Vomiting and aspiration — over-feeding re-read
The prosecution’s 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.
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. On Child G, the count where the over-feeding mechanism was most directly alleged, the Shoo Lee Panel found no evidence of over-feeding at all: it attributes the deterioration to infection, possibly enterovirus, and notes that the gaseous distension relied on appears on X-rays that were all taken after bag-and-mask ventilation had been given.
Key point: Serious aspiration-driven deteriorations in extremely preterm infants are, regrettably, routine on neonatal units. They are not, in themselves, evidence of deliberate harm — and in Child G's case the Panel found no evidence of over-feeding at all.
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 found no evidence of overfeeding in Child G — the case in which the over-feeding mechanism was principally alleged — and attributed the deterioration to infection, possibly enterovirus. The gaseous distension relied on appears on films taken after bag-and-mask ventilation.
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.
- Gastroesophageal reflux of prematurity is well documented as a cause of post-feed deterioration in extremely preterm infants and routinely produces aspiration events without any deliberate cause.
- BAPM feeding guidance explicitly notes the wide variability in feed tolerance between extremely preterm infants and between feeds in the same infant on the same day, undermining any 'standard volume' against which deviation can be characterised as deliberate.