The Unthinkable

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By Daniel O'DonoghueBBC News

Neonatal nurse Lucy Letby has been convicted of murdering seven babies and attempting to murder six others while working at the Countess of Chester Hospital.

Manchester Crown Court heard she targeted 17 babies between June 2015 and June 2016.

After listening to nine months of often harrowing evidence and deliberating for more than 110 hours, the jury of seven women and four men of the unthinkable.

She had faced 22 charges - seven of murder and 15 of attempted murder, involving 10 babies.

Letby was accused of several attempts to kill some of the infants.

Jurors were unable to agree verdicts on six counts of attempted murder, relating to four of the babies.

Legal reasons mean the victims' parents cannot be identified, so each baby is referred to only by a letter.

If you're affected by the issues in this piece, you can find support from. Baby A: Guilty of murder

Letby's first victim was a twin boy who was born and

He was born prematurely, delivered by Caesarean section at 31 weeks, and admitted to the neonatal unit's intensive care room.

The little boy was " stable" and breathing without oxygen support on 8 June.

Letby came on shift at 19:30 BST and took over his care from another nurse.

At 20:26, Letby called doctors to his incubator as he was " deteriorating rapidly".

Despite resuscitation attempts, Baby A was dead by 20:58.

The jury agreed that the boy collapsed and died as a result of a deliberate injection of air into his bloodstream.

Baby serial killer Lucy Letby

According to medical experts, the key symptoms of air injection is a rapid and inexplicable collapse that does not respond to treatment, accompanied by the appearance of an unusual skin rash.

In the case of Baby A, several medics noted " patches of pink over blue skin that seemed to appear and disappear".

In a post-mortem X-ray, there was a line of gas in front of the spine - something that was described as " unusual" by paediatric radiologist Dr Owen Arthurs. He told jurors its appearance was " consistent with, but not diagnostic, of air having been administered".

A pathologist who reviewed the case, Dr Andreas Marnerides, said it would be reasonable to conclude that air in Baby A's circulation was most likely caused by the administration of air through one of the tubes connected to the baby.

Baby B: Guilty of attempted murder

The twin sister of Baby A 28 hours after the death of her brother, in the early hours of 10 June 2015.

The jury heard she had required some resuscitation at birth but recovered quickly and stabilised.

At about 00:30 BST on 10 June, though, Baby B's heart rate suddenly dropped and her alarm monitor sounded.

Letby, along with other medics, attended to the infant.

It was noticed during resuscitation that Baby B had " purple blotches and white patches all over her body".

A nurse who treated her, who cannot be named for legal reasons, told the court: " She looked very ill. She looked very like her brother did the night before.

" I just remember thinking 'not again' - to see his sister with the same appearance. "

Baby B recovered and was eventually discharged a month later.

Medical experts agreed that Baby B was subjected to " some form of sabotage" and she may have been injected with a dose of air.

Baby C: Guilty of murder

The premature baby boy weighed just 800g (1lb 12oz) when he was born in early June 2015.

Despite his prematurity, medics recorded that he was in a " good condition" and stable.

He was being kept in nursery one, the highest priority section of the neonatal unit, for close observation when, on the night of 13 June, he suddenly stopped breathing.

The court heard Letby at about 23:15 BST by inserting air into his stomach via a nasogastric tube.

While Letby was the designated nurse for another child located in nursery three, she was present in nursery one when Baby C collapsed.

Medics failed to revive him and he was pronounced dead at 05:58 on 14 June.

Prosecutor Nick Johnson KC asked medical expert Dr Sandie Bohin during the trial: " When you looked for a reason for (Baby C's) collapse on June 13, can you find an explanation? "

Dr Bohin replied: " No. Babies like this should not collapse. You get prior warning that something is amiss.

" They don't go from being stable into a cardiorespiratory situation within minutes. They rarely collapse in this way but they are usually responsive to resuscitation and he was not. "

Baby D: Guilty of murder

Baby D, a baby girl, was the third child murdered by Letby in a two-week period.

