A DOCTOR recalled “unusual” skin mottling on a baby girl allegedly murdered by nurse Lucy Letby, a jury heard.

Letby, 33, is accused of injecting air into the youngster’s stomach via a feeding tube during a night shift at the Countess of Chester Hospital’s neonatal unit.

It is said to have been the defendant’s third attempt to kill her before she allegedly succeeded in another similar attack more than a week later in October 2015.

Giving evidence on Wednesday, February 1, registrar Dr Matthew Neame told Manchester Crown Court the premature-born infant, known as Child I, was “stable” when he examined her at 10.05pm on October 13.

He said he thought Letby asked him to see Child I at 5.55am on October 14 as her oxygen requirements had increased.

On examination, Dr Neame noted her abdomen was “distended”, “mottled” and with “some tenderness”.

He said he noticed Child I’s eyes were open and she “grimaced”.

Dr Neame said: “I don’t recall it clearly but it’s unusual to see mottling on the abdomen.

“My impression was the increase in abdomen distension may have caused (Child I’s) lungs to be squashed… making it hard for her to breathe.”

The court heard Letby retrospectively noted that at 5am Child I’s abdomen was “more distended and firmer in appearance with area of discolouration spreading on the right side”.

Letby, who was Child I’s designated nurse, noted she gave antibiotics at 5.05am.

She also retrospectively noted that at 5.30am Child I’s “abdo distended ++”.

Jurors were told that at 7am Child I had a “significant” drop in blood oxygen levels and heart rate.

At 7.45am, her heart rate fell “dangerously low” to below 60 beats per minute, said Dr Neame, which prompted CPR to begin.

Thirteen minutes of resuscitation from medical staff followed before she recovered.

The court has heard evidence of numerous babies having a “mottled, discoloured” appearance before collapsing.

Ben Myers KC, defending, asked Dr Neame: “Your view is mottling normally means circulation is not as good as it should be?”

Dr Neame replied: “That’s right.”

Mr Myers went on: “And the underlying cause could be infection in some cases?

Dr Neame said: “Yes (but) when seen infection is usually accompanied by other signs.”

Mr Myers said: “Or low oxygen levels?

The witness said: “It can be.”

In WhatsApp messages read to the court, Letby asked a colleague on the afternoon of October 14 if Child I was staying on the unit.

She added: “I’d like to keep her please.”

Her colleague, who cannot be identified for legal reasons, replied: “Yes. Staying for now. OK re keeping.”

An hour later the colleague messaged: “I’ve had to reallocate. Sorry.”

Letby said: “Has something happened?”

The colleague replied: “No. Was just asked to reallocate so no one has her for more than 1 night at a time. Or 1 shift. Not just night.” Letby responded: “Yeah that’s understandable.”

The Crown says Letby, originally from Hereford, murdered Child I in the early hours of October 23.

It was said to be her fourth attempt to deliberately harm the baby after earlier bids on September 30, October 13 and 14.

Letby denies murdering seven babies and attempting to murder 10 others between June 2015 and June 2016.

The trial continues on Thursday, February 2.