Child D
The prosecution’s theory: Air embolism.
Outcome: Died 22 June 2015
Gestation: Term; 37+1 weeks, 3.13 kg, female
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Prosecution theory
Air embolism.
Method alleged: Injection of air into an IV line.
Prosecution experts: Dr Dewi Evans; Dr Sandie Bohin.
Panel view (Feb 2025)
Panel: died of systemic sepsis, pneumonia and disseminated intravascular coagulation. No evidence of air embolism.
Pathology
Panel conclusion: Baby 4 died of systemic sepsis, pneumonia and disseminated intravascular coagulation (DIC); the mother should have received intrapartum antibiotics for prolonged premature rupture of membranes; there was delay in recognising respiratory distress after birth and in starting antibiotics and treatment; and there was no evidence of air embolism. NICU admission, blood gas and CPAP were delayed by three to four hours and the chest X-ray by six hours. The Panel's reading of the skin discolouration relied on at trial is that it was caused by DIC clotting in the small blood vessels of the skin — and it notes that coagulation defects do not occur with air embolism.
Natural-cause alternatives identified
- Systemic sepsis with pneumonia — the Panel's stated cause of death
- Disseminated intravascular coagulation (DIC), which explains the skin discolouration, purpuric patches and tracking lesions
- Failure to give the mother intrapartum antibiotics for prolonged premature rupture of membranes
- Three-to-six-hour delays in admission, blood gas, CPAP and chest X-ray
What the jury did not hear
- The Panel's conclusion that the cause of death was sepsis, pneumonia and DIC — not air embolism.
- That coagulation defects do not occur with air embolism, but do occur with DIC.
- That the mother should have received intrapartum antibiotics, and that treatment was delayed by hours.
Key primary sources
- International Expert Panel — Summary Report (February 2025), Panel Baby 4: https://lucyletbyinnocence.com/shoo-lee/International%20Expert%20Panel%20-%20Summary%20Report.pdf
- R v Letby sentencing remarks (August 2023)
Read the full long-form analysis →
Sources:
- Court of Appeal judgment (May 2024) and sentencing remarks — judiciary.uk
- Shoo Lee International Expert Panel Report (February 2025) — lucyletbyinnocence.com
- Per-baby trial evidence archive — lucyletbyinnocence.com
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