Bimal

I am not a lawyer, etc. etc. 99 is a medical forum and so we of course focus on the neonatology aspects of the case, but as someone who spends a great deal of time thinking about causal inference and bias in study design, the most obnoxious part of the Letby case is the "grid" shown at trial purporting that Letby was the only person present when all the listed events took place and that, therefore she was guilty. The problem of course is that, as the panel review discussed here addresses, its not clear all (any?) of the events in the grid were crimes and, worse, it appears the events on the grid were chosen specifically to include only events Letby was present for (reverse causation).

The ICU in question appears to be licensed only to care for babies >32 weeks on CPAP or lower respiratory support. Based on my best inference from various articles, he was born in 2020 or 2021 and transferred from a high risk perinatal center as a 10-12 day old ex-31 to 31 6/7 week twin boy, probably on CPAP or HFNC, probably on full enteral feeds. It is unclear if he was transitioned to formula feeds at the birth hospital or upon transfer to the local unit. There is probably significant variation in when babies are transitioned to formula feeds both internationally and within the US, but in my experience in multiple regions of the USA, transitioning at ~33weeks corrected is not unusual.

Our general approach is to counsel on the range of expected outcomes and allow parents to decide on whether to resuscitate. Key barriers we up against are getting OB to give steroids, achieving consensus on what a resuscitation at that age looks like (Many of my partners offer a "trial of ventilation", some insist on running a full code if they are going to try at all). I think the much more interesting question is under what circumstances it is permissible for the family to request palliative extubation/withdrawal of life sustaining interventions, assuming the child has made it to the ICU.