The Other Side of Lucy Letby (Michael McConville)

In episode 15 part 1 we examine the case of Baby C. References used: https://journals.lww.com/anesthesia-analgesia/fulltext/2015/06000/outcomes_for_extremely_premature_infants.25.aspx https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10670916/ https://onlinelibrary.wiley.com/doi/full/10.1111/apa.15225 https://www.theijcp.org/index.php/ijcp/article/view/352/299 Abstract Continuous positive airway pressure (CPAP) administered as a mixture of oxygen and compressed air via nasal prongs has dramatically improved survival rates and lessened the frequency of barotrauma and bronchopulmonary dysplasia in the premature infant with respiratory distress syndrome. Associated with the increased use of nasal CPAP has been the development of marked bowel distension (CPAP belly syndrome), which occurs as the infant's respiratory status improves and the baby becomes more vigorous. To identify contributing factors, we prospectively compared 25 premature infants treated with nasal CPAP with 29 premature infants not treated with nasal CPAP. Infants were followed up for development of distension, defined clinically as bulging flanks, increased abdominal girth, and visibly dilated intestinal loops. We evaluated birth weight, weight at time of distension, method of feeding (oral, orogastric tube), and treatment with nasal CPAP and correlated these factors with radiologic findings. Of the infants who received nasal CPAP therapy, gaseous bowel distension developed in 83% (10/12) of infants weighing less than 1000 g, but in only 14% (2/14) of those weighing at least 1000 g. Only 10% (3/29) of infants not treated with nasal CPAP had distension, and all three weighed less than 1000 g. Presence of sepsis and method of feeding did not correlate with occurrence of distension. Neither necrotizing enterocolitis nor bowel obstruction developed in any of the patients with a diagnosis of CPAP belly syndrome. Our study shows that nasal CPAP, aerophagia, and immaturity of bowel motility in very small infants were the major contributors to the development of benign gaseous bowel distension. https://pubmed.ncbi.nlm.nih.gov/1727337/ https://www.theijcp.org/index.php/ijcp/article/view/352/299 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10064400/ Sudden death in preterm neonates can be attributed to several critical factors, often related to the complications of prematurity and the vulnerability of their underdeveloped organ systems. Here are the main causes: 1. **Respiratory Distress Syndrome (RDS)**: This is one of the most common causes of death in preterm infants. It results from insufficient surfactant production in the lungs, leading to collapsed air sacs and inadequate oxygenation[6]. 2. **Infections**: Preterm neonates are highly susceptible to infections such as sepsis, pneumonia, and meningitis due to their immature immune systems. These infections account for a significant proportion of neonatal deaths[2][4]. 3. **Intraventricular Hemorrhage (IVH)**: This is a type of bleeding in the brain that is more common in preterm infants, particularly those with very low birth weights. Severe cases can lead to catastrophic brain injury and death[5][6]. 4. **Necrotizing Enterocolitis (NEC)**: NEC is a serious gastrointestinal condition that involves inflammation and bacterial invasion of the intestine, which can lead to bowel necrosis and perforation. It is a significant cause of mortality in preterm infants[6]. 5. **Pulmonary Hemorrhage**: This involves bleeding into the lungs and can occur suddenly, leading to rapid deterioration and death[6]. 6. **Sudden Infant Death Syndrome (SIDS)**: Although more commonly associated with older infants, preterm infants are at increased risk for SIDS, which is characterized by the sudden and unexplained death of an otherwise healthy infant[3]. 7. **Asphyxia**: This occurs when there is insufficient oxygen supply to the infant before, during, or after birth, leading to potential brain injury and death[2].

Final Thoughts on Baby N

 

Show notes: https://docs.google.com/document/d/1KUIB6TeimjSjuInwIVZudJgwHgryn5RRV5bBnYmQti8/edit?usp=sharing

 

 

A basic analysis of the International Panel Review into the true causes of death of some the babies at the Countess of Chester Hospital in 2015-2016

https://unherd.com/2025/02/why-the-letby-case-isnt-closed/

https://www.telegraph.co.uk/news/2024/10/02/lucy-letby-thirlwall-inquiry-countess-chester-hospital/

https://archive.ph/OjC0y

 

Continuing look at the Lucy Letby Appeal.

