Doctors came under pressure “not to make a fuss” when they raised concerns with hospital managers about a nurse who is accused of killing seven babies, a court has been told. Dr Ravi Jayaram, a consultant, told a jury his team alerted management to their concerns about Lucy Letby in October 2015, eight months before she was removed from frontline nursing duties. He said he raised the matter again in February 2016 but nothing was done, adding: “We were getting a reasonable amount of pressure from senior management at the hospital not to make a fuss.” Letby, 33, is accused of murdering seven babies and attempting to kill another 10 infants between June 2015 and June 2016. She denies all the charges. Jayaram, a paediatrician at the Countess of Chester hospital where Letby worked, said he and other clinicians highlighted concerns to managers after a number of unusual incidents on the neo-natal ward. He told jurors that in October 2015 his team raised an “association we had seen with an individual being present in those situations and, how do I say diplomatically, being told we really should not really be saying such things and not to make a fuss”. He told jurors it was raised again February 2016 and the hospital’s medical director was told. The doctors asked for a meeting but did not hear back for another three months. Letby is alleged to have murdered four babies and made seven attempts to kill four others between June and September 2015. She is accused of going on to murder three more and attempt to kill seven others between October 2015 and June 2016. The nurse, originally from Hereford, denies all the charges. Jayaram told the court he wished they had bypassed hospital management and contacted the police. He said was a “matter of regret that had I suggested this, and it could have been happening, I didn’t really have any hard evidence apart from the association we had seen”. He added that it was “a matter of regret and I wish I had been more courageous.” The consultant told jurors that the skin discoloration of one of the babies allegedly murdered by Letby “didn’t fit with anything I had ever seen”. Child A is said by prosecutors to be the first victim of Letby, who allegedly caused him to stop breathing by injecting air into his bloodstream on the evening of 8 June 2015. Jayaram told the jury of eight women and four men the situation he faced was “unusual” as the youngster’s observations were stable up to the point of collapse. He said: “[Child A] was pale. What I did not give any clinical significance to at the time was unusual patches of discoloration. I didn’t actually record it in the notes. “Pink patches, mainly on the torso, which seemed to appear and disappear and flit around. “I had never seen anything like it before but my focus at the time was on ABC, airway, breathing, circulation.” He added: “I could not explain the sequence of events, why they had happened. I couldn’t explain why it had happened in the first place and couldn’t explain why the physiological responses to timely and appropriate interventions did not happen as they should have happened.” Jayaram agreed with Ben Myers KC, defending Letby, that he did not reference unusual discoloration in his clinical notes which were recorded less than three hours after Child A died. The trial continues.