The Other Side of Lucy Letby

Mickey Mouse Medicine

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 Work of Fiction.

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/
 
 

Potentially

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
 
 

Experts who aren't expert.

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

No autopsy, no proof

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

"She was doing exceptionally well and was clinically very satisfactory.”

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
 

Not 100% Brilliiant

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

All Good Signs

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

Apples falling up

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

The ever changing Big Picture

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