 

Final thoughts on baby's F and L. What about the potassium?

Show Notes: https://docs.google.com/document/d/1tbc1FscQ-6fTfzijWzMOx06ajXlrvIvRHhtyf2YT2Cg/edit?usp=sharing

 

 

 

Continuing analysis of the International Panel of Experts

A lack of coordinated care is all too common in medical practice and is evident in this case. There are perfectly acceptable medical reasons for the collapses and death of Baby I, that are far removed from the fantastical and baseless conclusion of the cheif witness in this trial.

Link to Tattle life Wiki: https://tattle.life/wiki/lucy-letby-case-8/#child-i

Link to show notes: https://docs.google.com/document/d/1HT1AqoMvVBDxoWekK_Q5Hs2F94b_nwrQ3P7fp4960AU/edit?usp=sharing

 

Thoughts on Mark McDonald, Lucy Letby's new defence barrister, in a recent press conference.

Link to conference: https://www.youtube.com/watch?v=Sy6HIjJA0TA

 

The addition and removal of insulin from preterm neonates is still largely a mystery and varies significantly from one baby to the next. Some institutions use experimental mathematical models to estimate insulin requirements. The calculations needed are hugely complex and subject to error and assumption. But not for the experts in the Letby trial. 

One immunoassay for insulin and C-peptide is insufficient to prove exogenous insulin poisoning. Here are the key reasons:

1. Traditional immunoassays can have cross-reactivity with non-target compounds and may not be able to differentiate between endogenous insulin and recombinant pharmaceutical analogues[1][2][4].

2. Immunoassays are unreliable for postmortem specimens due to interferences with hemolyzed samples and are generally unsuitable for forensic purposes[1][2].

3. Accurate diagnosis requires measuring insulin, C-peptide, and proinsulin and interpreting these in context with each other. A single immunoassay cannot provide the comprehensive data needed for a definitive diagnosis[2][5].

4. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is now considered the definitive method for measuring insulin, C-peptide, and proinsulin, especially in forensic investigations, due to its ability to discriminate between various synthetic analogues[1][2].

Therefore, relying solely on one immunoassay for insulin and C-peptide is insufficient to prove exogenous insulin poisoning. A combination of tests, including LC-MS/MS, and a thorough clinical and forensic investigation are necessary to diagnose accurately.

Citations: [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6507008/

[2] https://jlpm.amegroups.org/article/view/5995/html

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2556768/

[4] https://www.sciencedirect.com/science/article/abs/pii/S0009912015002787

[5] https://onlinelibrary.wiley.com/doi/full/10.1002/pdi.875

Tattle Life link: https://tattle.life/wiki/lucy-letby-case-6/#professor-peter-hindmarsh

Show notes link: https://docs.google.com/document/d/1yK22YKISPEIS_enWH_HEdsTBseTqrPJKYUwOIiTODeg/edit?usp=sharing

 

In episode 30, we take a brief look at the chaotic care of Baby H. The NNU, with 13 babies and only four nurses, is a clear example of systemic failures. Every identified failing in the RCPCH report is in play, yet the blame is malignantly shifted to Letby. The behaviour towards patients in this example is shockingl. The standard of practice is abysmal, and the integrity of the prosecution is non-existent. 

https://tattle.life/wiki/lucy-letby-case-8/#mother

 

Dr Jayaram's inconsistent story about Baby K, for me is not credible. Letby was retried for the attempted murder, perhaps to save Jayaram's blushes. His public claim that the only reason that preterm babies dislodge ET tubes is not true.

https://feed.podbean.com/1962strat/feed.xml

 

Show notes: https://docs.google.com/document/d/1N92i69K4HSdzqi2KwE5s5PN5Wmc7C-5rDwgV--tUPU8/edit?tab=t.0

 

Baby O and Baby P. Out of place and out of time.

