A line of gas in front of the spine of a baby allegedly murdered by nurse Lucy Letby was consistent with “air having been administered”, her trial has heard.

Paediatric radiologist Dr Owen Arthurs said the “unusual finding” showed up on the post-mortem X-ray of the newborn baby known as Child A.

Dr Arthurs told Manchester Crown Court its appearance was “consistent with, but not diagnostic, of air having been administered”.

Letby, 32, is on trial accused of the murders of seven babies and the attempted murders of 10 others at the Countess of Chester Hospital’s neo-natal unit.

The nurse is said by the prosecution to have injected air into the bloodstream of Child A, who later collapsed and died on the evening of 8 June 2015.

The baby died just over 24 hours after its premature birth.

Dr Arthurs, professor of radiology at London’s Great Ormond Street Hospital, had been instructed to review X-rays taken of Child A – when alive and after death – alongside other babies in the investigation, the jury was told.

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Looking at one of the post-mortem X-rays, he said to the court there was gas within the bowel – a normal feature, he said – and also the heart.

When prosecutor Nick Johnson QC asked if there was anything unusual about the X-ray, Dr Arthurs replied: “You can also see a line of gas just in front of the spine. That is an unusual finding.”

He said such an image would not be seen in deaths by natural causes but had been documented in cases of road traffic accidents and sepsis infection.

Line of gas was ‘unusual’

“In my opinion this was an unusual appearance. In the absence of any other explanation this appearance is consistent with, but not diagnostic, of air having been administered,” he added.

Dr Arthurs said he could not say from the image alone that an air embolism – a gas bubble which enters a blood vessel – was the cause of Child A’s death.

The baby did not have intravenous fluids for up to four hours on 8 June before it received glucose through a “long line” plastic tube at 8.05pm – shortly after Letby came on duty, the court previously heard.

Earlier on the shift, a cannula to a blood vessel stopped working, followed by two failed attempts to correctly insert a catheter in the belly button.

Dr Arthurs told the court it was “possible” that gas could have been introduced by one of those above devices.

When the prosecutor asked if Dr Arthurs had ever seen this much gas in a baby that has not been explained, he said “only in one other case” and agreed that it was in one of the other children in the case.

Nurse says Child A looked ‘very ill’

The medic said he based his opinion on a published peer-reviewed study in 2015 which looked at how common it is that gas occurs in older children who have died, albeit with “very few babies” included in the study. He went on to review the deaths of 500 infants at Great Ormond Street.

A nurse, who cannot be named for legal reasons, later told the jury she was on duty the night that Child A collapsed.

When asked by junior prosecutor Philip Astbury how the baby looked, the nurse said: “I had never seen a baby look like that way before. He looked very ill.”

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She said the baby had “a discolouration pattern I had never seen before. It was purple blotchiness with white”.

“It was everywhere. It came on very suddenly,” she added.

Dr Arthurs also reviewed the X-rays of Child B, who the Crown says Letby attempted to murder via an injection of air on the following night shift at the neo-natal unit.

He said he found “no significant abnormalities” on Child B’s radiographic images, including on a X-ray taken 40 minutes after the baby suffered a sudden collapse, which the Crown say Letby was responsible for.

Letby denies all the offences said to have been committed between June 2015 and June 2016.

The trial was adjourned until Monday morning.

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