Child K
The prosecution’s theory: Dislodged ET tube; Dr Jayaram's eyewitness account.
Outcome: Transferred, later died of unrelated cause
Gestation: 25 weeks, 692 g, female (footling breech)
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Prosecution theory
Dislodged ET tube; Dr Jayaram's eyewitness account.
Method alleged: Deliberate dislodgement of the endotracheal tube.
Prosecution experts: Dr Dewi Evans; Dr Jayaram (treating consultant witness).
Panel view (Feb 2025)
Panel: no evidence of a dislodged endotracheal tube. The deterioration was caused by use of an UNDERSIZED endotracheal tube producing a 94% air leak; the incubator alarms were NOT turned off.
Pathology
No fatal outcome. Panel conclusion: there is no evidence to support a dislodged endotracheal tube; the clinical deterioration was caused by the use of an undersized endotracheal tube; the initial intubation was traumatic and poorly supervised; and the consultant did not understand the basics of resuscitation, air leak, mechanical ventilation, or how commonly used equipment such as the Neopuff and capnograph work. Baby 11 needed a size 2.5 tube but was intubated with a size 2, producing a 94% air leak — so only about 6% of each breath entered the lung. That explains the two findings the consultant treated as sinister: bagging with the Neopuff failed to move the chest because its pressure-limiting safety feature could not overcome the leak, and the capnograph read negative because CO2 could not build up in the tube. The Panel also found positive evidence that the incubator alarms were NOT turned off — a nurse (not Letby) stated she 'immediately became aware of the alarms sounding'.
Natural-cause alternatives identified
- An undersized endotracheal tube (size 2 where 2.5 was needed) producing a 94% air leak — the Panel's stated cause
- Progressive alveolar collapse from ineffective ventilation, leading to decompensation
- Neopuff pressure limits and capnograph failure both explained by the 94% leak, not by tube dislodgement
What the jury did not hear
- The Panel's conclusion that the deterioration was caused by an undersized endotracheal tube with a 94% air leak.
- That the failure of the Neopuff to move the chest, and the negative capnography, are both explained by that leak.
- That the Panel found the initial intubation was traumatic and poorly supervised.
- That a nurse (not Letby) stated she immediately became aware of the incubator alarms sounding — evidence the alarms were not turned off.
Key primary sources
- International Expert Panel — Summary Report (February 2025), Panel Baby 11: https://lucyletbyinnocence.com/shoo-lee/International%20Expert%20Panel%20-%20Summary%20Report.pdf
- R v Letby (Child K retrial) sentencing remarks (July 2024)
- Panel Additional 10 Cases Report (June 2025)
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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