It's all about energy
The top four causes of neonatal death, no matter which specific unit or location in the world, are asphyxia (particularly birth asphyxia and trauma from complications during labour and delivery), infection (particularly sepsis and pneumonia), low Birth Weight/Prematurity and congenital malformations. All the babies in the Letby case series had at least one, and usually more than one of these. 50% of neonatal deaths happen in the first 48 hours. (from womb to tomb). Preterm babies are born in a negative energy state. They use energy quicker than their stores can resupply. A preterm baby has enough glucose to last only a few hours. Therefore, they need a lot of external help to survive. The help need not be overly technical nor difficult to achieve, but it is difficult to sustain day in and day out. Bubble CPAP and a central line will get you 90% success. But you need the competence to apply these simple measures, and you need not be born in a literal shithole.
Go through each of the babies and tick the right boxes. Did they have one of these four, and did they have a sustained and competent response to the challenge? You will find the answer is yes to the first and no to the second. It isn't rocket science. Bigger units succeed because they have a culture of competence and a little sprinkling of know-how.
90% perspiration, 10% inspiration. Who said that?
In bigger units, you won't see people take 3 goes at intubation, causing the baby to choke and then bleed to death. Nor will you find doctors walking off after 7 failed attempts to insert a line, leaving the baby to fend for itself.
The smorgasbord of incompetence and criminal abuse displayed by so-called consultants on this unit was shocking. Their failure to recognise their failings and ask for help was unforgivable.
When Lucy is freed, we need to go back to court and put the right people away this time so that we leave a message that the medical profession will not readily forget.