A "persistent, calculated and cold-blooded" neo-natal nurse killed a baby girl on the fourth attempt before sending her grieving parents a sympathy card, a jury heard.
The baby, referred to as Child I, was one of seven infants 32-year-old Lucy Letby is accused of murdering between June 2015 and 2016 at the Countess of Chester Hospital. Letby is also accused of the attempted murder of 10 other babies, some on more than one occasion, but denies all 22 charges of murder and attempted murder against her.
Nick Johnson, KC, prosecuting, continued outlining the Crown's case for a third day at Manchester Crown Court, where Hereford native Letby is standing trial. Mr Johnson gave details of the the death of a baby girl referred to as Child I, which he said was an "extreme example even by the standards of this overall case".
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Mr Johnson told the jury: "(Child I) was born very early and very small. But she survived the first two months of her life and was doing well by the time Lucy Letby got her hands on her. What happened to Child I followed the pattern of what happened to others before and what was yet to happen to others.
"It was persistent, it was calculated and it was cold-blooded."
Letby is said to have deliberately administered large amounts of air into Child I's stomach through a nasogastric tube - one of various means she allegedly deployed to harm children in her care.
The first incident, in September 2015, was said to have taken place when Child I struggled to breathe just 30 minutes after Letby was said to have fed her. In the second alleged incident, in mid October, the court heard that a night shift colleague recalled Letby was standing in the doorway of a darkened room in the neo-natal unit.
She later told police Letby remarked that Child I "looked pale" in her cot. The fellow nurse went in and saw Child I "appeared to be at the point of death and was not breathing".
Mr Johnson said the baby recovered but "ironically" Letby then became Child I's designated nurse. Child I collapsed again on the next night shift and was "brought back from the brink of death", the court heard. During the early hours of October 23, another collapse followed, the court was told, but the baby was successfully resuscitated and recovered to the extent that she was showing signs of hunger.
Less than a hour later the infant's monitor alarm sounded and a colleague rushed to help and found Letby standing beside the incubator. Mr Johnson said Letby's fellow nurse wanted to intervene as Child I was "distressed", but Letby said "they would be able to sort it".
Child I then collapsed and died, the court heard. Mr Johnson told the court Child I's mother was allowed to bathe her "recently departed" daughter. He said: "Lucy Letby came into the room and, in the words of [Child I's mum], 'was smiling and kept going on about how she was present at Child I's first bath and how much Child I had loved it'."
Mr Johnson said an expert paediatrician who reviewed Child I's case concluded that the baby's collapses were consistent with the deliberate administration of a large amount of air into her stomach via a nasogastric tube.
The medic also believed that, on the final occasion, the infant had been injected with air into her bloodstream which led to her "screaming", followed quickly by her collapse. When interviewed later by detectives from Cheshire Police, Letby was asked about a sympathy card she had sent to Child I's parents.
Mr Johnson said: "She said for a nurse to send a card was not normal and it was the only time she had done it, but it was not often the nurses got to know a family so well."
Letby accepted that she kept an image of the card on her phone, he said. She could not recall taking an interest in Child I's parents on Facebook in the early hours of October 5 - a day off duty - or making searches on the parents of three other babies involved in the case.
The trial continues.
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