 

Tattle Life Wiki: https://tattle.life/wiki/lucy-letby-case-11/#child-o-amp-p-triplets

Show Notes: https://docs.google.com/document/d/1IcTHGuqQdQK1qlCDLS4SBRLOENkduxpqt8K2Fxd8FNc/edit?usp=sharing

 

 

Continued look at the COA judgement.

https://www.judiciary.uk/wp-content/uploads/2024/07/R-v-Letby-Final-Judgment-20240702.pdf

Paediatric and perinatal postmortem imaging: the need for a subspecialty approach.

https://www.researchgate.net/profile/Owen-Arthurs

American Journal of Perinatology Vascular air embolism in neonates: a literature review

 

 

 

Episode 35 is a quick review of the recent book Unmasking Lucy Letby, with a little science thrown in, which is more than can be said for the book.

Show Notes: https://docs.google.com/document/d/1vdALlJDrm5Bkd8P1WRSDSUDM6ia4xQzbrkBjgljY38I/edit?usp=sharing

 

 

 

Continuing my analysis of the Court of Appeal ruling in the Case of Lucy Letby.

Continuing to look at the Court of Appeal ruling against Lucy Letby.

https://www.bbc.co.uk/news/articles/c87873j449vo

https://www.judiciary.uk/wp-content/uploads/2024/07/R-v-Letby-Final-Judgment-20240702.pdf

https://docs.google.com/document/d/1fsjuT8VlvD-6ZsftxDxvdCfQ3qlnIwUu82bNTNqTsdo/edit?usp=sharing

 

 

Continuation of analysis of the Court of Appeal ruling against Lucy Letby.

Without an autopsy every opinion of the expert witnesses is mere speculation, some of it quite extraordinary and inappropriate for professional people. 

Opening thoughts on Baby N

 

Shoe notes: https://docs.google.com/document/d/12lUc8ZMnK2TUcriE8AFQrf9lEimVptP7fP1EBv1ZPOA/edit?usp=sharing

 

Final thoughts on Baby D. May she rest in peace.

Link to short essay 

https://www.perplexity.ai/page/neonatal-interuterine-pneumoni-dZsUdXwnQu2IkXX3HjtX7A

Papers By Professor Arthurs: https://pubmed.ncbi.nlm.nih.gov/?term=Arthurs%20OJ%5BAuthor%5D

 

In Episode 27, we move on with the case of Baby F and argue that the single immunoassay test used to construct the story that Baby F was poisoned should have been inadmissible as evidence and grounds for appeal. In the absence of a defence witness, the lawyer's ignorance of the nuances of medicine devastated Letby.

RSS feed: https://feed.podbean.com/1962strat/feed.xml

Tattle Life link: https://tattle.life/wiki/lucy-letby-case-6/

Link to show notes: https://docs.google.com/document/d/1HgBpAGPgiqD5FjVxAgmMVexY1dTJTJOLsGDeT4n1K9s/edit?usp=sharing

 

This episode examines the complexities of maintaining adequate glucose levels in preterm neonates. The expert witnesses in the Lucy Letby trial reduced these real-world challenges to primary school simplicity and offered only one outlandishly improbable possibility. This will contrast with the next episode, where we explain the flaws in the expert evidence in the case of Baby F.

Reference to the article discussed:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4753077/pdf/nihms755707.pdf

 

 

 

A few random thoughts on the trial of Lucy Letby, open justice, freedom of information and censorship.

Dewi Evan's interview with Raj Persaud, in retrospect.

https://rajpersaud.libsyn.com/lucy-letby-the-untold-story-from-the-key-prosecution-expert-witness-dr-dewie-evans-talks-to-dr-raj-persaud

 

Continued review of the Lucy Letby Appeal and analysis of the absence of any acceptable medical or scientific practice standard from the expert witnesses.

An introduction to the circumstance of the death of Baby I, where so called expert witnesses boil almost three months of progressive deterioration of a critically ill preterm neonate, into four single events. They do so in defiance of our knowledge of the cumulative effects of disease and its relationship to mortality and the extremely high mortality of neonates born after premature rupture of membranes at or before 21 weeks gestation.

https://tattle.life/wiki/lucy-letby-case-8/#child-i

Very premature rupture of membranes (PPROM) at 21 weeks gestation has significant effects on neonatal mortality and morbidity.

