Child N
The prosecution’s theory: Airway interference / injection.
Outcome: Survived
Gestation: Twin 2, male; 34+4 weeks, 1.67 kg, severe IUGR; moderate haemophilia (factor VIII 3%)
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Prosecution theory
Airway interference / injection.
Method alleged: Airway interference or injection.
Prosecution experts: Dr Dewi Evans; Dr Sandie Bohin.
Panel view (Feb 2025)
Panel: the crying was not due to injury or air embolism. The desaturation was due to bleeding — likely spontaneous haemophilia bleeding or bleeding from routine cares — exacerbated by repeated traumatic intubation attempts.
Pathology
No fatal outcome. Panel conclusion: the crying was not due to injury or air embolism, and the subsequent episode of desaturation was due to bleeding, likely spontaneously from haemophilia or from routine cares, exacerbated by repeated traumatic intubation attempts. Baby 14 had moderate haemophilia (factor VIII 3%) with raised coagulation times, and moderate haemophilia can cause spontaneous bleeding. The Panel notes that if a nasogastric tube had been thrust into his throat as alleged, the infant would have cried or screamed and there would be lacerations in the pharynx, oesophagus and vocal cords — none were reported by the intubating physicians. Trauma was, however, 'most certainly inflicted' during the eight intubation attempts, which aggravated the bleeding and caused epiglottic swelling. The Panel adds that in a haemophilia patient intubation should be done by an experienced operator, not escalated up from junior doctors, and that transfer to Alder Hey should have happened far sooner than 11 hours.
Natural-cause alternatives identified
- Spontaneous bleeding from moderate haemophilia (factor VIII 3%) — the Panel's stated cause
- Bleeding provoked by routine nursing cares in an unprotected haemophilia patient
- Trauma from eight repeated intubation attempts, aggravating the bleeding and causing epiglottic swelling
What the jury did not hear
- The Panel's conclusion that the desaturation was caused by haemophilia bleeding, exacerbated by repeated traumatic intubation.
- That no lacerations of the pharynx, oesophagus or vocal cords were reported — which the alleged NG-tube trauma would have produced.
- That the infant underwent eight intubation attempts, and that transfer to Alder Hey took 11 hours.
Key primary sources
- International Expert Panel — Additional 10 Cases report (June 2025), Panel Baby 14: https://lucyletbyinnocence.com/shoo-lee/International%20Expert%20Panel%20New%20Summary%20Report%20of%20additional%2010%20cases.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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