The court heard that while the mother of Baby D's waters had broken on 18 June 2015, she was not given a Caesarean section until two days later, following attempts to induce labour.

She said she had not been given antibiotics, despite being concerned about having an infection.

The mother said that when her daughter was delivered she looked " lifeless" and was worried because the newborn seemed to be limp, struggling to breathe and not an even colour.

The prosecution accepted that the failure to give antibiotics was a " legitimate target of criticism".

But it was noted that although ill, Baby D " was responding well to treatment and was not expected to deteriorate".

During the, the baby girl collapsed several times, with medics " struck" by the sight of " brown and black discolouration to the baby's skin".

Despite resuscitation attempts, she was pronounced dead at 04:25 BST on 22 June.

Medical experts agreed that while there was clear evidence of an infection, Baby D's deterioration and unusual rash was caused by an injection of air.

Baby E: Guilty of murder

Baby E was a premature twin boy who was born in late July 2015.

Medical notes shown to the court revealed he initially required breathing support but stabilised in the days that followed.

Jurors heard that on the evening of 3 August, his mother visited him in the neonatal unit.

Prosecutor Nick Johnson KC asked her: " What could you see and hear when you walked into the room? "

She replied: " I could hear my son crying and it was like nothing I had heard before. And I walked over to the incubator to see blood coming out of his mouth. I panicked because it felt there was something wrong. "

She recalled Letby standing at a nearby work station when she entered the room.

Letby is said to have told the mother that a registrar was on the way and that she should go back to her ward.

Baby E later deteriorated and his mother was later brought back to the unit where she sat outside in the corridor as medics unsuccessfully attempted to resuscitate him.

The court heard Baby E lost 25% of his blood volume before his death in the early hours of 4 August.

Medical expert Dr Dewi Evans said this could have been the result of an

Dr Evans concluded Baby E's death was a result of his internal bleed and an injection of air.

Baby F: Guilty of attempted murder

The day after murdering Baby E, Letby to poison his twin brother.

The prosecution said the nurse struck after midnight on a night shift which had started on 4 August 2015 as Baby F received a new feed of nutrients via a bag connected to an intravenous line.

Shortly after, his heart rate surged and his blood sugars plummeted.

Blood samples taken from Baby F returned an " extremely high" insulin level of 4,657 and a very low C-peptide level of less than 169.

Medical expert Dr Dewi Evans told the trial that there was " only one explanation" for the " astonishing" blood readings.

" These were very, very striking results, " he said. " There's only one explanation for this, (Baby F) had received insulin from some outside source. "

Dr Evans said he had concluded the drug had most likely been added to the baby's Total Parenteral Nutrition (TPN) bag, which is used to intravenously provide feeds to infants.

Baby F eventually made a full recovery after a decision was made in the early evening to stop giving him nutrients from the second stock bag.

Baby G: Guilty of attempted murder

Baby G was the most premature of all the babies in this case, weighing just 535g (1lb 3oz) at birth in May 2015.

She had a number of " septic" or " suspected septic" episodes requiring antibiotics and received nine blood transfusions in the weeks after her birth.

In mid-August she was transferred from Arrowe Park Hospital in Wirral to the Countess of Chester's neonatal unit. She was " clinically stable" up until 7 September.

Medics noted the baby had projectile vomited at about 02:00 BST and her abdomen appeared " purple and distended".

Her oxygen levels dropped and she stopped breathing several times over the next few hours. She did respond to breathing support on ventilation.

The prosecution said Letby with milk through a nasogastric tube or injected air into the same tube.

Letby was convicted of another attempt to murder Baby G on 21 September and acquitted of making

Jurors were told Baby G now has quadriplegic cerebral palsy and requires round-the-clock care.

Baby H: Not guilty of attempted murder & hung jury on a second count

Baby H was a premature baby girl who was delivered via Caesarian section in September 2015 at the Countess of Chester.

Soon after birth, she had breathing difficulties and was transferred to nursery one.

The prosecution acknowledged that its case was " complicated by the sub-optimal treatment" given to Baby H, namely that there was an " unacceptable delay" in intubating her and administering medicine to help her lungs.

