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.
Acute desaturation and circulatory-instability episodes in indicted infants were framed as anomalous and as requiring a deliberate-act explanation.
Patent ductus arteriosus (PDA) — a fetal cardiovascular structure that should close shortly after birth — remains open in a substantial proportion of preterm neonates and produces hemodynamic instability ranging from mild oxygen-dependence to abrupt cardiovascular collapse. The likelihood of haemodynamically significant PDA increases with prematurity: ~40-60% of infants born under 28 weeks and ~20% of late-preterm infants. PDA-mediated collapse can present suddenly, mimicking the trajectory the prosecution attributed to deliberate harm, and is documented in echocardiographic and clinical-management records that were variably available across the indicted cases.
A haemodynamically significant patent ductus arteriosus in an extremely preterm infant produces sudden cardiovascular collapse. It is the textbook differential for the trajectory the prosecution treated as anomalous.
PDA was acknowledged as part of the general clinical context for some infants. Its independent association with sudden circulatory collapse was not given equal weight as a competing explanation.
PDA is not among the Panel's conclusions in any indicted case — its findings lie elsewhere and are case-specific (thrombosis, sepsis, haemorrhage, pneumothorax, hypoglycaemia, untreated infection, birth injury). PDA belongs to the Panel's methodological point rather than to its diagnostic one: well-characterised natural causes of sudden collapse in preterm infants were never systematically excluded before a deliberate-harm explanation was adopted.