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Found 549 results
  1. News Article
    A paediatric nurse who called in to LBC news during a discussion on Lucy Letby, says she can see how Letby was able to get away with her crimes as she herself was 'blacklisted' when she reported a colleague. Watch the video Source: LBC News, 19 August 2023
  2. Content Article
    On 18 August 2023, Lucy Letby was found guilty of murdering seven babies and convicted of trying to kill six other infants at the Countess of Chester Hospital. Looking ahead to the forthcoming independent inquiry into this case, Patient Safety Learning, reflecting on the inquiries of the past, sets out some key patient safety themes and issues that should be considered as part of this.
  3. News Article
    US regulators this week have approved the first RSV vaccine for pregnant women so their babies will be born with protection against the respiratory infection. The Food and Drug Administration cleared Pfizer’s maternal vaccination to guard against a severe case of RSV when babies are most vulnerable – from birth through six months of age. The next step: the Centers for Disease Control and Prevention must issue recommendations for using the vaccine, named Abrysvo, during pregnancy. “Maternal vaccination is an incredible way to protect the infants,” said Dr Elizabeth Schlaudecker of Cincinnati Children’s Hospital, a researcher in Pfizer’s international study of the vaccine. If shots begin soon, “I do think we could see an impact for this RSV season.” RSV is a coldlike nuisance for most healthy people but it can be life-threatening for the very young. It inflames babies’ tiny airways so it’s hard to breathe or causes pneumonia. In the US alone, between 58,000 and 80,000 children younger than five are hospitalised each year, and several hundred die, from the respiratory syncytial virus. Read full story Source: The Guardian, 22 August 2023
  4. Content Article
    We now know that Lucy Letby is a murderer, responsible for the deaths of seven babies and the attempted murders of six more. But as unimaginable as her crimes were, this verdict raises as many questions as it answers. Letby was not working in a vacuum. Could the killings at the Countess of Chester Hospital NHS Foundation Trust have been stopped sooner? Did organisational failures cost the lives of babies who could have been protected? The timeline gives us a clue, writes Minh Alexander, a retired consultant psychiatrist and NHS whistleblower, in this Guardian opinion piece. In June 2016, Letby’s hospital trust commissioned a review of neonatal care by the Royal College of Paediatrics and Child Health after “concerns about increasing neonatal mortality”, which oddly did not feature a case-note review. This prevented detailed examination of the deaths, which should have been the prime objective. The college reported “extremely positive relationships” among staff but “remote” relationships with executives. Astonishingly, the college’s report seemingly did not explicitly acknowledge a possibility of deliberate harm. Nevertheless, the college raised concern that not all deaths were followed by postmortem investigations – as they should have been, according to guidelines – and that where postmortems did take place, they did not include systematic blood tests and toxicology. It noted concerns from obstetrics staff about four unexpected deaths. In the coming days, there will be many questions. Why did it take so long for the hospital to refer matters to the police? Were doctors pressured not to persist with their concerns about Letby? How many trust board members knew there was a possibility of deliberate harm but failed to act?
  5. News Article
    Lucy Letby sat with her parents in a meeting with senior managers at the Countess of Chester Hospital, where she worked, waiting patiently for an apology. She had prepared a statement that was read out by her parents to Tony Chambers, the hospital’s chief executive, about being bullied and victimised on the neonatal unit. It was December 22, 2016, and for the previous 18 months, two doctors on the unit had been trying to find an answer for a series of mysterious deaths of babies. Their detective work had led them to a single common denominator: Letby. The neonatal nurse had been on shift for each of the incidents. Rumours of a killer on the ward had spread and Letby had complained about the doctors and their finger-pointing, claiming she was being wrongly blamed. Chambers, who had trained as a nurse, was convinced by Letby’s account, and in front of her parents, John and Susan, offered sincere apologies on behalf of the hospital trust. The doctors in question would be “dealt with’’. Except the doctors were right. By that point Letby had secretly murdered seven babies and tried to kill six more, one of them twice. An investigation by The Sunday Times, based on a cache of internal documents, reveals in detail how the hospital delayed calling the police for months and that senior management, including the board, sided with Letby against doctors after commissioning perfunctory investigations. Read full story (paywalled) Source: The Times, 19 August 2023
  6. Content Article
    On the 20 February 2019 an investigation commenced into the death of Bethan Naomi Harris who was born on the 16 November 2018 at the St George's University Hospitals NHS Foundation Trust. Bethan Naomi Harris died at Shooting Star Hospice on the 26 November 2018. Her mother's pregnancy had been uneventful. After admission to labour ward labour progressed very quickly indeed and Bethan sustained severe brain injury during delivery. Despite best efforts by the neonatal team she succumbed to her injuries. The Investigation concluded at the end of the Inquest on the 19 November 2019. The conclusion of the inquest was that the medical cause of Bethan's death was (1a) hypoxic ischaemic encephalopathy.
