What this page relies on
The medical account below is taken from the case entry for Baby 15 — trial Child O — in the International Expert Panel — Summary Report (February 2025). Where this page states a clinical fact or a causal conclusion, it is because the Panel states it. Nothing here is inferred beyond that report. An earlier version of this page departed from that rule badly; see the correction at the foot of the page.
The question
Child O was the second of three triplet brothers born at the Countess of Chester Hospital in June 2016 by in-labour Caesarean section, preterm at 33+2 weeks, weighing 2.02kg. He had mild respiratory distress requiring CPAP and oxygen. He collapsed on his third day, was resuscitated at length, and died. The post-mortem showed a ruptured subcapsular haematoma of the liver.
Two explanations for a dead baby with a torn liver are easy to reach for, and both are wrong. The first is the prosecution’s: that somebody struck him. The second is the one that circulates in defence of the conviction being unsafe: that the injury was simply the price of the CPR that was performed on him. The Panel rejects the first outright. It does not adopt the second.
What the Panel concluded: a birth injury
The Panel’s conclusion is that Child O died from a subcapsular liver haematoma caused by traumatic delivery, resulting in haemorrhage into the peritoneal cavity and profound shock — and that this was not recognised before death.
The mechanism it describes is specific. A subcapsular liver haematoma is the result of “traction” or “shear” forces applied to the thin, fragile liver capsule through the hepatic ligaments. In Child O, the Panel says, this was highly likely the result of the extremely rapid delivery: the triplets were extracted at Caesarean section very quickly, a minute apart. Extremely rapid delivery is, in the Panel’s words, a well-recognised cause of birth injury.
What follows from that is a bleed with a characteristic shape. Bleeding into a subcapsular haematoma is initially slow, because it is contained by the pressure of the enveloping liver capsule; in those early stages the clinical signs are insidious and difficult to recognise. The slow deterioration is then followed by acute collapse when the capsule ruptures and free blood is released into the peritoneal cavity. Child O’s haemoglobin was 168g/l on the day of birth. By the time of the final blood gas it had nearly halved, to 86g/l. The Panel records that the significance of his rising heart rate and falling pH before the terminal collapse was not recognised.
The injury, on this account, was already there — and already bleeding — before the resuscitation began. It dates from his birth, not from the hands that tried to save him and not from any hand that is alleged to have harmed him.
Where resuscitation does come in
The Panel does identify two ways in which what was done to Child O during his deterioration and resuscitation bore on the outcome. Neither is chest compressions, and neither is the cause of the fatal haematoma.
- High-pressure ventilation contributed to liver congestion. Child O was intubated and ventilated at high pressures (28/5, later raised to 32/6 in 100% oxygen). The Panel states that high-pressure ventilation decreased venous return to the heart and contributed to liver congestion.
- The blind needle aspiration may have added a further injury. During the resuscitation, a needle aspiration of the abdomen was performed. The Panel considers that this blind abdominal insertion of a needle may have penetrated the right lobe of the liver, causing further injury — the parenchymal haematoma and laceration noted by the pathologist.
The second point is the one that is most often garbled, so it is worth stating flatly. The Panel says a resuscitation procedure may have added injury to a liver that was already ruptured and bleeding. It does not say that resuscitation caused the subcapsular haematoma, and it does not say that resuscitation killed him. The distinction matters: one is an incidental addition to the post-mortem picture, the other would be a cause of death. Only the first is supported.
What the Panel rules out
- Inflicted blunt trauma. The Panel calls blunt direct trauma to the right abdomen or chest implausible, because it is very difficult to generate the kind of forces required to produce the observed injuries in a liver protected by the lower chest wall.
- Air pushed down a nasogastric tube. The gaseous distension of the intestinal tract was, on the Panel’s reading, likely due to air swallowing and insufflation during non-invasive respiratory support.
- Air injected into the circulation. The allegation against Child O was initially inflicted blunt trauma to the abdomen, and later changed to deliberate injection of air into his circulation. Of that later version, the Panel’s verdict is one word: conjecture. The mechanism as it was run across the indictment is examined in our air embolism line by line analysis.
Why the distinction matters
It would be easier, rhetorically, to say that the CPR explains the liver. It is a tidy answer and it points the same way — away from a perpetrator. But it is not what the Panel found, and a case for a wrongful conviction that is built on a misreport of the evidence is worth nothing. It can be checked, and when it is checked it fails, and the failure is then used to discredit the parts of the argument that were sound.
The Panel’s actual finding is, in any event, the stronger one. A resuscitation injury is an injury that happens in the course of trying to reverse a collapse whose cause is still unexplained; it leaves the question of why the baby collapsed open, and an open question is where a prosecution theory lives. A birth injury is a complete alternative account. It explains the insidious early signs, the rising heart rate, the falling pH, the distended abdomen, the sudden collapse, and the near halving of the haemoglobin — and it does so with a cause that was present before Lucy Letby, or anyone else on the unit, came anywhere near him.
What the CCRC will have to weigh
The liver finding is among the most concrete forensic-pathology elements in the Crown’s case. Unlike the skin-sign descriptions, it is a physical finding at autopsy with a paper record, and it is therefore reviewable. What the Commission has to weigh is not whether the pathology was real — it was — but whether the inference drawn from it at trial survives an alternative causal account that was not put before the jury. The reports submitted in support of the application are indexed on our CCRC expert reports page. The general standard expected of forensic-pathology reasoning is discussed in our forensic pathology standard analysis.
Correction
An earlier version of this page stated that the Shoo Lee Panel read Child O’s liver findings as consistent with vigorous neonatal resuscitation, and that the pattern of injury was explained by prolonged CPR. It also described the triplets as term infants, and supported its argument with claims about the paediatric-pathology literature and about triplet gestation that had no source. All of that was wrong. The Panel attributes the fatal subcapsular haematoma to traumatic delivery; the triplets were born preterm at 33+2 weeks; and the only resuscitation-related injury the Panel identifies is the possible further damage from the blind needle aspiration of the abdomen. The unsourced claims have been removed rather than re-cited. The page was rewritten on 14 July 2026.
Source
- International Expert Panel — Summary Report (February 2025), entry for Baby 15 (trial Child O). Read the report (PDF).