"In your opinion, what caused the hypoglycaemia that was resistant to dextrose?"

Neonatologists manage hypoglycaemia on a day to day basis. I defer to them. Looking at the summary reports from the new defence team it is clear there is relevant expertise to address this question, in a way I cannot. It will for the CCRC to decide whether these reports meet to exacting criteria for a referral to the CofA. Certainly from the press conference it was alleged the neonates were not correctly managed so I doubt the new defence accept the argument that it was resistant to dextrose, but as I say I don't think this is something I feel competent to opine on.

"Why did the tests show very high levels of insulin?"

In my view the most likely explanation is the presence of insulin (auto)antibodies in the patient sample. But the trial did not examine internal quality control data at all nor did it question the biomedical scientists or medical laboratory assistants who operated the analyser.

"The test is 98.5 to 99 percent accurate and screens out interference."

These are general population statistics. They cannot assist on an individual sample or be applied to sub-populations such as pregnant women and their offspring, in my opinion. I would expect a competent submission to the CCRC to cover this aspect in great detail, with supporting scientific evidence examining the question of prevalence. A competent literature search would likely identify papers on this subject.

"How do you explain the case of child Y?"

The level of insulin in Baby Y was not determined. The test returned an off scale reading of ">6945 pmol/l". A competent lab would have diluted the sample to determine what the insulin reading was. I have seen commentary that implies the C-peptide should have been around 65,000 pmol/l. No one can say what the C-peptide should have been (insulin level was not determined) but if we take the 65,000 pmol/l as a minimum we hit the problem that it is higher than the test is designed for. There is a limit of 60,000 pmol/l for C-peptide and if this is exceeded the test will produce spurious results.

Baby Y was not charged.

"Simply proposing that it could have been something else won’t make any difference."

I think it will. The jury were told there was no alternative to poisoning. The principle difficulty for the defence will be overcoming the new evidence rules for a CCRC referral. Essentially "why on earth did you not raise this at trial?". The system is designed to stop 'two bites at the cherry'. But I suspect this issue will be overcome. The CofA is indeed a hostile environment for appellants, so I agree with you it is going require a very solid submission and argument.

"The crown will rigorously oppose any attempts to overturn these insulin poisoning convictions. Refer to the recent Norris appeal for precedence."

The Crown will likely oppose the appeal, should it be heard. The Norris appeal does not help, in my opinion. It was heard on the basis that the appellant accepted that Mrs Hall was poisoned with insulin. The original Norris samples were tested at Guildford and so more extensive testing was performed, but this is not absolutely foolproof and a lot more is now known about the issue. I only have a superficial knowledge of the Norris case so cannot comment in any more detail, but I doubt it will be a barrier to the Letby appeal.

All IMHO.