  7. Content Article
    Babies would have survived if hospital executives had acted earlier on concerns about the nurse Lucy Letby, a senior doctor who raised the alarm has said. In an exclusive Guardian interview, Dr Stephen Brearey accused the Countess of Chester hospital trust of being “negligent” and failing to properly address concerns he and other doctors raised about Letby as she carried out her killings. Brearey was the first to alert a hospital executive to the fact that Letby was present at unusual deaths and collapses of babies in June 2015. The paediatrician and his consultant colleagues raised concerns multiple times over months before Letby, then 26, was finally removed from the neonatal unit in July 2016. The police were contacted almost a year later, in May 2017. Speaking publicly for the first time, Brearey told the Guardian that executives should have contacted the police in February 2016 when he escalated concerns about Letby and asked for an urgent meeting.
  8. News Article
    Nurse Lucy Letby has been found guilty of murdering seven babies on a neonatal unit, making her the UK's most prolific child serial killer in modern times. The 33-year-old has also been convicted of trying to kill six other infants at the Countess of Chester Hospital between June 2015 and June 2016. Letby deliberately injected babies with air, force fed others milk and poisoned two of the infants with insulin. Commenting on the verdict, Parliamentary and Health Service Ombudsman Rob Behrens said: “We know that, in general, people work in the health service because they want to help and that when things go wrong it is not intentional. At the same time, and too often we see the commitment to public safety in the NHS undone by a defensive leadership culture across the NHS. “The Lucy Letby story is different and almost without parallel, because it reveals an intent to harm by one individual. As such, it is one of the darkest crimes ever committed in our health service. Our first thoughts are with the families of the children who died. “However, we also heard throughout the trial, evidence from clinicians that they repeatedly raised concerns and called for action. It seems that nobody listened and nothing happened. More babies were harmed and more babies were killed. Those who lost their children deserve to know whether Letby could have been stopped and how it was that doctors were not listened to and their concerns not addressed for so long. Patients and staff alike deserve an NHS that values accountability, transparency, and a willingness to learn. “Good leadership always listens, especially when it’s about patient safety. Poor leadership makes it difficult for people to raise concerns when things go wrong, even though complaints are vital for patient safety and to stop mistakes being repeated. We need to see significant improvements to culture and leadership across the NHS so that the voices of staff and patients can be heard, both with regard to everyday pressures and mistakes and, very exceptionally, when there are warnings of real evil.”
  9. News Article
    While most babies born more than two months prematurely now survive thanks to medical advances, little progress has been made in the past two decades in preventing associated developmental problems, an expert review has found. The review also found that very preterm babies can have their brain development disrupted by environmental factors in the neonatal intensive care unit (NICU), including nutrition, pain, stress and parenting behaviours. A review conducted by experts from the Children’s Hospital of Orange County in the US and the Turner Institute for Brain and Mental Health at Monash University in Australia found that while these neurodevelopmental problems can be related to brain injury during gestation or due to cardiac and respiratory issues in the first week of life, the environment of the NICU is also critical. To improve outcomes for very preterm babies, the review recommended family based interventions that reduce parental stress during gestation, more research into rehabilitation in intensive care and in the early months of life, and greater understanding of the role of environment and parenting after birth. Read full story Source: The Guardian, 3 August 2023
  10. News Article
    An 11-year-old boy suffered permanent brain damage after birth because of negligence by hospital midwives who then fabricated notes, a high court judge has ruled. Jayden Astley’s challenges in life include deafness, motor impairments, cognitive difficulties and behavioural difficulties, his lawyers said. After a five-day trial at the high court in Liverpool, Mr Justice Spencer ruled that staff at the Royal Preston hospital in Lancashire were negligent in their treatment of Jayden in 2012. The brain injury was caused by prolonged umbilical cord compression that resulted in acute profound hypoxia – lack of oxygen – sustained during the management of the birth, the court found. Midwives failed to accurately monitor Jayden’s heart rate when he was born and failed to identify his bradycardic, or slow, heart rate during delivery. The judge also found that some entries in notes were fabricated. In his judgment Spencer said it was agreed that all permanent damage to Jayden’s brain would have been avoided if he had been delivered three minutes earlier. Read full story Source: The Guardian, 2 August 2023
