A rigid wire or tube may have been used to cause “extraordinary bleeding” in a baby boy allegedly murdered by nurse Lucy Letby, a court has heard.
Jurors at Manchester Crown Court heard the infant lost a quarter of his blood volume before he collapsed and died in the Countess of Chester Hospital’s neo-natal unit.
The blood loss took place during a night shift on August 3 2015 in which Letby was the designated nurse for the premature-born twin boy, referred to as Child E.
The Crown says Letby, 32, injected a fatal amount of air into the bloodstream of the youngster.
Giving evidence on Friday, expert medical witness Dr Dewi Evans said he thought Child E had suffered a fatal air embolism – a blockage of the blood supply – after a treating medic noticed “unusual” purple patches on the child’s abdomen.
He said a second “major” issue was “significant haemorrhaging from the upper gastrointestinal tract, somewhere between the mouth and the stomach”.
Dr Evans said: “I think he (Child E) suffered trauma from some other form of injury and there were a number of bits of equipment on a neo-natal unit that are relatively rigid.
“Plastic tubes used for suction for interference, so it could have been interference with that.”
He said another medical instrument known as an introducer – a thin wire surrounded by plastic which can be used to intubate a baby – would be “more than sufficient to cause trauma if used inappropriately”.
Dr Evans said: “I cannot be 100 per cent certain what caused the trauma to the gastrointestinal system but it had to be some kind of relatively stiff (equipment) which was sufficient to cause this extraordinary bleeding.”
Prosecutor Nick Johnson KC asked the consultant paediatrician if there could be an “innocent explanation” for the level of bleeding.
Dr Evans replied: “No. The other explanation for this is a bleeding ulcer. I have never seen a bleeding ulcer cause this sort of presentation.”
In his initial reports Dr Evans said he was “at a loss” to explain the haemorrhaging and it was not possible to say if any deliberate harm took place because of an absence of a post-mortem.
In a further report – after he reviewed a statement from Child E’s mother who described “horrendous crying” from her son and blood around his mouth – he suggested something “had been done or used” to cause trauma.
Dr Evans suggested that a nasogastric tube could have been thrust into the baby’s stomach with inappropriate force.
However, he told the court he later saw the type of tube used by the hospital at the time and ruled out it could be capable of causing such damage.
Letby, originally from Hereford, denies the murders of seven babies and the attempted murders of 10 others between June 2015 and June 2016.