The survival rate for neonates born after PPROM at less than 24 weeks gestation is generally low. Studies indicate that survival with rupture of membranes at less than 21 weeks of gestation is rare. The survival rate to discharge can be highe with expectant management with one study claiming that 26% of babies survived to discharge from hospital when PPROM occurred before 23 weeks gestation.

Neonates who survive PPROM at such early gestational ages often experience severe morbidity. Studies have shown that among survivors, a high percentage experience severe morbidities such as intraventricular hemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia, and necrotizing enterocolitis. For instance, one study reported that 77.8% of survivors experienced severe morbidity at the time of discharge.

The duration of the latency period (time between onset of PPROM and birth) is a critical factor. Longer latency periods are associated with better survival rates and fewer severe morbidities. For example, a study found that later gestational age at PPROM and longer latency periods were significantly associated with survival without severe morbidities, but these studies do not include premature rupture of membranes occurring at 21 weeks gestation. 

The gestational age at birth also plays a crucial role. Babies born at more advanced gestational ages tend to have better outcomes. For instance, one study found that survivors were born at more advanced gestational ages compared to non-survivors.

In summary, PPROM at 21 weeks gestation is associated with high neonatal mortality and morbidity rates. 

Citations:

Neonatal outcomes in women with preterm premature rupture of membranes at periviable gestational age

 

Preterm Premature Rupture of Membranes Between 14 and 24 Weeks of Gestation Outcomes With Expectant Management

 

Preterm infant outcomes in relation to the gestational age of onset and duration of prelabour rupture of membranes: a retrospective cohort study

 

Preterm prelabour rupture of membranes before 23 weeks’ gestation: prospective observational study

 

Prognosis of preterm premature rupture of membranes between 20 and 24 weeks of gestation: A retrospective cohort study

 

Analysis of the clinical baloney of the case of Baby L

 

Tattle life Link: https://tattle.life/wiki/lucy-letby-case-10/#prosecution-opening-statement-child-l

 

Show notes: https://docs.google.com/document/d/1ILJApDGuJhL2lD8E1r7FyZR1rVt6zkj-SmIqlgTja9I/edit?usp=sharing

Not only was the evidence against Lucy Letby in the Baby F case circumstantial, but the circumstances were a menu of assumptions. How on earth is this just?

Show notes: https://docs.google.com/document/d/1a90Z6DiIYQGxrpwka1jkDBYi9UCgUWNyPE0ockfhXqI/edit?usp=sharing

Tattle Life Wiki: https://tattle.life/wiki/lucy-letby-case-6/

 

 

The ultimate stable baby at the CoCH. Thirty weeks gestation, actively bleeding from the gut, has lost at least 25% of total blood volume, is on 100 oxygen and is still "a stable baby".

Tattle Life Wiki: https://tattle.life/wiki/lucy-letby-case-5/

Show notes.

https://docs.google.com/document/d/1MeX2ipz0PRKCGQC1mLb3kmg6DkKSNbadwK36tpagTKs/edit?usp=sharing

 

 

In a long episode we analyse the basic medical science that can easily explain the collapse of Baby J. 

Tattle Life Link: https://tattle.life/wiki/lucy-letby-case-9/#child-j

Show notes link: https://docs.google.com/document/d/116CV35WDmiXb4f1zNDIChiLNB0FMockTY01ZJosAQuM/edit?usp=sharing

 

Continuing the review of the Court of Appeal Ruling against Lucy Letby.

Final analysis of the international panel review.

Recommended YouTube channels:

https://www.youtube.com/@StuartGilham

https://www.youtube.com/@JabesAllowed

https://www.youtube.com/@hopeisthething1965

https://www.youtube.com/@cperkins4114

 

In this episode, we continue with the expert witnesses in Baby E's case. Without post-mortem findings, it's open season for the imagination, bizarre claims abound, and the defence remains in the trenches.

