The Death of Baby D

or details and citations refer to

https://docs.google.com/document/d/1Lql0NRpwxHhksnw0HmQAew1SbCGQMuheL_fBlDQ0nUk/edit?usp=sharing

A personal description of the fate of Baby D who arguably developed pneumonia while still in utero. A baby with findings of acadaemia while in ICU,a circumstance often lethal to newborns and which occurred long before Letby's involvement.

A blood pH between 7.194 and 7.173 in a 2-day-old term neonate with pneumonia is concerning and potentially dangerous, as it indicates significant metabolic acidosis.

1. Normal blood pH range: The normal arterial blood pH range for neonates is 7.35-7.45[1]. A pH below 7.35 is considered acidosis.

2. Severity of acidosis: The pH values of 7.194 and 7.173 are well below the normal range, indicating moderate to severe acidosis[2]. This level of acidosis can have serious implications for the newborn's health.

3. Causes and implications:

- Pneumonia in neonates can lead to respiratory acidosis due to impaired gas exchange and CO2 retention[3].

- Metabolic acidosis may also occur due to sepsis, tissue hypoxia, or poor perfusion associated with severe pneumonia[4].

- Acidosis of this severity can negatively impact various organ systems, including the cardiovascular, respiratory, and central nervous systems[5].

4. Potential complications:

- Severe acidosis can lead to myocardial dysfunction, decreased cardiac output, and hypotension[4].

- It may also cause pulmonary vasoconstriction, potentially worsening respiratory distress[4].

- Neurological complications such as intraventricular hemorrhage are associated with severe acidosis in neonates[6].

5. Need for intervention:

- A pH this low requires immediate medical attention and intervention to correct the underlying cause and manage the acidosis[2].

- Treatment may include respiratory support, antibiotics for pneumonia, fluid management, and in some cases, cautious use of buffer solutions like sodium bicarbonate[7].

6. Monitoring and follow-up:

- Close monitoring of blood gases, electrolytes, and clinical status is crucial[2].

- Serial measurements are important to track the response to treatment and guide further management.

A blood pH between 7.194 and 7.173 in a 2-day-old neonate with pneumonia is dangerous and requires urgent medical intervention. The acidosis needs to be addressed promptly to prevent potential complications and improve outcomes.

Citations:

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8558493/

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2869402/

[3] https://onlinelibrary.wiley.com/doi/full/10.1111/apa.16127

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10662854/

[5] https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/neonatal/blood-gas-interpretation-for-neonates

[6] https://onlinelibrary.wiley.com/doi/full/10.1111/ppe.12663

[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4533247/

[8] https://www.medicalnewstoday.com/articles/ph-of-blood

[9] https://www.cochrane.org/CD003215/NEONATAL_base-administration-or-fluid-bolus-for-preventing-morbidity-and-mortality-in-preterm-infants-with-metabolic-acidosis

Final thoughts on the explainable natural cause of death for Baby C

https://academic.oup.com/bjr/article/96/1147/20211078/7469184

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10746609/

https://insightsimaging.springeropen.com/articles/10.1186/s13244-021-01042-1

https://www.nature.com/articles/s41390-018-0075-z

Erratum Professor "Owens" is actually Professor Arthurs.

Reimagining the Letby Defence Baby C part. 3

https://pubs.rsna.org/doi/10.1148/113.1.155?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

https://etheses.whiterose.ac.uk/22429/1/Final%20copy_%20whitrose.pdf

Baby C Part 2

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937445/pdf/JIR2018-6963754.pdf

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In episode 15 part 1 we examine the case of Baby C.

References used:

https://journals.lww.com/anesthesia-analgesia/fulltext/2015/06000/outcomes_for_extremely_premature_infants.25.aspx

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10670916/

https://onlinelibrary.wiley.com/doi/full/10.1111/apa.15225

https://www.theijcp.org/index.php/ijcp/article/view/352/299

Abstract

Continuous positive airway pressure (CPAP) administered as a mixture of oxygen and compressed air via nasal prongs has dramatically improved survival rates and lessened the frequency of barotrauma and bronchopulmonary dysplasia in the premature infant with respiratory distress syndrome. Associated with the increased use of nasal CPAP has been the development of marked bowel distension (CPAP belly syndrome), which occurs as the infant's respiratory status improves and the baby becomes more vigorous. To identify contributing factors, we prospectively compared 25 premature infants treated with nasal CPAP with 29 premature infants not treated with nasal CPAP. Infants were followed up for development of distension, defined clinically as bulging flanks, increased abdominal girth, and visibly dilated intestinal loops. We evaluated birth weight, weight at time of distension, method of feeding (oral, orogastric tube), and treatment with nasal CPAP and correlated these factors with radiologic findings. Of the infants who received nasal CPAP therapy, gaseous bowel distension developed in 83% (10/12) of infants weighing less than 1000 g, but in only 14% (2/14) of those weighing at least 1000 g. Only 10% (3/29) of infants not treated with nasal CPAP had distension, and all three weighed less than 1000 g. Presence of sepsis and method of feeding did not correlate with occurrence of distension. Neither necrotizing enterocolitis nor bowel obstruction developed in any of the patients with a diagnosis of CPAP belly syndrome. Our study shows that nasal CPAP, aerophagia, and immaturity of bowel motility in very small infants were the major contributors to the development of benign gaseous bowel distension.

