MEDICS could find no reason why a baby suddenly collapsed during a night shift at the Countess of Chester Hospital, the trial of nurse Lucy Letby heard.
It is alleged the defendant 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, registrar Dr Alison Ventress said she received an urgent bleep call from nurses in the early hours of September 26.
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 andlung which causes it to collapse.
Dr Ventress agreed with Simon Driver, prosecuting, that it had been a “rocky night” for Child H, telling the court that tension pneumothorax sometimes does happen in premature babies needing breathing support.
The next night, she noted a “cluster” of desaturations in a two-hour period and found a chest drain inserted to drain air 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 started at 3.26am when her oxygen levels and heart rate continued to drop, and Child H was given several doses of adrenaline before compressions stopped at 03.46am when her heart rate rose to a safe level.
The doctor said they had never found a reason why the child got into that state.
The court heard that three chest drains were put into Child H over several days before her first sudden collapse.
Ben 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, also agreeing there had been multiple desaturations in the days leading up to September 26, including a series of desaturations in the hours leading up to the event.
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”.
But, Dr Ventress said that while arrests are not impossible, 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.
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