  11. News Article
    Serious systemic failings contributed to the death of a newborn baby in a cell at Europe’s largest women’s prison, a coroner has concluded. Rianna Cleary, who was 18 at the time, gave birth to her daughter Aisha alone in her prison cell at HMP Bronzefield, in Surrey, on the night of 26 September 2019. The care-leaver was on remand awaiting sentence after pleading guilty to a robbery charge. The inquest into the baby’s death heard that Cleary’s calls for help when she was in labour were ignored, she was left alone in her cell for 12 hours and bit through the umbilical cord to cut it. In a devastating witness statement read to the court, Cleary described going into labour alone as “the worst and most terrifying and degrading experience of my life”. She said: “I didn’t know when I was due to give birth. I was in really serious pain. I went to the buzzer and asked for a nurse or an ambulance twice.” Cleary passed out and when she woke up she had given birth. The senior coroner for Surrey, Richard Travers, said Aisha “arrived into the world in the most harrowing of circumstances”. He concluded it was “unascertained” whether she was born alive and died shortly after or was stillborn. Read full story Source: The Guardian, 28 July 2023
  12. News Article
    Women who lose babies during pregnancy will be able to get a certificate as an official recognition of their loss as well as better collection and storage of remains under new government plans. The government will make sure the certificate is available to anyone who requests one after experiencing any loss pre-24 weeks’ gestation. The NHS will develop and deliver a sensitive receptacle to collect baby loss remains when a person miscarries. A&Es will also have to ensure that cold storage facilities are available to receive and store remains or pregnancy tissue 24/7 so that women don’t have to resort to storing them in their home refrigerators. The new recommendations are part of the government’s response to the independent Pregnancy Loss Review. Read full story Source: The Independent, 23 July 2023
  13. Content Article
    A vision for improving the care and support available to families when baby loss occurs before 24 weeks' gestation.
  14. Content Article
    This policy paper from the Department of Health and Social Care sets out the Government’s response to the recommendations of the Independent Investigation into East Kent Maternity services.
  15. News Article
    Soon after her son Jaxson was born, Lauren Clarke spotted that his eyes were yellow and bloodshot. “We kept asking if he had jaundice, but each time we were told to keep feeding him and just put Jaxson in front of a window,” she says. It was only when Clarke was readmitted six days later with an infection that Jaxson’s jaundice was detected by a midwife. By this time, his levels were becoming dangerously high. “We spent a further five days in hospital for Jaxson to be treated with light therapy and antibiotics. If I hadn’t had to go back to hospital, he could have died or had serious long-term health conditions,” she says. This week, the NHS race and health observatory will announce new funding for research into the efficacy of jaundice screening in black, Asian and minority ethnic newborns on the back of a recent report showing that tests to assess newborn babies’ health are not effective for non-white children. The research cannot come too soon. Jaxson’s aunt, Gemma Poole, a midwife from Nottingham, created her company, the Essential Baby Company, to develop resources and training about the specific needs of women and babies with black and brown skins, after Jaxson’s jaundice was initially missed by clinicians. Poole believes the trauma her nephew, brother and sister-in-law had to go through could have been avoided if health professionals had known better ways to spot jaundice in non-white babies. “The colour of gums, the soles of the feet and hands, the whites of eyes, how many wet and dirty nappies and if the baby is waking for feeds and alert could be more reliable indicators if a black or brown baby has jaundice,” she says. Read full story Source: The Guardian, 16 July 2023
  16. Content Article
    Tests that indicate the health of newborns, moments after birth, are limited and not fit-for-purpose for Black, Asian and ethnic minority babies, and need immediate revision according to the NHS Race and Health Observatory.
  17. Content Article
    Jane Plumb is the Co-Founder of Group B Strep Support and the Women's Voices Lead for the Royal College of Obstetricians & Gynaecologists. In this interview, she emphasises the importance of actively involving patients and families in patient safety discussions so that improvements can be informed by their insights and experiences. Jane also talks about her campaigning and advocacy work, reflecting on the challenges and achievements to date as well as looking ahead to future aims and activity. 
