Baby was making good progress before fatal collapse, murder trial told

A baby girl allegedly murdered by nurse Lucy Letby was making “good progress” before she later fatally collapsed, a doctor has told a jury.

Dr Sarah Rylance cared for the infant in her role of registrar on the day shifts of June 20 and 21, 2015 at the Countess of Chester Hospital’s neo-natal unit.

The baby, referred to as child D, is said to be the third child murdered by the defendant in a two-week period, with another suffering a life-threatening collapse during the same time.

The court has heard the mother’s waters had broken on June 18 but she was not given a Caesarean section until two days later, on June 20, after attempts to induce labour.

Twelve minutes after birth Child D lost colour, became floppy in her father’s arms, and required five rescue breaths.

The mother said she had been concerned about getting an infection but was not given antibiotics.

Child D first received antibiotics when she was transferred to the neo-natal unit under Dr Rylance’s care – some four hours after her birth.

The registrar also noted Child D’s blood gas readings were “abnormal” and she needed help with her breathing.

Dr Rylance told jurors at Manchester Crown Court that Child D was progressing well the next day as she decided to try her off CPAP (continuous positive airway pressure) respiratory support.

However, her breathing became “irregular” and her oxygen levels dropped “a few times” and CPAP was continued.

Dr Rylance said she did not attach much importance though to the changes and added: “She was heading in the right direction and was not needing any additional oxygen.”

Asked by prosecutor Simon Driver what her clinical assessment of Child D was as she handed over to the night shift on June 21, Dr Rylance said: “I believe she was a stable baby.

“She was receiving a very minimal level of breathing support. She was responsive, making good progress and she had responded well to treatment given since she had been admitted to the neo-natal about 24 hours earlier.

“Yes she was not a healthy baby by that time and still required some level of respiratory support, but much less. I was happy with her progress.”

Dr Rylance agreed with Ben Myers KC, defending, that – although the witness was not responsible – a four-hour wait for antibiotics in Child D’s circumstances was below the “proper standard required”.

She also agreed that during her care she had concerns for Child D of infection, or potential infection

Mr Myers said: “During the time you cared for her she was also unable to sustain respirations without some form of support?”

Dr Rylance replied: “Yes.”

Child D later collapsed three times in the early hours of June 22, and stopped breathing on the final occasion, as medics were unable to resuscitate her.

The nursing shift leader – who cannot be identified for legal reasons – told the court that on the first occasion Child D’s skin was discoloured and she was “stiff in appearance”.

She said: “The discolouration was like a mottled appearance, It was like a reddy colour. I remember it being an odd rash. Unusual.

“I remember mottled patches of almost circular white skin with this reddy brown around.”

Following the fatal collapse she said she recalled Letby asking her how she knew what doses of resuscitation drugs to administer, after a sheet of paper listing such calculations went amiss.

She told the court: “I said I knew those doses because I had worked in an ICU unit for a long time. It was useful to have it in your head and I recommend she should learn.”

In a statement read to the court, Dr Emily Thomas said she was on duty when she heard a call for help from a member of staff.

She said: “I think the member of staff was Lucy… this nurse later became very upset in front of me.

“I think she said something like ‘this is my second baby this has happened to me’.”

Letby, 32, originally from Hereford, denies the murders of seven babies and the attempted murders of 10 others at the Countess of Chester Hospital between June 2015 and June 2016.

The trial continues on Wednesday.