Additionally, when Baby H was put on a ventilator she was left with butterfly needles in her chest for prolonged periods, which may have punctured her lung tissue.

The prosecution Baby H in the early hours of 26 September 2015 and then again the following morning after infant's designated nurse had temporarily left the intensive care room.

Jurors found Letby not guilty of the first charge andwere unable to reach a verdict on the second.

The defence said Baby H was another example of " sub-optimal care" by the Countess of Chester Hospital and " nothing to do with Lucy Letby".

Baby I: Guilty of murder

Baby I was born prematurely at Liverpool Women's Hospital and transferred to the Countess of Chester on 18 August 2015.

In the first few weeks of life she had a few problems with her breathing - but all had obvious causes and all were resolved.

On 30 September the baby girl needed emergency attention after she vomited and her heart rate dropped.

Baby I suddenly collapsed again on 13 and 14 October before a fatal deterioration on 23 October.

The prosecution said by administering a fatal dose of air into her bloodstream.

Medical expert Dr Dewi Evans told the trial: " My opinion was that (Baby I) had been subjected to an infusion of air.

" In other words, air had been injected into her stomach. That interferes with your ability to move your diaphragm up and down, and that interferes with your breathing. "

Baby J: Hung jury on attempted murder charge

A premature baby girl, Baby J was born at the Countess of Chester in late October 2015.

She was transferred to Alder Hey Hospital in Liverpool on 1 November as it was discovered she had a bowel condition which required surgery.

She recovered well, though, and was returned to Chester on 10 November, where she remained stable until the early hours of 27 November.

The trial heard that the infant suffered within a 30 minute period and required urgent breathing support.

The court heard that Baby J had not suffered a seizure before.

Medical expert Dr Dewi Evans said the collapse didn't have a straightforward explanation and said it could be " consistent with some form of obstruction of her airways, such as smothering".

The defence said the Countess of Chester was " well out of its depth" with Baby J and knowing how to treat her.

They argued an assumption of deliberate harm had been made rather than an alternative explanation of a baby receiving inadequate care.

Jurors were unable to reach a verdict.

Baby K: Hung jury on attempted murder charge

Despite being born at 25 weeks and weighing just 692g (1lb 10oz), Baby K was considered in as " good a condition as possible for a baby born that early".

As a precaution, an hour-and-a-half after Baby K's birth arrangements were made to transfer her to a more specialist unit at Arrowe Park Hospital in Wirral.

While waiting for transport, Baby K's designated nurse Joanne Williams left the baby girl in Letby's care.

The prosecution said that in this window, in the early hours of 17 February 2016,

The trial heard from consultant Dr Ravi Jayaram, who felt uneasy about Ms Letby being left with the infant.

He said: " At this point, in mid-February, we were aware as a team of a number of unexpected and unusual events and we were aware of an association with Lucy Letby. That's all we were aware of. No cause and effect had been ascribed. "

Dr Jayaram told jurors that when he went to check on Baby K, he saw Letby standing by her incubator.

Dr Jayaram said he noticed the girl's breathing tube had become dislodged and that Letby was doing " nothing" to correct the desaturation until he arrived.

The baby was given rescue breaths and she eventually stabilised but died three days later.

Letby is not accused of her murder.

The defence say the probable cause of the tube moving was the child inadvertently doing it herself. They added that her case was another example of " sub-optimal care" by the hospital.

Jurors were unable to reach a verdict.

Baby L: Guilty of attempted murder

A twin boy born in early April 2016, Baby L stabilised after treatment for mild low blood sugar.

He was moved to nursery one - the highest priority section of the neonatal unit - shortly after birth.

Letby was caring for two other babies in the nursery on a day shift on 9 April.

In the hours that followed Letby's arrival, Baby L's glucose levels fell abnormally low and he had to be given additional doses of glucose in an attempt to correct the hypoglycaemia. They proved ineffective.

Blood tests were subsequently conducted on Baby L and they revealed a very high level of insulin in his blood, with the reading being at the very top of the scale that the equipment was capable of measuring.

