A hospital nurse sent a sympathy card to the grieving parents of a baby girl she murdered on her fourth attempt, a court has heard.
The infant was one of seven babies that Lucy Letby is alleged to have killed while she was working in the neo-natal unit at the Countess of Chester Hospital.
The 32-year-old is also accused of attempting to murder 10 other babies within the same period, between June 2015 and 2016.
Continuing his opening of the Crown’s case on Wednesday, prosecutor Nick Johnson KC told jurors at Manchester Crown Court that the death of Child I – who cannot be identified for legal reasons – was an “extreme example even by the standards of this overall case”.
He said: “This is a case where we allege Lucy Letby tried four times to kill her. (Child I) was resilient but ultimately at the fourth attempt Lucy Letby succeeded and killed her.”
Letby is said to have deliberately administered large amounts of air into Child A’s stomach through a nasogastric tube – one of various means she allegedly deployed to harm children in her care.
The first incident on September 30 2015 was said to have taken place – days after she attempted to murder another baby – when Child I struggled to breathe just 30 minutes after Letby was said to have fed her.
In the second alleged incident on October 13 the court heard that a night shift colleague recalled Letby was standing in the doorway of a darkened room in the neo-natal unit when the defendant remarked that Child I looked pale in her cot.
The fellow nurse went in and saw Child I “appeared to be at the point of death and was not breathing”.
Mr Johnson said the baby recovered but “ironically” Letby then became Child I’s designated nurse.
Child I collapsed again on the next night shift and was “brought back from the brink of death”, the court heard.
During the early hours of October 23 another collapse followed, the court was told, but the baby was successfully resuscitated and recovered to the extent that she was showing signs of hunger.
Less than a hour later the infant’s monitor alarm sounded and a colleague rushed to help and found Letby standing beside the incubator.
Mr Johnson said Letby’s fellow nurse wanted to intervene as Child I was “distressed”, but Letby said “they would be able to sort it”.
Child I then collapsed and died, the court heard.
Mr Johnson said Child I’s mother was allowed to bathe her “recently departed” daughter.
He said: “Lucy Letby came into the room and, in the words of (the mother), ‘was smiling and kept going on about how she was present at (Child I’s) first bath and how much (Child I) had loved it’.”
Mr Johnson said an expert paediatrician who reviewed Child I’s case had concluded that the baby’s deteriorations were consistent with the deliberate administration of a large amount of air into her stomach via a nasogastric tube.
The medic also believed that, on the final occasion, the infant had been injected with air into her bloodstream which led to her “screaming”, followed quickly by her collapse.
When interviewed later by police, the defendant was asked about a sympathy card she had sent to Child I’s parents.
Mr Johnson said: “She said for a nurse to send a card was not normal and it was the only time she had done it but it was not often the nurses got to know a family as well.”
Letby accepted that she kept an image of the card on her phone, he said.
She could not recall taking an interest in Child I’s parents on Facebook in the early hours of October 5 – a day off duty – or making searches on the parents of three other babies involved in the case.
Mr Johnson said: “(Child I) was born very early and very small. But she survived the first two months of her life and was doing well by the time Lucy Letby got her hands on her.
“What happened to (Child I) followed the pattern of what happened to others before and what was yet to happen to others.
“It was persistent, it was calculated and it was cold-blooded.”
A court order prohibits reporting of the identities of surviving and deceased children allegedly attacked by Letby, and prohibits identifying parents or witnesses connected with the children.
Letby, originally from Hereford, denies all the allegations.
The trial continues.
