The clinical context
On the Panel’s summary of the record, Baby J was a twin girl born at 32 weeks and 2 days weighing 1.709 kg, by elective Caesarean section, to a mother whose pregnancy had involved twin-to-twin transfusion treated with laser, and preterm prelabour rupture of membranes.
She was not a straightforward preterm baby. She underwent a laparotomy with small-bowel resection and stoma formation — a functioning ileostomy and mucous fistula — for malrotation and volvulus with necrotic, perforated bowel and adhesions. She went on to develop stomal excoriation and a mucocutaneous fistula. At 17 days of age she developed seizures, and was treated with antibiotics and phenobarbitone.
At 47 days of age she was found blue and crying, then became pale, and was resuscitated with cardiac compressions and bagging because of a low heart rate of 40 per minute. She recovered quickly and was transferred to Alder Hey Hospital, where she was diagnosed with sepsis. About 10½ hours after that transfer, she had another similar episode of clinical deterioration at Alder Hey.
The prosecution theory
It was alleged that Baby J deteriorated on day 47 of life because of malicious airway obstruction. The jury could not reach a verdict on her count.
What the Panel found: one infection, not one event
The Panel’s reading is that the day-47 deterioration at the Countess of Chester was most likely an episode of seizure, apnoea or hypoventilation, and that it was an early manifestation of the sepsis that was diagnosed after she reached Alder Hey.
The reasoning turns on the natural history of infection. As the Panel puts it, infection does not just happen suddenly: it brews in the body over time, usually one to two days, before it overwhelms the body’s defences and clinical symptoms appear. The deterioration in question is therefore most likely part of the same infection episode as the sepsis diagnosed at Alder Hey, and cannot be treated as a separate event. The occurrence of a similar episode of deterioration at Alder Hey, 10½ hours later, supports the diagnosis of sepsis as the cause of the episode at the Countess of Chester.
That is the structural problem with the count. The Crown’s case required the day-47 collapse to be an isolated, unexplained event on a nurse’s shift. On the Panel’s reading it is not isolated and it is not unexplained: it is the leading edge of a septic illness that was confirmed at another hospital and that produced a further episode there, on a different unit, with different staff.
The resuscitation itself
The Panel is also critical of the response. It describes the resuscitation with chest compressions as an apparent overreaction from the nurses. Dr Soni, who responded immediately to the crash call, recorded that the heart rate was 46 per minute on the monitor but greater than 100 per minute on auscultation, and that the infant was crying under the mask while cardiac massage was ongoing. The nurses reported that the infant was breathing throughout, though laboured.
On the Panel’s account, bagging or oxygen would have been appropriate for desaturation, but cardiac compressions were not — they can cause harm to the infant, including trauma to the heart and other organs, rib fractures, and disruption of the circulation. The Panel also records that the parents were concerned about the care their baby was receiving at the Countess of Chester, and successfully requested that she not be transferred back there.
The Panel’s conclusions on Baby J
- Baby 10’s deterioration on day 47 of life was due to sepsis.
- There is no evidence to support malicious airway obstruction.
Source: International Expert Panel — Summary Report (February 2025), “Baby 10”. Read the Panel report (PDF). For how to read it, see how to read the Panel report.
Why this case matters
Baby J is a case where the alternative explanation is not a hypothesis: it is a diagnosis that was actually made, at a tertiary hospital, within hours of the event the Crown said was an assault. The Panel’s point about the incubation of infection converts that diagnosis into an explanation for the collapse itself, rather than a coincidence that followed it.
The Panel’s report was published in February 2025, after the 2023 trial, and has not been tested in court. It forms part of the post-conviction material now before the CCRC. Lucy Letby’s convictions currently stand.
What the Panel’s report adds
- The Panel’s conclusion that the day-47 deterioration was sepsis, and that there is no evidence to support malicious airway obstruction.
- The point that infection brews over one to two days, so the sepsis diagnosed at Alder Hey was already under way at the Countess of Chester.
- The significance of the second, similar episode at Alder Hey 10½ hours later, on a different unit.
- The Panel’s criticism of the resuscitation itself — chest compressions given to an infant recorded as breathing, and as crying under the mask, with a heart rate above 100 on auscultation.