Child O was in good condition and stable up until the afternoon of June 23 when he suffered a “remarkable deterioration”, the court heard.
A post-mortem examination found unclotted blood in his body from a liver injury and a coroner certified death on the basis of natural causes and intra-abdominal bleeding.
The expert also concluded child O had fatefully received excessive amounts of air into the bloodstream and through a nasogastric tube.
Child P
The defendant is said to have murdered Child P, one of triplets on June 24 2016 – the day after she is said to have murdered his brother, Child O.
Child P suffered an “acute deterioration” before preparations were put in place to move him to another hospital.
Just before the planned transfer, a doctor was said to be “optimistic” about his prospects but then “all of a sudden Lucy Letby said to him something like ‘he’s not leaving alive here, is he?’”, said Mr Johnson.
Shortly after, Child P collapsed and died, Manchester Crown Court heard.
A coroner recorded the death as “prematurity” but independent experts who were tasked with reviewing Child P’s case said the most likely cause was air injected into his stomach which compromised his breathing.
After Child P’s death, Letby spent time with his parents and at one point took a photograph of Child P and his brother, Child O, in a cot, the court heard.
Child Q
The final incident, outlined by prosecutor Nick Johnson QC, was the alleged attempted murder by Lucy Letby of Child Q on June 25 2016, the day after she allegedly killed Child P.
The Crown say the neo-natal nurse injected Child Q with excess air and a clear fluid, possibly water or saline, into his stomach via a nasogastric tube in a bid to murder him.
The youngster was later transferred to another hospital, where he went on to make a “rapid recovery” when removed from the “orbit of Lucy Letby”, said the prosecutor.
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