Tattle Life Wiki: https://tattle.life/wiki/lucy-letby-case-5/

Link to detailed show notes

https://docs.proton.me/u/0/doc?mode=open&volumeId=nQGA2CWSuKl6zOCuObFrpj6OeqaqusHoARmBS4bl5n2lrVzNZDYAqOOdHe9vH8dqcz0u5l_pBrbmwCurC2ZWCQ%3D%3D&parentLinkId=ihkEGwDzluWqaim1zWuhrKyUrikwAw4Npj5jEI-5yDDhRa_jUq-0KhMgwMfL1MNQGLjLHF01lZcZU4f3edULBg%3D%3D&linkId=C3Odrqhs9belrlvrQxrr40tjb9v_Yny2CPBLdFDEqYVrP-Ob1p_u265KGWLkAgq3SqAlSAwxc7k6MwZdSx6mNA%3D%3D

In the final part of the analysis of Baby the expert witnesses conveniently miss other episodes of "projectile" vomiting, not caused by injecting air ( or something else) into the stomach.

Tattle Life WiKI: https://tattle.life/wiki/lucy-letby-case-7/

Show notes: https://docs.google.com/document/d/1X98yb_nMiRE0FyBVSnWMXOAi0U3VIRCObFj9Q0wj2F4/edit?usp=sharing

 

Show Notes:

https://docs.google.com/document/d/1r2HoSFEDhKjyPERLuJJLP3a1BngMUDy1rEpW52xjk-Q/edit?usp=sharing

Rex V Letby Court of Appeal: https://www.judiciary.uk/wp-content/uploads/2024/07/R-v-Letby-Final-Judgment-20240702.pdf

 

Show notes: https://docs.google.com/document/d/1vhPDBPBbYwU4VekCs1HKGd0T7ZVKh1-qp42DqmO8bKU/edit?usp=sharing

 

 

Tattle Life Wiki: https://tattle.life/wiki/lucy-letby-case-11/#agreed-facts-child-o-amp-p

Show notes: https://docs.google.com/document/d/1hRM4SPkB9ApoU_mlqWA27M3IL4ppBt1suNbJ_Xltyfo/edit?usp=sharing

 

Academia strikes back. The 4/2/2025 Shoo Lee press conference that will change everything.

A continuing look at the Court of Appeal Ruling against Lucy Letby. How can so many scientific falsehoods go unnoticed?

https://www.judiciary.uk/wp-content/uploads/2024/07/R-v-Letby-Final-Judgment-20240702.pdf

Show notes: https://docs.google.com/document/d/1mVgVTNmZSCRb4-Wz4VhM3vH4HYUbRySSWRpcuXuOYwE/edit?usp=sharing

 

Reaching the end of my analysis of the flaws in the Letby appeal.

Why were there ever indictments for Babies F and L?

Show Notes: https://docs.google.com/document/d/1WzB0vdthD-Nm6Ibgz_tpl3oQ43JobenP8BpG6zAf8oE/edit?usp=sharing

 

A review of the Court of Appeal through the eyes of a scientist.

 

https://www.judiciary.uk/wp-content/uploads/2024/07/R-v-Letby-Final-Judgment-20240702.pdf

 

 

The Road to Hell Part 2: Death of Baby O

Tattle Life Wiki: https://tattle.life/wiki/lucy-letby-case-11/#agreed-facts-child-o-amp-p

Show notes: https://docs.google.com/document/d/1pySZHl9lqOtnua88jCpeEox_GtmpyrFCJQ0yz010BBk/edit?usp=sharing

 

The final part of an analysis and theory of the death of Baby O

Tattle Life Wiki: https://tattle.life/wiki/lucy-letby-case-11/#prosecution-opening-statement-child-o

Show notes: https://docs.google.com/document/d/1y7mWFpcVMh1wxir5oj4aCD93snpDulgDwbev8heCnvc/edit?usp=sharing

 

We finish the evidence given by Dewi Evans in the case of Baby A

A stripped-down analysis of Dr Jayaram's statement about Baby A compared to Dr Harkness' and the Lee and Tanswell Paper