Baby L went on to recover and was discharged from hospital the following month.

The prosecution said the only explanation for this anomaly was that synthetic insulin, a drug not prescribed to Baby L, had been administered.

Prosecutors said this was a " deliberate act of sabotage" done by Letby with the intention of killing him.

Baby M: Guilty of attempted murder

Baby L's twin brother, Baby M, suffered an unexpected life-threatening event at about 16:00 BST on 9 April 2016 - the same time that his twin's blood sugar levels were dangerously low.

Consultant Dr Ravi Jayaram, who attended a crash call for Baby M, noticed unusual patches of discolouration on his skin, which he thought was similar to what he had seen in the cases of Baby A and Baby B.

Baby M needed six doses of adrenaline within a 25-minute period and resuscitation before he stabilised.

Medics could find no cause for

Like his brother, Baby M went on to recover and was discharged from hospital the following month.

Medical expert Dr Dewi Evans said the likely cause of the baby boy's sudden deterioration was an injection of air.

Baby N: Guilty of attempted murder

Baby N was born in early June 2016. In the hours after his birth he was stabilised and his clinical condition was described as " excellent" by medics.

He did, however, have a blood disorder, which made him more prone to bleeding.

The prosecution said this disorder gave Letby " cover" to attack him, because if he bled it would be put down to the condition.

Prosecutors said Baby N's three deteriorations in June 2016 were consistent with some kind of " inflicted injury" or him having received an injection of air.

The trial heard that in the early hours of 3 June, Baby N experienced a " sudden deterioration" and was heard " screaming" and crying for 30minutes. Medical experts said the incident was consistent with the boy having been attacked.

Jurors convicted her on this count of attempted murder.

On 15 June, Baby N suffered further collapses and bleeding was noted at the back of his throat.

Expert Dr Dewi Evans said in his opinion " the bleeding was a result of trauma to his upper airway".

The defence said there are many reasons a baby will shout or scream.

They also said Baby N was another baby who received " sub-optimal care" and should have been treated elsewhere at a specialist unit.

The jury was unable to reach a verdict on these two counts.

Baby O: Guilty of murder

Baby O was one of and was born in good condition in June 2016.

He was stable up until the afternoon of 23 June when he suffered a " remarkable deterioration".

At 14:40 BST he collapsed and was moved to nursery one, where he stabilised for a period.

At about 16:15 the boy suffered a further collapse which required resuscitation, including cardiac compressions.

Those efforts were unsuccessful and Baby O was ultimately pronounced dead at 17:47.

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.

An independent pathologist, who reviewed the case, said in his opinion Baby O had suffered an " impact injury" to his liver akin to a road traffic collision.

Medical experts said that the boy died due to a combination of air being injected into his bloodstream and the injury to his liver.

Baby P: Guilty of murder

Baby P was Baby O's triplet brother and was in the same room as him on the neonatal unit.

The trial heard that after the death of his brother, he was put under close observation as a precaution.

At 09:35 BST on 24 June the baby boy was reviewed by a registrar and found to be " self-ventilating in air" and was stable.

But 15 minutes later he

Baby P collapsed several more times on 24 June before being pronounced dead at 16:00 after 45 minutes of unsuccessful resuscitation attempts.

Medical expert Dr Dewi Evans told the trial that, in his view, the collapses were consistent with an " additional amount of air being given to this baby during the morning of 24 June".

Baby Q: Hung jury on attempted murder charge

Baby Q was born in late June 2016 and was " initially stable".

Jurors heard that the infant shortly after 09:00 on 25 June.

Prosecutors said Letby injected air and fluid into the boy's stomach via a nasogastric tube in an attempt to kill him.

Medical expert Dr Dewi Evans told jurors that vomit found on Baby Q on the morning of 25 June was evidence that liquid had been given to him by someone.

Dr Evans said the subsequent respiratory problems experienced by Baby Q were likely caused by the fluid, which placed pressure on his diaphragm and prevented him from breathing normally.

The defence said there was no evidence that Ms Letby inflicted harm.

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