Lucy Letby: Baby triplet died after trauma to liver, jury told

A baby boy died after suffering "trauma" to his liver and an injection of air into his bloodstream, nurse Lucy Letby's murder trial has heard.

Ms Letby is said to have killed the boy, referred to as Child O, in June 2016 on her return from a week's holiday in Ibiza.

She is charged with murdering seven babies and attempting to murder 10 others at the Countess of Chester Hospital between 2015 and 2016.

The 33-year-old denies all charges.

Manchester Crown Court has previously heard how Child O was in good condition and stable up until the afternoon of 23 June when he suffered a "remarkable deterioration" and died.

The boy was one of triplets and his brother, referred to as Child P, died just over 24 hours later after also being allegedly attacked by Ms Letby.

Medical expert Dr Dewi Evans told the court Child O's death was a result of an intravenous air injection and trauma to his liver, which caused an internal bleed.

First referencing the blood found in Child O's liver, Dr Evans said: "I felt that the blood found in the liver was responsible for his collapse.

"And at the time I thought that this was the result of trauma. In other words there was some trauma to the liver which had led to the collapse.

"Any bleeding to the liver would destabilise the baby and would comprise the baby's wellbeing."

Dr Evans ruled out CPR being a cause for the liver bleed, saying that the chest compressions needed by Child O on 23 June were "carried out by experienced doctors" and "doesn't get near the liver".

The expert, who was asked to review the case by Cheshire Police in 2017, said upon reviewing Child O's X-rays he noticed an "excessive" amount of air in his abdomen.

"I thought the air in the abdomen was excessive and could indicate air having been injected into [the] stomach via a nasogastric tube," he said.

The court earlier heard from a doctor, who cannot be named for legal reasons, who told the court that he noticed Child O's "skin looked unusual" and "mottled" on the afternoon of 23 June.

Jurors previously heard in the hours before Child O's death another doctor, Dr Stephen Brearey, had noticed an "unusual" rash on the boy's chest.

Dr Evans said the rash observed was a signal the boy had been injected with air and noted the similarities between this baby's collapse and the collapse of the second child in this case, Child B, in June 2015.

"This was repeating the pattern I had seen," he said.

"My opinion for the terminal collapse was [Child O] was a victim of an air embolus and I couldn't find any evidence where this could have occurred accidently."

Ben Myers KC, defending, put it to Dr Evans that he "chops and changes" when reviewing evidence to support his theory of air embolus.

"That is incorrect, I apply my clinical experience to the evidence in front of me," Dr Evans said.

Mr Myers accused the expert of attempting to "knit" pieces of evidence together to "support the allegation" against Ms Letby.

"Nothing about a small discoloured rash on the chest wall matches any description in the literature of air embolus, does it?", the lawyer said.

Dr Evans said it was not just the rash that brought him to the conclusion of air embolus, but also the repeated collapses and the fact resuscitation was unsuccessful.

Mr Myers put it to the medic that he would "seize on whatever you think you can" to support the theory of air embolus.

"You are working this together as you go along aren't you?", he said.

Dr Evans rejected the accusation and repeated that air embolus was his clinical opinion for Child O's collapse.

The court has previously heard the surviving triplet was later discharged to another hospital after their parents "begged" a doctor to remove him from the Countess of Chester Hospital.

The jury were later read a summary of Ms Letby's police interviews in relation to the death of Child O.

In her first interview in 2018, she told Cheshire Police that she was "shocked and upset" by the baby boy's death.

She denied deliberately causing the boy harm and when asked if she had knowledge of anyone who would, she responded: "It wasn't me."

The court heard that Ms Letby carried out a Facebook search for the mother of Child O on the anniversary of the baby's death in June 2017, when asked why by police she "could not explain why she would be doing it".

The trial continues.

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