Vomiting and aspiration — over-feeding re-read
Prosecution claim
On certain counts the prosecution proposed that Letby had deliberately over-fed infants via nasogastric tube, causing aspiration (milk drawn into the lungs) and collapse. On Child G in particular, feed volumes were cited as abnormal and deliberate.
Counter-evidence
Neonatal feed volumes are calculated per kilogram and adjusted per baby per feed based on tolerance. Feed volumes described at trial as 'excessive' fall within the published tolerance ranges for the gestation and weight of the infants concerned. Aspiration is a common and well-documented cause of sudden deterioration in very preterm babies, independent of any wrongdoing — their gag reflex is underdeveloped and their anatomy favours reflux. The Panel concludes that in every indicted case where aspiration was proposed, natural aspiration is a more parsimonious explanation than deliberate over-feeding.
Serious aspiration-driven deteriorations in 23-week infants are, regrettably, routine on neonatal units. They are not, in themselves, evidence of deliberate harm.
What the jury heard
The jury heard specific feed-volume figures described as excessive. The context — that neonatal feed tolerance varies widely between babies and even between feeds in the same baby — was given less prominence.
What the Panel says
The Panel reviewed the feed records and concluded that volumes were within observed ranges. The post-aspiration deteriorations seen were entirely consistent with the babies' gestation and underlying condition.
What independent experts add
- Child G was born at approximately 23 weeks — the edge of viability. Severe complications at this gestation are the expected trajectory, not an anomaly.
- Feed-chart records showing volumes at the high end of tolerance are not evidence of deliberate over-feeding in the absence of contemporaneous clinical concern about the feed.