https://pubmed.ncbi.nlm.nih.gov/1727337/

https://www.theijcp.org/index.php/ijcp/article/view/352/299

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10064400/

Sudden death in preterm neonates can be attributed to several critical factors, often related to the complications of prematurity and the vulnerability of their underdeveloped organ systems. Here are the main causes:

1. **Respiratory Distress Syndrome (RDS)**: This is one of the most common causes of death in preterm infants. It results from insufficient surfactant production in the lungs, leading to collapsed air sacs and inadequate oxygenation[6].

2. **Infections**: Preterm neonates are highly susceptible to infections such as sepsis, pneumonia, and meningitis due to their immature immune systems. These infections account for a significant proportion of neonatal deaths[2][4].

3. **Intraventricular Hemorrhage (IVH)**: This is a type of bleeding in the brain that is more common in preterm infants, particularly those with very low birth weights. Severe cases can lead to catastrophic brain injury and death[5][6].

4. **Necrotizing Enterocolitis (NEC)**: NEC is a serious gastrointestinal condition that involves inflammation and bacterial invasion of the intestine, which can lead to bowel necrosis and perforation. It is a significant cause of mortality in preterm infants[6].

5. **Pulmonary Hemorrhage**: This involves bleeding into the lungs and can occur suddenly, leading to rapid deterioration and death[6].

6. **Sudden Infant Death Syndrome (SIDS)**: Although more commonly associated with older infants, preterm infants are at increased risk for SIDS, which is characterized by the sudden and unexplained death of an otherwise healthy infant[3].

7. **Asphyxia**: This occurs when there is insufficient oxygen supply to the infant before, during, or after birth, leading to potential brain injury and death[2].

A brief look at the Lee and Tanswell Paper used to convict Lucy Letby:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1592039/pdf/archdisch00901-0075.pdf

And references to material used in this podcast:

file:///Users/michaelsmacbookair/Downloads/kogutt-2012-systemic-air-embolism-secondary-to-respiratory-therapy-in-the-neonate-six-cases-including-one-survivor.pdf

https://www.ajronline.org/doi/epdf/10.2214/ajr.131.3.425

https://pubmed.ncbi.nlm.nih.gov/98984/

https://pubmed.ncbi.nlm.nih.gov/1106225/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2984251/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC524111/

https://www.frontiersin.org/articles/10.3389/fped.2023.1094855/full

https://erj.ersjournals.com/content/42/6/1536

https://pubmed.ncbi.nlm.nih.gov/16161157/

https://www.sciencedirect.com/science/article/abs/pii/S0379073812005488

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC524111/

https://erj.ersjournals.com/content/42/6/1536

https://www.sciencedirect.com/science/article/abs/pii/S0379073812005488

https://www.nejm.org/doi/full/10.1056/NEJM197005142822007

https://pubmed.ncbi.nlm.nih.gov/382064/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1627609/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1627609/pdf/archdisch00760-0077.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381094/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1763230/pdf/v088p0F521.pdf

https://venice.ai/chat/aa5a34c6-e925-4427-bc5a-5fc171d69406#veniceShareKey=kCTumERVyA47XHh1BCDG43%2FWso5d0ke6oXfNrbMTo%2BY%3D&veniceShareNonce=1v4W3Gv3HOszMhwxQZ5Sbhq52qEMJLSJ

https://pubs.asahq.org/anesthesiology/article/106/1/164/8884/Diagnosis-and-Treatment-of-Vascular-Air-Embolism

In episode 13 we look at the podcast

https://www.youtube.com/watch?v=K7iWU_0FDXg&t=198s&pp=ygUaTHVjeSBMZXRieSBkb3VibGUgamVwb3JkeSA%3D

Here are some citations used in the episode:

[1] https://www.nature.com/articles/s41598-020-59566-3

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8266827/

[3] https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/

unexplaineddeathsininfancyenglandandwales/2021

[4] https://www.thelancet.com/journals/langlo/article/PIIS2214-109X%2822%2900043-2/fulltext

[5] https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/unexplaineddeathsininfancyenglandandwales/2018

[6] https://www.england.nhs.uk/long-read/perinatal-post-mortem-investigation-of-fetal-and-neonatal-deaths-england-scotland-and-wales/

[7] https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-11-S3-S11

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860427/

[9] https://bmcemergmed.biomedcentral.com/articles/10.1186/s12873-018-0208-z

[101 https://link.springer.com/article/10.1007/s12024-022-00511-3

[11] https://pubmed.ncbi.nlm.nih.gov/8439228/

[12] https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/617123

13] https://jlpm.amegroups.org/article/view/5995/html

[14] https://pubmed.ncbi.nlm.nih.gov/31239889/

[15] https://www.medscape.com/viewarticle/432906_6

[16] https://www.ncbi.nlm.nih.gov/books/NBK542310/