Child E — the Panel finds a massive gastrointestinal haemorrhage
The prosecution’s claim: The Crown alleged that Lucy Letby caused Child E to bleed via deliberate manipulation of or injection through the nasogastric tube, producing a haemorrhagic event that could not otherwise be explained. The prosecution presented the bleeding as a characteristic sign of deliberate harm and as part of the wider pattern of alleged acts on the neonatal unit.
Prosecution claim
The Crown alleged that Lucy Letby caused Child E to bleed via deliberate manipulation of or injection through the nasogastric tube, producing a haemorrhagic event that could not otherwise be explained. The prosecution presented the bleeding as a characteristic sign of deliberate harm and as part of the wider pattern of alleged acts on the neonatal unit.
Counter-evidence
The Panel's conclusion is that Child E died from a massive gastrointestinal haemorrhage — caused either by ulceration secondary to intrauterine hypoxia, or by a congenital vascular lesion. It found no evidence of air embolism. It also records that a post-mortem should have been requested and was not: the one examination capable of settling the source of the bleeding was never carried out. Independent reviewers of the primary record, including the Pitman case-by-case analysis, had separately identified natural bleeding mechanisms — coagulopathy of prematurity, and gastric or duodenal ulceration in a sick, physiologically stressed neonate — as live differentials that the prosecution's causation case never systematically excluded. On the Panel's reading the bleeding the Crown presented as the signature of a deliberate act is the presenting sign of the natural pathology that killed him.
Key point: The Panel's cause of death for Child E is a massive gastrointestinal haemorrhage — from ulceration caused by intrauterine hypoxia, or from a congenital vascular lesion. And no post-mortem was ever requested.
What the jury heard
The jury heard that the bleeding associated with Child E was presented by the Crown's medical witnesses as consistent with the prosecution's mechanism theory and as part of the wider alleged pattern of harm. The natural-cause alternatives were raised by the defence but were not given the same evidential weight in the prosecution's narrative — and no post-mortem had ever been carried out to test either account.
What the Panel says
The Panel concludes Child E died from a massive gastrointestinal haemorrhage, caused by ulceration secondary to intrauterine hypoxia or by a congenital vascular lesion. It found no evidence of air embolism, and it states that a post-mortem should have been requested.
What independent experts add
- The Panel's finding is a haemorrhage with a natural source — intrauterine-hypoxia-related ulceration, or a congenital vascular lesion — not an injected or instrumented injury.
- Coagulopathy of prematurity is well documented in the neonatal literature as a cause of bleeding events in preterm infants; Child E's gestational age placed him in the at-risk population.
- The Pitman primary-record review identifies specific clinical entries in Child E's contemporaneous notes consistent with natural bleeding mechanisms that the prosecution did not address in its causation case.
- No post-mortem was carried out on Child E. The Panel says one should have been requested — which is why the source of the bleeding was never established at the time.