You only look at bacteria. What about viral infections: parechovirus, enterovirus. Outbreaks in neonnatal wards all around the world are getting more common, though maybe 10 years before the LL case they were pretty much unknown. See for instance: "Cluster of human parechovirus infections as the predominant cause of sepsis in neonates and infants, Leicester, United Kingdom, 8 May to 2 August 2016", https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2016.21.34.30326 The symptoms reported in this and other reports include unusual rashes. Just as were observed in three of the LL babies. Prosecution witnesses (or maybe this an expert giving evidence to one of the earlier NHS reviews) reported that the rashes were strange and that they'd never seen anything like that before.
Every investigation needs a starting point and to that end what I have done is started from a logical position initiated and supported by the most recent defence evidence. There are any number of potential starting points - it just happened that this is mine. I think that, given the evidence already in play, this just happens to be the squeakiest wheel right now.
I agree, but I'm just saying it is even squeakier since virus infections can also start with sewage problems. But indeed, the defence did not bring this up, and of course, the prosecution didn't either.
I am wanting to get to a point in my investigation where I can develop a root cause BN covering a range of maybe 6 or 8 potential causes on which the signs and symptoms for each neonate can be observed and the probability for each can be reasoned about. I am a fair way from that yet... but my work is ongoing
For the deaths, this is maybe doable, except (maybe) for the problem that some of deaths were of babies who had previously suffered a number of collapses which the prosecution believes to to caused by murder attempts. Then there are the twins and the triplets in which natural causes might be strongly correlated. But it is a noble project!
Jun 23, 2023·edited Jun 23, 2023Liked by Mr Law, Health and Technology
From another website currently being built "In nearly every infant covered in the trial the medical notes clearly state that the child exhibited signs of sepsis , but they had no positive bacterial cultures. Although bacterial infection is a common occurrence in neonates, it is estimated that ~13% of cases of sepsis, occurring in the first 7 days of life, are due to enteroviral infection. In a review of Severe enterovirus infection 46.0% neonates had hepatitis or coagulopathy, 37.1% had myocarditis, 11.0% had meningoencephalitis, and 5.9% had other complications such as hemophagocytic lymphohistiocytosis and pulmonary hemorrhage. The lethality rate of neonates with severe infection was 30.4%." and "During June 2015 and June 2016, there were reports that enteroviruses were prevalent in the UK. Many of the symptoms that reportedly occurred in the infants at CoCH overlapped with enteroviral infections. These infections exhibit a seasonal pattern, where infections peak in the period May to October. The viruses are particularly harmful to infants under the age of 90 days old, due to their limited immune reactivity". And so on. I think this strengthens your story! Parechovirus and Enterovirus are also spread by sewage. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3811204/, https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(22)00178-1/fulltext
Enterococci as you saw is one of the three I am closely exploring. It fits many of the S/S and presentations. That said, I think overall Acinetobacter fits even more (esp. the spontaneous disappearing rash). Either way it makes me think that I am exploring the right area. I had a look at the parechovirus paper you suggested and did some digging there and it didn't feel right given the details I have atm. The thing with Enterococci and Acinetobacter that is especially relevant is that they can both cause NEC (and in several studies around half of the babies that got NEC from either bacteria went from seemingly healthy to dead in hours... others lingered for weeks and seemed to get better on antibiotics only for the ABs to be stopped 5-7 days later (which was too soon) and for them to be dead within a week or two.
Ok, could be, I am not an expert. My expert friend has pretty strong arguments for her theory, and her theory also appears to match the symptoms which you describe. A nice point is the time period, matching similar epidemics in other neontal wards at the same time, including one not far away (Leicester, 2016). These viruses are seasonal.
WHY DID NOBODY - sorry, I am so upset I am shouting - MENTION THIS? Before the trial, or during. Every medical expert stated they were puzzled by the weird rashes. The only possible explanation found in a forty (40 !) year old "talking paper" from Canada. Did none of these pediatric/neonatal medical experts read these articles about events occurring in NICU's in more recent years ? This is mind-boggling !
The main part of the Countess of Chester hospital was a standard new NHS modular build and was first occupied in or around 1982/1983. I know, because I was one of the first staff in there as a trainee administrator. I don't know about this unit though.
"It would be incredible (meaning not credible) to think that they are occuring everywhere else in the world EXCEPT the UK." My major criticism of the NHS is lack of transparency, again confirmed.
Australian paediatric doctor. Not a neonatologist. Got up to Baby D’s case in a podcast covering the trial, and had to pause in disgust
The “expert witness” saying a baby with congenital pneumonia was not contributed to by 60hrs PROM without intrapartum antibiotics. Saying a term baby requiring intubation for sepsis (untreated for the first couple of hours of life!) was “getting better” the very same day. Calling apnoeas/bradys/desats “unexplained collapses” when it’s such a recognised phenomenon that every nursery baby has a recording sheet specifically for these. An unusual skin rash that sounds a hell of a lot like skin mottling from poor perfusion in a critically unwell neonate
But what would I know? I’m only actually working in Paed, not retired for 15yrs while neonatal practice “has barely changed”; just dropping the threshold of viability to 22 weeks, peripheral TPN, HFOV, minimally invasive surfactant, high flow for neonates, cooling for HIE… all going from never heard of to becoming mainstream, standard practices
You only look at bacteria. What about viral infections: parechovirus, enterovirus. Outbreaks in neonnatal wards all around the world are getting more common, though maybe 10 years before the LL case they were pretty much unknown. See for instance: "Cluster of human parechovirus infections as the predominant cause of sepsis in neonates and infants, Leicester, United Kingdom, 8 May to 2 August 2016", https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2016.21.34.30326 The symptoms reported in this and other reports include unusual rashes. Just as were observed in three of the LL babies. Prosecution witnesses (or maybe this an expert giving evidence to one of the earlier NHS reviews) reported that the rashes were strange and that they'd never seen anything like that before.
