Premature baby allegedly targeted by Lucy Letby in a murder bid by neonatal nurse was doing well before suddenly deteriorating, court hears

A doctor who delivered a premature baby allegedly attacked by neonatal nurse Lucy Letby told a jury today that the infant was initially doing well.

Dr James Smith, a locum registrar, said Baby K was born feet-first and weighing 692g at 2.12am on February 17, 2016.

The infant was immediately wrapped in plastic to keep her warm, and a mask placed over her face so he could give her two sets of inflation breaths to inflate her lungs.

Medical notes recorded that Baby K was initially floppy and dusky in colour. However, both these factors were expected in a pre-term infant.

The baby was breathing for herself at four minutes and six minutes after the birth her saturation levels had risen to 85 per cent.

Medical staff went through a standard resuscitation process, which included an intubation procedure carried out by Dr Smith.

Letby, 34, is accused of attempting to murder Baby K by displacing a breathing tube within two hours of her birth.

The former nurse is currently serving 14 whole life orders after being convicted last August of murdering seven babies in her care and attempting to murder a further six.

The jury in her original trial could not reach a verdict in the case of Baby K. At the retrial on a charge of attempted murder Letby has pleaded not guilty.

Dr Smith told the jury at Manchester Crown Court that he recalled being told that a '25-weeker' was expected to be born during the shift he started on February 16, 2016, recalled being told that a '25-weeker' was due to be born.

Shortly before the birth he asked one of the nurses to call the on-call consultant, Ravi Jayaram, so he could be present. The consultant remained throughout the resuscitation process.

Dr Smith said Baby K needed to be intubated because of her small size and short gestation. He made three attempts to carry out what was 'a technically very difficult' intubation, finally succeeding when he used a smaller 2.0 tube.

He did not recall seeing any significant bleeding during the process. Had he done so, he would have handed her to his more senior colleague.

Dr Jayaram was present the whole time, but at no stage felt the need to intervene because 'he had confidence in me'.

The general clinical picture in the minutes after Baby K's birth was that it had been 'a good resuscitation and the baby is stable'.

Dr Smith recalled being outside the room at the time Baby K suffered a 'sudden desaturation' a short time later.

When he walked in he saw Dr Jayaram on the right side of the incubator, trying to bag the baby through her ET tube.

'He was trying to bag manually through the tube, but that was not successful. I remember coming in and saying 'What's going on? What's happening?'I asked if he wanted me to re-intubate. So he's taken the tube out and was giving her breaths while I'm assembling equipment. I then perform the intubation'.

The re-intubation took two attempts, with Baby K being given a single dose of morphine to help calm her.

Simon Driver, prosecuting, asked what he understood to have been the cause of the collapse. Dr Smith replied: 'The cause appeared to be that the tube had been displaced'.

Cross-examined by Letby's barrister, Ben Myers KC, he maintained that the resuscitation had gone well, and the baby's initial duskiness and floppiness 'is not anything unusual'.

He said one of the reasons the first intubation might not work was that the tube might not make it through the vocal cords, so a smaller tube would be needed.

That was 'probably' why a larger sized tube was used initially.

Mr Myers said that was the answer he had given during Letby's first trial. The medic agreed that it was.

The barrister asked whether there was a 'danger' in using a tube that was too small. Dr Smith said it was a scenario that had never occurred to him, and that he believed the tube was functioning properly.

Mr Myers said that in relation to Baby K's first desaturation there had been no mention in Dr Jayaram's notes of a tube being dislodged.

Dr Smith said he had no memory of seeing blood-stained secretions during reintubation, nor any sign of trauma. Had he done so, he would have handed over to Dr Jayaram who was 'right there'.

He agreed there was no record to indicate whether the tube had been checked or that it had been clear.

Mr Myers asked about Baby K's second desaturation at around 6.15am, when Dr Jayaram pulled back the tube from 6.5cm depth to 6cm. Dr Smith said that was to see if it resulted in any effect on oxygen saturation levels.

The trial continues.