COUNTESS of Chester Hospital nurse Lucy Letby injected air into new-born twins, leading one to die and one to suffer a non-fatal-collapse, within just 28 hours of each other, a jury has been told.

Letby is accused of the murder of seven babies at the hospital's neonatal unit between June 2015 and June 2016. She has pleaded not guilty to all of those charges.

The 32-year-old, from Arran Avenue, Hereford, is also accused of the attempted murder of 10 babies, some on multiple occasions. Letby has denied all 15 attempted murder charges.

Prosecuting at Manchester Crown Court on the afternoon of Monday, October 10, Nicholas Johnson KC gave details of the prosecution's case for two of the babies named on the charges.

Due to reporting restrictions, the babies are named as Child A and Child B. Child A, a boy, and twin sister Child B were born at the Countess of Chester Hospital in June 2015 and placed in the neonatal unit, a special area of the hospital which looks after sick and/or vulnerable babies.

The court heard Child A died just 90 minutes after being passed into the care of Letby, while Child B suffered a non-fatal collapse 28 hours later, where Letby was present despite not being the designated nurse.

Mr Johnson told the court Child A was "stable" at the time care responsibility was passed over to Letby at the beginning of her night-shift.

The previous nurse had not been able to administer intravenous fluids during her daytime shift, so the process began under Letby's watch at 8.10pm.

But just 10 minutes later, Letby reported Child A had white feet and hands, and called a doctor to the incubator at 8.26pm as the boy was deteriorating.

Doctors at the time observed "an odd discolouration on Child A's abdominal skin - flitting patches of pink over blue skin that seemed to appear and disappear".

Mr Johnson said: "This proved to be the first of a series of similar presentations on the skin of babies suddenly and catastrophically collapsing at the Countess of Chester Hospital neonatal unit over the succeeding months.

"It is a hallmark of some of the cases in which Lucy Letby injected air into the blood streams of some of these small babies."

Child A was pronounced dead at 8.58pm, less than 90 minutes after Letby began her 7.30pm night shift.

Mr Johnson said independent medical experts had concluded the cause was "not some natural disease process", but a dose of air "deliberately administered".

In a police interview, it was put to Letby that she had administered an air emolus. She replied it would have been very hard to push air through the line.

In a November 2020 police interview, police put to her that Letby had tracked the family of Child A on Facebook. She said she had no memory of doing so but accepted it if there was evidence on her computer doing so.

The prosecution said there was evidence.

The court also heard the prosecution case in respect of Child B, who was stable after initial breathing difficulties at birth, which had required ventilator support.

Letby was not the designated nurse for Child B on her night-shift, but Letby had taken Child B's blood gases at 12.16am, and had started a bag of liquid feed with the assistance of the designated nurse, through an IV line, into Child B.

At about 12.30am, Child B's alarm sounded and Letby had called the nurse to the child's incubator. Child B was not breathing.

A crash call was put out at 12.33am, and resuscitation began. The nurse noted purple blotches and white patches all over Child B's body, and the heart rate had dropped.

In a witness statement three years later, Letby's colleague, the designated nurse for Child B, said she and Letby had been preparing antibiotics at the time of the collapse.

After efforts to resuscitate Child B, Child B "recovered very quickly".

A doctor subsequently found "loops of gas filled bowel".

The prosecution told the court this was a finding replicated many times in the upcoming cases.

Child B improved until being discharged the following month.

Mr Johnson told the court that independent medical expert Dr Dewi Evans concluded Child B was "subjected to form of sabotage" that night.

Mr Johnson said: "Here you can see that we have twins who were born prematurely but in pretty good condition.

"No one expected them to face grave problems, yet both suffered unusual symptoms within a short time of each other which in interview Lucy Letby said were similar.

"The prosecution’s expert paediatricians say that the collapses and skin mottling were the result of air being injected into their bloodstream.

"The first injection caused the death of [Child A], the second the dangerous collapse of his sister.

"We say that there is no plausible alternative to an air injection [air embolus]. The fact that it happened in two cases just over 24 hours apart shows that these were no accidents.

"Lucy Letby was the only person present [with Child A] at the time he collapsed...and was in the room when the same happened to [Child B].

"We also say that you are entitled to look at the evidence of what happened to [Child A and B] in the context of one, what Lucy Letby did to other children and two, most starkly, her having poisoned [two other children] with insulin."

It is the prosecution's case that other babies were injected with fluids - and in two cases, "poisoned" with insulin, with Mr Johnson telling the jury Letby was "a poisoner at work".

The trial continues on Tuesday.