A hospital consultant has told the Lucy Letby murder trial how he and other clinicians had previously raised concerns to bosses over an individual present as babies collapsed but were told “not to make a fuss”.

Dr Ravi Jayaram, a paediatrician at the Countess of Chester Hospital, added that he “didn’t really have any hard evidence apart from the association we had seen” and “it is a matter of regret and I wish I had been more courageous”.

He also said the unusual skin discolouration of Letby’s first alleged victim, a baby boy known as Child A, “didn’t fit with anything I had ever seen”.

He said he responded to an emergency alert after the premature newborn twin suddenly collapsed on the neo-natal unit after Letby allegedly caused him to stop breathing by injecting air into his bloodstream on the evening of 8 June 2015.

Dr Jayaram told Manchester Crown Court that he was aware there was talk on the unit about a “moving” purple rash on the body of Child A’s twin sister, Child B, who the Crown allege Letby, 32, tried to kill with a similar air injection the following night.

Dr Jayaram said there were similar discussions following the death of Child D on 22 June 2015, who is also said to have been murdered by the defendant using the same method.

The paediatrician said that around the time of Child A’s inquest he and a group of clinicians highlighted to hospital bosses the “association we had seen with an individual being present in those situations and, how do I say diplomatically, being told we really should not really be saying such things and not to make a fuss”.

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Dr Jayaram added it was a “matter of regret that had I suggested this, and it could have been happening, I didn’t really have any hard evidence apart from the association we had seen”.

“And it is a matter of regret and I wish I had been more courageous.”

Meanwhile, a nurse thought “not again” after Child A and Child B collapsed on successive nights at the neonatal unit, the trial also heard.

Giving evidence, Letby’s colleague said she was preparing medicines when the monitor alarm sounded at Child B’s incubator.

She added that Letby was the first who got to the cot and called her for help.

Asked about Child B’s appearance, she said: “She looked very like (Child A) the night before. Pale, white, with this purple blotchy discolouration. It was all over her body.

“I just remember thinking ‘not again’ – to see (another baby) with the same appearance.”

Child B “started to stabilise quite quickly” after a breathing tube was inserted, said the witness.

The nurse went on: “(Child A’s) deterioration was very sudden and to an unusual degree. Babies can be very poorly quickly but there is usually some indication that is happening. We had no undue concerns.

“To go from that is very unusual and then (Child B) had been good throughout the evening for me… then she became ill very quickly. She deteriorated very quickly and then this discolouration.”

Child B recovered and was eventually discharged a month later.

‘Mentor’ to Letby

The nurse said she couldn’t remember who administered intravenous fluids to Child A before his collapse but accepted she told police that another nursing colleague had “pressed start” in the process and Letby assisted with checks.

She said she acted as “mentor” to Letby, who first came to the unit as a trainee around 2010/11 while studying at the University of Chester.

They became “good friends”, she said, as Letby went on to join the unit after she qualified.

Defending Letby, Ben Myers KC asked the nurse: “We know the allegations but your experience when working with her was she was highly professional?

“Yes,” replied the witness.

Mr Myers said: “And dedicated to the work she was doing?”

“Yes,” agreed the witness.

Letby denies murdering seven babies and the attempted murders of 10 others while she worked at the neonatal unit between June 2015 and June 2016.

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