A senior doctor has told a jury that a “fear of retribution” from NHS bosses was one of the reasons he did not contact police after walking in on the nurse Lucy Letby allegedly trying to murder a baby. Letby, 34, is accused of trying to kill the two-hour-old girl by dislodging her breathing tube on the neonatal unit at the Countess of Chester hospital in north-west England. Dr Ravi Jayaram, a consultant paediatrician, told Letby’s trial on Wednesday that he felt “very uncomfortable” leaving the nurse alone with the infant, known as Baby K, after doctors linked her to a series of “unusual incidents”. The jury has been told that Letby has been convicted of murdering five babies in the months before Baby K was born in the early hours of 17 February 2016. Letby denies attempting to murder the infant. Jayaram told Manchester crown court that by February 2016 he and other senior doctors had begun to think the “unthinkable thought” that Letby was deliberately harming babies. He said this was “not a fixed belief” at the time but was enough to make him “very uncomfortable” when Letby was left alone with Baby K when the infant’s nurse briefly left her side at 3.31am. Jayaram said he went in to check on Letby “to reassure myself that everything was OK”. He found the nurse standing beside Baby K’s incubator while the newborn’s oxygen saturation levels dropped to a “life-threatening” level. He told jurors there was no “obvious evidence” that the nurse was helping the baby or investigating the cause of collapse. An alarm that should have been sounding was silent, he said. The court has heard that Jayaram told a hospital transfer team at the time that he believed Baby K’s breathing tube had become dislodged, causing her oxygen saturation levels to plummet. Letby’s barrister, Benjamin Myers KC, pressed Jayaram on why he had not contacted the police immediately if he suspected Letby of harming the infant. Jayaram told the court: “There was the element of denial, an element of fear of retribution from those people above. In subsequent months we were actually told it would be inappropriate to contact the police.” He added: “We were being advised from the start the police would be the wrong route, and the trouble is it’s a matter of infinite regret I didn’t handle it differently. “If we’d actually not had faith in those who were supposed to be guiding us then we would have gone to the police.” Myers asked Jayaram why he had been prepared to allow Letby to remain on the unit if he suspected he had caught her “virtually red-handed” harming a baby. “None of us were prepared to do that at all,” Jayaram said. “But we were in uncharted territory. There’s absolutely no precedent or training for us knowing how to deal with this. We were meeting big resistance from people the top. “Knowing what we know now I would challenge that hierarchy and unfortunately it’s a matter of regret now that I didn’t.” In an ITV interview that was played to the jury, Jayaram said the incident would be “in my nightmares for ever”. Pressing Jayaram about why he had not called the police immediately if the incident was so significant, the doctor said that at the time it was only a possibility that Letby had tampered with Baby K’s breathing tube. He said he did not record the breathing tube issue in his medical notes at the time because his priority was caring for Baby K. “You did not suspect this was a nightmare, did you?” asked Myers. Jayaram replied: “It will be in my nightmares. I only wish, number one, my documentation had more information. I only wish I had the courage to escalate in a different way. “I only wish I had the courage to do that. That’s why it’s going to be in my nightmares for ever.” The jury has been told that Letby was convicted last year of murdering seven babies and attempting to kill another six. The jury in that trial was unable to reach a verdict on the count of attempted murder related to Baby K, which Letby denies. Jayaram said he and colleagues “spent a lot of time trying to escalate [concerns about Letby] and spent a lot of time running into walls”. He said they had “put faith in our medical leaders at senior executive level to do the right thing and it’s a matter of enormous regret to me that I didn’t handle this differently at the time”. He went on: “We didn’t believe that people who worked in healthcare go into work to cause harm. I think I was a victim of my own cognitive dissonance. “There was also knowing I probably wasn’t going to be believed because we had already had issues where we weren’t being believed.” Asked by Johnson whether he “received support” from management when doctors raised concerns about Letby, Jayaram told the jury: “We were explicitly told at that stage it was the wrong thing to contact the police because it would be bad for the reputation of the trust and there would be blue and white tape everywhere.” Letby denies tampering with the newborn’s breathing tube. Myers has told jurors the case relies on whether they believe Jayaram’s evidence is “truthful or accurate”. The trial continues.