May 2026: Thirlwall Inquiry report delayed to at least September 2026 · six-baby inquests relisted to 2027 · CCRC review active · Shoo Lee Panel: no medical evidence of deliberate harm.
The Crown alleged that Lucy Letby caused Child E to bleed via deliberate manipulation of or injection through the nasogastric tube, producing a haemorrhagic event that could not otherwise be explained. The prosecution presented the bleeding as a characteristic sign of deliberate harm and as part of the wider pattern of alleged acts on the neonatal unit.
Independent paediatric gastroenterology and neonatal haematology identify at least two alternative explanations for the bleeding documented in Child E's clinical record that are well-established natural-cause diagnoses: coagulopathy of prematurity and stress ulceration. Coagulopathy of prematurity — impaired clotting function in preterm infants due to immature hepatic production of coagulation factors — is a recognised complication in the preterm neonatal population at the gestational ages involved. Stress ulceration of the gastric or duodenal mucosa, producing haemorrhagic events visible via the NG tube, is a documented complication of physiological stress in sick neonates. The Pitman case-by-case analysis of Child E's record identifies both of these natural mechanisms as live differentials that were not systematically excluded in the prosecution's approach to causation.
Haemorrhagic events in preterm neonates via the NG tube are a recognised presentation of coagulopathy of prematurity and stress ulceration — both natural causes in the context of Child E's clinical trajectory.
The jury heard that the bleeding associated with Child E was presented by the Crown's medical witnesses as consistent with the prosecution's mechanism theory and as part of the wider alleged pattern of harm. The natural-cause alternatives — coagulopathy of prematurity and stress ulceration — were raised by the defence but were not given the same evidential weight in the prosecution's narrative.
The Panel's case-by-case review of Child E's clinical record concludes that the deterioration and haemorrhagic event are consistent with natural causes in the context of Child E's gestational age, clinical trajectory and the unit conditions documented in the contemporaneous record. The Panel finds no medical evidence requiring a deliberate-harm explanation for Child E's events.