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

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

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

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

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 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.

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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

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/