In episode 12, we finish Babies A and B and look at Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883377/ https://tidsskriftet.no/en/2018/05/oversiktsartikkel/outcomes-following-neonatal-cardiopulmonary-resuscitation https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665124/ https://www.indianpediatrics.net/dec2018/1089.pdf https://www.sciencedirect.com/science/article/abs/pii/S030095721500252X https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3599160/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1719711/pdf/v089p01043.pdf https://www.medigraphic.com/cgi-bin/new/resumenI.cgi?IDARTICULO=101279 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5052132/

A brief introduction to the podcast series. The podcast will examine the scientific validity of claims made by the prosecution and expert witness at the trial of Lucy Letby

Erratum Professor "Owens" is actually Professor Arthurs. Reimagining the Letby Defence Baby C part. 3 https://pubs.rsna.org/doi/10.1148/113.1.155?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed https://etheses.whiterose.ac.uk/22429/1/Final%20copy_%20whitrose.pdf

In this episode, we finish off the evidence for Baby A

In this episode we consider the public record of the confusing evidence given against Lucy Letby in the trial of Baby A by a junior doctor. We see a continuation of the mystification of Letby by the use of yet more undocumented and anecdotal clinical evidence.

We look at a YouTube podcast claiming that concerns about the conviction of Lucy Letby are misinformation. Some papers referenced in episode 11: https://starship.org.nz/guidelines/insulin-neutral-for-the-newborn-intensive-care/ https://www.sciencedirect.com/science/article/abs/pii/S0025556416301183 https://www.rxlist.com/dextrose/generic-drug.htm https://academic.oup.com/qjmed/article/110/4/249/2843731?login=false https://www.sciencedirect.com/science/article/abs/pii/S0009912015002787 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9996747/ https://www.sciencedirect.com/science/article/pii/S0022347615003583 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775554/ https://www.ncbi.nlm.nih.gov/books/NBK537105/ https://folk.ntnu.no/skoge/prost/proceedings/ifac2014/media/files/0212.pdf

An analysis of the expert witness, Dr Sandie Bohin, for Baby A. https://www.resuscitationjournal.com/article/S0300-9572(15)00252-X/abstract https://www.indianpediatrics.net/dec2018/1089.pdf

In Episode 6, we analyse the evidence given by the Chief witness, Dewi Evans.

Baby C Part 2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937445/pdf/JIR2018-6963754.pdf References 1. Poets, C.F. ∙ Roberts, R.S. ∙ Schmidt, B. ... Association between intermittent hypoxemia or bradycardia and late death or disability in extremely preterm infants JAMA. 2015; 314:595-603 Crossref Scopus (317) PubMed Google Scholar 2. Fairchild, K. ∙ Mohr, M. ∙ Paget-Brown, A. ... Clinical associations of immature breathing in preterm infants: part 1-central apnea Pediatr Res. 2016; 80:21-27 Crossref Scopus (72) PubMed Google Scholar 3. Martin, R.J. ∙ Di Fiore, J.M. ∙ Davis, R.L. ... Persistence of the biphasic ventilatory response to hypoxia in preterm infants J Pediatr. 1998; 132:960-964 Full Text Full Text (PDF) Scopus (86) PubMed Google Scholar 4. Waggener, T.B. ∙ Frantz, III ∙ Cohlan, B.A. ... Mixed and obstructive apneas are related to ventilatory oscillations in premature infants J Appl Physiol. 1989; 66:2818-2826 Crossref Scopus (20) PubMed Google Scholar 5. Bolivar, J.M. ∙ Gerhardt, T. ∙ Gonzalez, A. ... Mechanisms for episodes of hypoxemia in preterm infants undergoing mechanical ventilation J Pediatr. 1995; 127:767-773 Full Text Full Text (PDF) Scopus (122) PubMed Google Scholar 6. Esquer, C. ∙ Claure, N. ∙ D'Ugard, C. ... Role of abdominal muscles activity on duration and severity of hypoxemia episodes in mechanically ventilated preterm infants Neonatology. 2007; 92:182-186 Crossref Scopus (36) PubMed Google Scholar 7. Esquer, C. ∙ Claure, N. ∙ D'Ugard, C. ... Mechanisms of hypoxemia episodes in spontaneously breathing preterm infants after mechanical ventilation Neonatology. 2008; 94:100-104 Crossref Scopus (30) PubMed Google Scholar 8. Dormishian, A. ∙ Schott, A. ∙ Aguilar, A.C. ... Etiology and mechanism of intermittent hypoxemia in spontaneously breathing extremely premature infants J Pediatr. 2023; 262:113623 Full Text Full Text (PDF) Scopus (3) Google Scholar 9. Leung, A.K.C. ∙ Leung, A.A.M. ∙ Wong, A.H.C. ... Breath-holding spells in Pediatrics: a narrative review of the current evidence Curr Pediatr Rev. 2019; 15:22-29 Crossref Scopus (37) PubMed Google Scholar 10. Southall, D.P. ∙ Samuels, M.P. ∙ Talbert, D.G. Recurrent cyanotic episodes with severe arterial hypoxaemia and intrapulmonary shunting: a mechanism for sudden death Arch Dis Child. 1990; 65:953-961 Crossref Scopus (90) PubMed Google Scholar 11. Dormishian, A. ∙ Schott, A. ∙ Aguilar, A.C. ... Pulse oximetry reliability for detection of hypoxemia under motion in extremely premature infants Pediatr Res. 2023; 93:118-124 Crossref Scopus (9) PubMed Google Scholar 12. Rhein, L.M. ∙ Dobson, N.R. ∙ Darnall, R.A. ... Effects of caffeine on intermittent hypoxia in infants born prematurely: a randomized clinical trial JAMA Pediatr. 2014; 168:250-257 Crossref Scopus (131) PubMed Google Scholar

