What an endotracheal tube is, and why 25 weeks matters
An endotracheal (ET) tube is a thin plastic tube passed through the mouth or nose into the trachea to ventilate a baby who cannot breathe adequately on its own. A 25-week- gestation baby is at the extreme of viability. Such a baby has no strong airway reflexes, a tiny trachea (measured in millimetres), and a very short neck. Every movement — a cough, a repositioning, a change of nappy, a deliberate wriggle — exerts forces on the tube that an adult body mass would dissipate but a 25-week neonate does not.
The paediatric and neonatal literature is explicit that spontaneous ET-tube dislodgement in extremely preterm infants is not a rare event. It is one of the most common adverse incidents on neonatal intensive care. Units manage the risk with specialised tube fixation devices, careful nursing, and rapid-response re-intubation protocols — which is to say, the system is designed around the assumption that dislodgement will happen.
What the Crown said at the retrial
The Crown’s case rested on Dr Jayaram’s evidence that on the night in question he entered Child K’s bed space and found Lucy Letby standing over the baby, with the ET tube dislodged, without calling for help. The prosecution’s inference from this factual account was that Letby had herself dislodged the tube and was waiting for the baby to collapse. Jayaram’s 2024 oral testimony at the retrial was presented as the primary evidence of that inference.
What Jayaram’s own contemporaneous notes show
Independent commentators have noted a material difference between what Dr Jayaram recorded in his contemporaneous 2016 notes and what he told the retrial jury in 2024. In particular, the specific detail that most supports the prosecution inference — the suggestion that Letby was standing passively over the baby without calling for help — is not present in the contemporaneous written record at the same level of emphasis.
This is not an accusation that Dr Jayaram has been dishonest. Memory of a traumatic event on a neonatal unit, reconstructed under oath eight years later, will not match a contemporaneous note perfectly. It is, however, an argument that the jury should have had the contemporaneous note and the 2024 oral testimony in front of it together, with the differences examined. The cross-examination record from the retrial suggests this was not done to the depth that independent commentators regard as required.
See our summaries at Dr Ravi Jayaram — witness evidence and day 2 of his Thirlwall evidence.
What independent neonatologists say
The Panel’s position on Child K, as reported in the February 2025 report and the Additional 10 Cases report, is that a 25-week baby with a dislodged ET tube is a textbook instance of a foreseeable neonatal emergency, not an indicator of deliberate harm. Specific points made by Panel neonatologists (and independently by UK consultants including Dr Michael Hall and Prof. Neena Modi) include:
- Spontaneous ET-tube dislodgement rates in 25-week babies are measured as a percentage per intubation-day, not as individual rare events.
- Re-intubation of a dislodged tube in a 25-week baby is a procedure requiring a competent practitioner, adequate lighting, appropriate equipment and, ideally, a second pair of hands. A nurse in the bed space who has identified the dislodgement is often waiting for those conditions to be met before proceeding.
- The question of whether the nurse was “waiting” or was in the middle of a managed response cannot be reliably inferred from the entry-point observation of a doctor walking in a few seconds later.
- In Child K’s specific clinical picture — which included multiple other risk factors beyond the tube dislodgement — the subsequent collapse is attributable to the underlying vulnerability of a 25-week baby, not to any requirement that deliberate interference be posited.
What the Panel’s Additional 10 Cases report adds
The Additional 10 Cases report (June 2025) includes Child K within its expanded review. The Panel’s conclusion on Child K in that document is consistent with the original: ET-tube dislodgement at 25 weeks is a common, foreseeable neonatal event, and the Panel’s medical review finds no evidence of deliberate interference. See our summary.
Why the retrial conviction is a specific CCRC question
The retrial conviction is procedurally separate from the original 2023 convictions. The CCRC application filed by Mark McDonald KC in October 2025 addresses both. The Child K conviction is, in many ways, the cleanest evidential test of the post-conviction expert evidence, because it rests on a single eyewitness account of a single event rather than on a pattern aggregated across many babies. If independent neonatologists’ reading of the 25-week ET-tube dislodgement is correct, the inference from Dr Jayaram’s account does not survive.