Every investigation needs a starting point and to that end what I have done is started from a logical position initiated and supported by the most recent defence evidence. There are any number of potential starting points - it just happened that this is mine. I think that, given the evidence already in play, this just happens to be the squeakiest wheel right now.
I agree, but I'm just saying it is even squeakier since virus infections can also start with sewage problems. But indeed, the defence did not bring this up, and of course, the prosecution didn't either.
I am wanting to get to a point in my investigation where I can develop a root cause BN covering a range of maybe 6 or 8 potential causes on which the signs and symptoms for each neonate can be observed and the probability for each can be reasoned about. I am a fair way from that yet... but my work is ongoing
For the deaths, this is maybe doable, except (maybe) for the problem that some of deaths were of babies who had previously suffered a number of collapses which the prosecution believes to to caused by murder attempts. Then there are the twins and the triplets in which natural causes might be strongly correlated. But it is a noble project!
From another website currently being built "In nearly every infant covered in the trial the medical notes clearly state that the child exhibited signs of sepsis , but they had no positive bacterial cultures. Although bacterial infection is a common occurrence in neonates, it is estimated that ~13% of cases of sepsis, occurring in the first 7 days of life, are due to enteroviral infection. In a review of Severe enterovirus infection 46.0% neonates had hepatitis or coagulopathy, 37.1% had myocarditis, 11.0% had meningoencephalitis, and 5.9% had other complications such as hemophagocytic lymphohistiocytosis and pulmonary hemorrhage. The lethality rate of neonates with severe infection was 30.4%." and "During June 2015 and June 2016, there were reports that enteroviruses were prevalent in the UK. Many of the symptoms that reportedly occurred in the infants at CoCH overlapped with enteroviral infections. These infections exhibit a seasonal pattern, where infections peak in the period May to October. The viruses are particularly harmful to infants under the age of 90 days old, due to their limited immune reactivity". And so on. I think this strengthens your story! Parechovirus and Enterovirus are also spread by sewage. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3811204/, https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(22)00178-1/fulltext
Enterococci as you saw is one of the three I am closely exploring. It fits many of the S/S and presentations. That said, I think overall Acinetobacter fits even more (esp. the spontaneous disappearing rash). Either way it makes me think that I am exploring the right area. I had a look at the parechovirus paper you suggested and did some digging there and it didn't feel right given the details I have atm. The thing with Enterococci and Acinetobacter that is especially relevant is that they can both cause NEC (and in several studies around half of the babies that got NEC from either bacteria went from seemingly healthy to dead in hours... others lingered for weeks and seemed to get better on antibiotics only for the ABs to be stopped 5-7 days later (which was too soon) and for them to be dead within a week or two.
Ok, could be, I am not an expert. My expert friend has pretty strong arguments for her theory, and her theory also appears to match the symptoms which you describe. A nice point is the time period, matching similar epidemics in other neontal wards at the same time, including one not far away (Leicester, 2016). These viruses are seasonal.
WHY DID NOBODY - sorry, I am so upset I am shouting - MENTION THIS? Before the trial, or during. Every medical expert stated they were puzzled by the weird rashes. The only possible explanation found in a forty (40 !) year old "talking paper" from Canada. Did none of these pediatric/neonatal medical experts read these articles about events occurring in NICU's in more recent years ? This is mind-boggling !
The main part of the Countess of Chester hospital was a standard new NHS modular build and was first occupied in or around 1982/1983. I know, because I was one of the first staff in there as a trainee administrator. I don't know about this unit though.
Oh, I just checked: "The current Women and Children’s Building was built in 1971 – 12 years before the main building first opened and 13 years before the hospital was officially named the ‘Countess of Chester’ on 30 May 1984. " This explains my initial confusion. Apparently a new building is going up shortly ..https://www.coch.nhs.uk/corporate-information/news/plans-submitted-for-new-women-and-childrens-building.aspx
"It would be incredible (meaning not credible) to think that they are occuring everywhere else in the world EXCEPT the UK." My major criticism of the NHS is lack of transparency, again confirmed.
Australian paediatric doctor. Not a neonatologist. Got up to Baby D’s case in a podcast covering the trial, and had to pause in disgust
The “expert witness” saying a baby with congenital pneumonia was not contributed to by 60hrs PROM without intrapartum antibiotics. Saying a term baby requiring intubation for sepsis (untreated for the first couple of hours of life!) was “getting better” the very same day. Calling apnoeas/bradys/desats “unexplained collapses” when it’s such a recognised phenomenon that every nursery baby has a recording sheet specifically for these. An unusual skin rash that sounds a hell of a lot like skin mottling from poor perfusion in a critically unwell neonate
But what would I know? I’m only actually working in Paed, not retired for 15yrs while neonatal practice “has barely changed”; just dropping the threshold of viability to 22 weeks, peripheral TPN, HFOV, minimally invasive surfactant, high flow for neonates, cooling for HIE… all going from never heard of to becoming mainstream, standard practices
Thank you for this.
Please read for more info also
https://jameganx.notepin.co