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's case on several counts, particularly those involving abdominal distension, 'air in stomach' and rapid gastrointestinal deterioration, framed the findings as consistent with deliberate injection of air via nasogastric or other routes.
Necrotising enterocolitis (NEC) is a devastating bowel disease of premature infants. It is one of the single leading causes of neonatal death and morbidity on NICUs worldwide. The clinical presentation of evolving NEC includes abdominal distension, bilious aspirate, temperature instability, and rapid circulatory collapse — the exact constellation of findings prosecuted as 'air in stomach' in multiple indicted cases. The Panel's case-by-case review identifies evolving NEC as a plausible, and in several cases likely, alternative diagnosis for collapses charged as deliberate harm. NEC is also substantially more common in units under the kinds of stresses the Countess of Chester neonatal unit was under in 2015–16: outbreak conditions, staffing pressures, infants below unit designation. In no indicted case was NEC rigorously excluded using the structured differential-diagnosis approach a modern UK NICU would apply.
'Air in stomach' is not a diagnosis. It is a radiological observation with multiple causes. NEC is one of the most common of them in extremely preterm infants — and NEC was not systematically excluded before a criminal cause was adopted.
The prosecution's narrative framed 'air in stomach' findings as a specific deliberate-harm pattern attributable to tampering with nasogastric lines. NEC was mentioned as a clinical reality but not systematically developed as a competing diagnosis for the specific indicted collapses.
The Panel reviewing the cases case-by-case identifies evolving NEC as a plausible or likely diagnosis for several collapses charged as 'air in stomach'. The Panel's conclusion — no medical evidence of deliberate harm in any case reviewed — incorporates the NEC re-reading across multiple counts.