  18. News Article
    Olly Vickers died of a brain injury in February last year just weeks after two midwives at Royal Bolton Hospital let his mother Emma Clark feed him while she was having gas and air – in breach of guidelines. Despite being well when he was born, Olly was found “pale and floppy” hours later due to his airways being obstructed. He developed a brain injury and died five months later. Coroner Peter Sigee ruled his death was a result of “neglect” and due to a “gross failure to provide basic medical care”. An inquest into his death heard a student midwife placed a pillow under his mother’s arm while she was feeding him, “contrary to accepted practice”. Another midwife then gave Ms Clark gas and air while she was feeding Olly as she was stitched up for a tear obtained during labour – which again went against guidance. No risk assessment was carried out and the coroner said Olly’s breastfeeding should have been stopped before the midwives began to suture Ms Clark. Read full story Source: The Independent, 8 July 2023
  19. News Article
    Premature babies across England will be offered a sight-saving drug, the NHS has announced. Retinopathy of prematurity (ROP) is an eye disease that can occur among babies who are born early or those born with a low birth weight. The NHS routinely screens these babies for the condition, which affects blood vessels in the retina, creating damaging scar tissue and causing blindness. Traditionally the condition is treated with laser eye surgery but some babies are too unwell or fragile to have the treatment. Now the NHS is offering new “life-changing” drug ranibizumab to babies with ROP across England who are unable to receive traditional treatment. NHS chief executive Amanda Pritchard said: “The impacts of vision loss can be absolutely devastating, particularly for children and young people, so it’s fantastic that this treatment will now give families across the country another life-changing option to help save their child’s precious sight." Read full story Source: The Independent, 4 July 2023
  20. News Article
    Men who take the epilepsy drug sodium valproate could beat increased risk of having children with disabilities, research has found. A study ordered by the European Medicines Agency (EMA) has suggested a link between fathers taking the drug three months before babies are conceived and a small increased likelihood that the children will have neurodevelopmental disorders. The drug manufacturer Sanofi has not published the full results, leading to confusion among patients and doctors. Sodium valproate, sold in the UK as Epilim, is prescribed to treat epilepsy, bipolar disorder and migraines. It is known to cause deformities in one in ten babies exposed to it in the womb because their mothers are taking the drug. Four in ten babies suffer developmental delays. Read full story (paywalled) Source: The Times, 2 July 2023
  21. News Article
    Maltese lawmakers have unanimously approved legislation to ease the strictest abortion laws in the EU, voting to allow terminations – but only in cases where a woman’s life is at risk. Ahead of the vote on Wednesday, pro-choice campaigners withdrew their support, saying last-minute changes make the legislation “vague, unworkable and even dangerous”. The original bill allowing access to abortion if a pregnant woman’s life or health is in danger was hailed as a step in the right direction for Malta, a majority-Catholic country. It was introduced last November after an American tourist who miscarried had to be airlifted off the Mediterranean island nation to be treated. Under the amendments, however, a risk to health is not enough. A woman must be at risk of death to access an abortion, and then only after three specialists consent. The new legislation allows a doctor to terminate a pregnancy without specialist consultation only if the mother’s life is at immediate risk. Read full story Source: The Guardian, 28 June 2023
  22. Content Article
    In the UK, up to two-thirds of GBS infection in babies are of early onset (showing within the first 6 days of life). Read more about the symptoms and download an awareness poster via the link below to the Group B Strep Support website.
  23. Content Article
    Whether you need information about the latest guidelines on group B Strep during pregnancy, labour and after birth, the key signs of GBS infection in babies, or information leaflets for families in your care, this section is for you. The group B Strep Support website has resources to support you and the families in your care.
  24. News Article
    A study in 11 countries over four continents has shown the “catastrophic impact” of antibiotic resistance on babies with sepsis, with nearly one in five dying. The two year observational study enrolled 3204 babies with clinical sepsis in 19 hospitals in Africa, Asia, Europe, and Latin America. It found that 17.7% were blood culture pathogen positive, and mortality rates among infants up to 60 days old with culture positive sepsis was 17.7%. The research, published in PlOS Medicine, also highlighted wide variation in treatment and frequent switching of antibiotics because of resistance, with 206 antibiotic combinations used by the hospitals studied in Bangladesh, Brazil, China, Greece, India, Italy, Kenya, South Africa, Thailand, Vietnam, and Uganda. Read full story Source: BMJ, 9 June 2023
  25. News Article
    One of the NHS’ largest hospital trusts is being investigated over “possible gross negligence manslaughter” after a baby died 24 hours after her birth. Polly Lindop died at St Mary’s Hospital on 13 March and Greater Manchester Police have now launched a probe into her death. Police said its major incident team launched the investigation into “possible Gross Negligence manslaughter” after concerns were raised to the force and local coroner. DCI Mark Davis of GMP’s major incident team said: “First, I want to express my condolences to the parents of Polly at what is an extremely difficult time for them. Our thoughts will remain with them as we carry out our investigation. “A number of hospital staff have been spoken to as witnesses by officers and no arrests have been made at this time. “The hospital trust has been fully cooperative with the police and all relevant authorities have been kept informed. The investigation into Polly’s death is on-going and her family will continue to be kept updated in relation to any significant developments.” Read full story Source: The Independent, 5 June 2023
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