This episode describes the medical condition of Baby A's mother and the condition of her babies at birth

In this episode we examine the value of evidence given by Professor Owen Arthurs in the case of Baby A

A personal description of the fate of Baby D who arguably developed pneumonia while still in utero. A baby with findings of acadaemia while in ICU,a circumstance often lethal to newborns and which occurred long before Letby's involvement. A blood pH between 7.194 and 7.173 in a 2-day-old term neonate with pneumonia is concerning and potentially dangerous, as it indicates significant metabolic acidosis. 1. Normal blood pH range: The normal arterial blood pH range for neonates is 7.35-7.45[1]. A pH below 7.35 is considered acidosis. 2. Severity of acidosis: The pH values of 7.194 and 7.173 are well below the normal range, indicating moderate to severe acidosis[2]. This level of acidosis can have serious implications for the newborn's health. 3. Causes and implications: - Pneumonia in neonates can lead to respiratory acidosis due to impaired gas exchange and CO2 retention[3]. - Metabolic acidosis may also occur due to sepsis, tissue hypoxia, or poor perfusion associated with severe pneumonia[4]. - Acidosis of this severity can negatively impact various organ systems, including the cardiovascular, respiratory, and central nervous systems[5]. 4. Potential complications: - Severe acidosis can lead to myocardial dysfunction, decreased cardiac output, and hypotension[4]. - It may also cause pulmonary vasoconstriction, potentially worsening respiratory distress[4]. - Neurological complications such as intraventricular hemorrhage are associated with severe acidosis in neonates[6]. 5. Need for intervention: - A pH this low requires immediate medical attention and intervention to correct the underlying cause and manage the acidosis[2]. - Treatment may include respiratory support, antibiotics for pneumonia, fluid management, and in some cases, cautious use of buffer solutions like sodium bicarbonate[7]. 6. Monitoring and follow-up: - Close monitoring of blood gases, electrolytes, and clinical status is crucial[2]. - Serial measurements are important to track the response to treatment and guide further management. A blood pH between 7.194 and 7.173 in a 2-day-old neonate with pneumonia is dangerous and requires urgent medical intervention. The acidosis needs to be addressed promptly to prevent potential complications and improve outcomes. Citations: [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8558493/ [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2869402/ [3] https://onlinelibrary.wiley.com/doi/full/10.1111/apa.16127 [4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10662854/ [5] https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/neonatal/blood-gas-interpretation-for-neonates [6] https://onlinelibrary.wiley.com/doi/full/10.1111/ppe.12663 [7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4533247/ [8] https://www.medicalnewstoday.com/articles/ph-of-blood [9] https://www.cochrane.org/CD003215/NEONATAL_base-administration-or-fluid-bolus-for-preventing-morbidity-and-mortality-in-preterm-infants-with-metabolic-acidosis

