Lucy Letby- Breathing Tube Science Refs & Stats

Facts we know about neonatal tube dislodgement and deaths in neonatal care- this is from deep prompts in chatgpt and google- please check this all out for youself. 

 More nuanced search and science is what the police and ccrc must be researching.

"About that ‘40% tube dislodgement’ claim at Liverpool Women’s (2012–15):

Neonatal care is extremely high-risk, especially for very premature babies. Peer-reviewed studies show:

Nearly 50% of neonatal intubations fail on the first try.

Adverse events (like tubes moving, oxygen drops, heart issues) happen in up to 40% of neonatal intubations, versus 20% in older kids.

Most of these issues are linked to baby fragility, staff experience, and unit policies — not foul play.


Sources anyone can read:

1. https://www.mdpi.com/2227-9032/13/11/1242


2. https://pmc.ncbi.nlm.nih.gov/articles/PMC8529572/


3. https://www.nature.com/articles/s41390-025-04168-w

Neonatal tube events and death rates in context (UK 2012–2016)

Nearly 50 percent of neonatal intubations fail on the first attempt. First-pass success rates are only 30 to 57 percent. When the tube is placed correctly on the first attempt, serious events like oxygen drops, tube slipping, or heart issues occur in only about 3 to 4 percent of cases. When staff need multiple attempts, complications rise sharply to 35 to 40 percent. 

Most of this is linked to very fragile premature infants, junior doctors performing intubations with low first-pass success, and unit policies such as waiting to see if a baby self-corrects, rather than deliberate harm.

Across the UK during 2013 to 2015, the national neonatal death rate was about 1.7 to 1.8 per 1,000 live births. At most NHS trusts, neonatal deaths were between 1 and 2 per 1,000. Some “red flag” trusts exceeded this, with rates above 2 per 1,000, but still within expected variation for very high-risk units. For example, Leeds Teaching Hospitals NHS Trust had a rate of 4.46 per 1,000 in 2022, which was among the highest in the country but based on a much larger birth volume than Chester.

At the Countess of Chester Hospital in 2015 and 2016 there were about 13 to 17 neonatal deaths among roughly 3,000 births, a crude rate of about 2.96 per 1,000.

 The unit normally recorded 2 to 3 deaths per year before 2015, so this was a sharp increase. The deaths included eight babies in 2015, five in 2016, and additional deaths of babies transferred to other hospitals after deterioration, which were still investigated as part of Operation Hummingbird. This rate was nearly double the national average and the highest among hospitals of comparable size, putting the unit into the “red flag” category used by NHS oversight and making it a statistical outlier.

Tube-related adverse events and elevated death rates can overlap. Fragile babies, repeated intubation attempts by less experienced doctors, overstretched staff, hygiene and infrastructure problems on the unit, and unusual practices like delayed intervention could all contribute to both a high rate of tube incidents and an unusual spike in deaths.

 It was the combination of these factors and the sharp rise in neonatal deaths, far above the UK baseline, that triggered police involvement, Operation Hummingbird, and the current public inquiry.

Consolidation of the key facts about neonatal tube events, deaths, gestational age, and comparisons with other UK hospitals in 2015–2016.

Unplanned extubation and tube-related events are common in neonatal intensive care, especially with fragile infants and junior-led intubations. Peer-reviewed studies show nearly 50 percent of neonatal intubations fail on the first attempt, with first-pass success rates between 30 and 57 percent. When the tube is placed correctly on the first attempt, serious complications like oxygen drops, tube slipping, and bradycardia occur in about 3 to 4 percent of cases. When multiple attempts are needed, complications rise to 35 to 40 percent. About 44 to 46 percent of all unplanned extubations cause significant clinical problems, and about 15 to 20 percent of those events can lead to death or cardiovascular collapse. In 2015, UK NICUs had an average unplanned extubation rate of about 2.54 per 100 ventilator days, though international figures ranged from 1 to 18 percent annually, with a global median of 18 percent. Extremely preterm infants can experience as many as six unplanned extubations per baby, while more mature infants average around two. Quality improvement programmes have reduced unplanned extubations by nearly 50 percent in some UK units through better tube fixation, staffing, and training.

