The Other Side of Lucy Letby

Circumstances made to measure

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].

Apples, Oranges and Gobbledygook

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

Shadow of a Doubt

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/

Quackery

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/

Misinformation

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

Farce heaped on farce

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

Not stable, extremely stable

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

Ruling in and Ruling Out

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

No New Research

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

Sounds Like My Kind of Case

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