In episode 13 we look at the podcast https://www.youtube.com/watch?v=K7iWU_0FDXg&t=198s&pp=ygUaTHVjeSBMZXRieSBkb3VibGUgamVwb3JkeSA%3D Here are some citations used in the episode: [1] https://www.nature.com/articles/s41598-020-59566-3 [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8266827/ [3] https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/ unexplaineddeathsininfancyenglandandwales/2021 [4] https://www.thelancet.com/journals/langlo/article/PIIS2214-109X%2822%2900043-2/fulltext [5] https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/unexplaineddeathsininfancyenglandandwales/2018 [6] https://www.england.nhs.uk/long-read/perinatal-post-mortem-investigation-of-fetal-and-neonatal-deaths-england-scotland-and-wales/ [7] https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-11-S3-S11 [8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860427/ [9] https://bmcemergmed.biomedcentral.com/articles/10.1186/s12873-018-0208-z [101 https://link.springer.com/article/10.1007/s12024-022-00511-3 [11] https://pubmed.ncbi.nlm.nih.gov/8439228/ [12] https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/617123 13] https://jlpm.amegroups.org/article/view/5995/html [14] https://pubmed.ncbi.nlm.nih.gov/31239889/ [15] https://www.medscape.com/viewarticle/432906_6 [16] https://www.ncbi.nlm.nih.gov/books/NBK542310/

The Death of Baby D or details and citations refer to https://docs.google.com/document/d/1Lql0NRpwxHhksnw0HmQAew1SbCGQMuheL_fBlDQ0nUk/edit?usp=sharing

Final thoughts on the explainable natural cause of death for Baby C https://academic.oup.com/bjr/article/96/1147/20211078/7469184 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10746609/ https://insightsimaging.springeropen.com/articles/10.1186/s13244-021-01042-1 https://www.nature.com/articles/s41390-018-0075-z

In Episode 7 we continue with the evidence of the chief witness Dewi Evans in the

A brief look at the Lee and Tanswell Paper used to convict Lucy Letby: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1592039/pdf/archdisch00901-0075.pdf And references to material used in this podcast: file:///Users/michaelsmacbookair/Downloads/kogutt-2012-systemic-air-embolism-secondary-to-respiratory-therapy-in-the-neonate-six-cases-including-one-survivor.pdf https://www.ajronline.org/doi/epdf/10.2214/ajr.131.3.425 https://pubmed.ncbi.nlm.nih.gov/98984/ https://pubmed.ncbi.nlm.nih.gov/1106225/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2984251/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC524111/ https://www.frontiersin.org/articles/10.3389/fped.2023.1094855/full https://erj.ersjournals.com/content/42/6/1536 https://pubmed.ncbi.nlm.nih.gov/16161157/ https://www.sciencedirect.com/science/article/abs/pii/S0379073812005488 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC524111/ https://erj.ersjournals.com/content/42/6/1536 https://www.sciencedirect.com/science/article/abs/pii/S0379073812005488 https://www.nejm.org/doi/full/10.1056/NEJM197005142822007 https://pubmed.ncbi.nlm.nih.gov/382064/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1627609/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1627609/pdf/archdisch00760-0077.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381094/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1763230/pdf/v088p0F521.pdf https://venice.ai/chat/aa5a34c6-e925-4427-bc5a-5fc171d69406#veniceShareKey=kCTumERVyA47XHh1BCDG43%2FWso5d0ke6oXfNrbMTo%2BY%3D&veniceShareNonce=1v4W3Gv3HOszMhwxQZ5Sbhq52qEMJLSJ https://pubs.asahq.org/anesthesiology/article/106/1/164/8884/Diagnosis-and-Treatment-of-Vascular-Air-Embolism