In the UK in 2013 to 2015, the national neonatal death rate was about 1.7 to 1.8 per 1,000 live births. Most NHS trusts had rates between 1.6 and 2 per 1,000, with only about 21 trusts flagged by MBRRACE-UK as “red flag” outliers with rates more than 10 percent above their peer group. Some large high-volume centres such as Leeds Teaching Hospitals Trust reached around 4.4 per 1,000 in later years, but those spikes are less statistically unusual due to sheer size and case complexity. The Countess of Chester Hospital saw around 13 to 17 neonatal deaths among roughly 3,000 births in 2015 to 2016, a crude rate of about 2.96 per 1,000. The unit typically recorded only two or three deaths per year before 2015, so this was a major anomaly. This was the highest death rate among 43 hospitals of similar size and led to a red-flag classification by MBRRACE-UK.

Many of the babies under Lucy Letby’s care were not extremely preterm. Most were between 28 and 34 weeks gestation, and several were full-term or nearly full-term, considered stable before their collapse. Only a minority were in the extremely preterm category below 27 weeks, where deaths are common. Normally, most neonatal deaths in UK NICUs involve extremely preterm infants under 1,000 grams, which helps explain why Chester’s mortality spike stood out: more deaths occurred among babies who would not usually be expected to die based on gestational age and initial condition. This gestational profile, combined with the high number of deaths, made the unit’s outcomes statistically abnormal.

Taken together, the rise in deaths at Chester can be linked to several overlapping risk factors seen in neonatal care: fragile preterm infants, repeated intubation attempts by junior doctors, weak tube fixation, overstretched staff, unusual “wait and see” policies before re-intubation, and hygiene or infrastructure problems. These factors all raise the likelihood of unplanned extubations and related complications, which can lead to death in a significant fraction of cases even without foul play. The Countess of Chester’s death rate of 2.96 per 1,000, almost double the national average, combined with the fact that many affected infants were not in the highest-risk gestational groups, is why the unit was investigated, flagged by MBRRACE-UK, and became the focus of Operation Hummingbird.

This context shows why police, the Crown Prosecution Service, and the Criminal Cases Review Commission must examine detailed unplanned extubation logs, staffing records, fixation and intervention policies, and compare Chester’s outcomes directly with other UK NICUs using the MBRRACE-UK trust-level tables for 2015 and 2016. Only by correlating specific incidents and deaths with unit practices and comparing those figures to national benchmarks can investigators determine whether the spike in deaths was driven primarily by systemic failings, unprevented clinical risk, or individual wrongdoing. For Lucy Letby’s situation, the science shows this:

Unplanned breathing tube problems are common in neonatal units, especially with fragile premature babies. About half of all tube insertions fail on the first try. If a tube goes in correctly on the first attempt, serious problems happen in about 3 or 4 out of 100 cases. If several tries are needed, serious problems happen in 35 to 40 out of 100 cases. About 15 to 20 percent of these events can lead to a baby dying, even without anyone doing anything wrong.

Most hospitals in the UK have about 1.7 to 1.8 baby deaths for every 1,000 births. The Countess of Chester Hospital, where Letby worked, had about 2.96 deaths per 1,000 in 2015 to 2016. That is almost double the normal rate and was the highest among similar hospitals. What made it stand out even more is that many of the babies who died were not the most fragile extreme preterm babies, but late preterm or even near full-term infants, who normally survive.

These facts mean that, even without assuming foul play, the unit had the right mix of risks to create more tube problems and more deaths. But because the death rate was so high, and many of the babies were not in the usual high-risk group, the hospital was flagged as abnormal. That is why the police and review bodies are treating the cases as suspicious and digging deeper into what caused these deaths.

The science does not clear or convict Letby on its own. It shows that deaths could rise sharply from normal risks when a unit is overstretched, has fragile babies, and has junior doctors doing most of the tube work. But it also shows why the numbers were so alarming and why investigators are still examining if something more than bad conditions was happening.
 

-