COUNTESS of Chester Hospital nurse Lucy Letby attempted to murder child L and child M, twin boys, in similar circumstances to two other twin boys heard earlier in the trial, a court has been told.

Eight months earlier the Crown says Letby, 32, of Arran Avenue, Hereford, murdered child E by injecting air into his bloodstream and attempted to murder his brother, child F, by poisoning him with insulin.

Letby, who faces seven counts of murdering babies and 15 counts of attempted murder in relation to 10 further babies, has pleaded not guilty to all charges.

On April 9, 2016 Letby was working a day shift when she is said to have given an unauthorised dose of insulin to child L and while that attack was under way, she turned her attentions to child M by administering air into his circulation.

Nicholas Johnson KC, prosecuting, said: “By this time Lucy Letby was supposed only to be working day shifts because the consultants were concerned about the correlation between her presence and unexpected deaths and life-threatening episodes on the night shifts.”

The Crown say the defendant volunteered to work an extra shift on April 9 after she noted child L’s low glucose levels shortly after his birth the previous day.

Mr Johnson said: “We say that in effect she saw the opportunity to complete what she had attempted with (child F).”

The prosecutor told the court Lucy Letby had failed to kill child F so decided to increase the dose of insulin administered to child L.

He said the defendant went on to agree the insulin could not have been given accidentally but said she was not responsible.

Her only explanation was it must have already been in one of the bags he was receiving but the Crown say that was “not a credible possibility”, he added.

Mr Johnson said child M came “close to death” after his heart rate and breathing dropped dramatically without warning but improved on the night-shift that followed and went on to make a speedy recovery.

When Lucy Letby’s home, then in Chester, was searched two years later, a number of medical notes were found which detailed how many doses of adrenaline were given to child M during his collapse.

A note of his collapse was also recorded in her diary, the court heard.

Mr Johnson said: “She thought she had taken home the notes by accident and simply noted what had happened in her diary.

“She denied that the notes were a souvenir and she denied deliberately trying to harm (child M).

“We suggest these cases (children E, F, L and M) are similar in that one of each pair suffered an insulin overdose whereas it is suggested the other suffered an air embolism.

“What are the chances of that happening innocently? We suggest coincidences like that simply do not happen innocently.”

Child N was born at 34 weeks on June 2, 2016 at the Countess of Chester Hospital, weighing 3.6lbs.

His clinical condition was described as “excellent” although he did have mild haemophilia, a blood disorder.

Mr Johnson said this meant Letby believed, wrongly, that his haemophilia gave her “cover” to attack him – because if he bled it would be put down to the condition.

The nurse allegedly went on to attack him three times.

In fact, children with mild haemophilia rarely bleed for no reason, the jury at Manchester Crown Court heard.

The day child N was born, Lucy Letby was one of five nurses working the night shift on the neo-natal unit.

At 1.05am, the day-old baby suffered a sudden lowering of his blood oxygen levels to life-threatening levels.

Unusually for such a small, premature baby he was "crying and screaming". The child recovered after emergency assistance from doctors and nurses.

Independent medical experts said the baby’s sudden deterioration was consistent with some kind of “inflicted injury” or him having received an injection of air.

Twelve days later, on June 15, Letby is alleged to have made two more attempts to murder child N.

Child N was almost ready to go home, except for treatment for jaundice when Letby came in on for her day shift and went to child N’s room to say ‘hello’, the court was told.

When a second nurse had her back turned Letby told her the baby had lost oxygen and immediately assisted with his breathing.

A doctor was called but was unable to put a breathing tube into the child after discovering fresh blood inside his mouth. The medic could not see the back of the child’s throat as it was so swollen.

Around 3pm that day there was a further collapse of child N with his oxygen levels falling to life-threatening levels and a further attempt to insert a breathing tube again found blood in his throat.

He was later transferred to a specialist children’s hospital in Liverpool, where he recovered quickly.

Independent medical experts suggested the blood in child N’s mouth was as a result of the “thrusting” of a tube into the back of his throat to inflict injury, the court heard.

The prosecution also told of Child O, one of three triplet brothers, who was allegedly murdered.

Child O weighed 2.02kgs, which was good for a premature triplet. He was in good condition and made good progress.

He was stable up to June 23, when he suffered what medical expert Dr Dewi Evans said was a “remarkable deterioration” and died.

Prior to Child O's collapse, a colleague said of Child O: "he doesn’t look as well now as he did earlier. Do you think we should move him back to [room] 1 to be safe?"

Letby did not agree.

The prosecution is due to complete its outline of the case tomorrow (Thursday). The defence is also expected to outline its case the same day.