Nurse Lucy Letby wrote a sympathy card to the grieving parents of a baby girl she is accused of murdering, her trial has heard.
She sent the "not normal" card just weeks after she allegedly murdered the premature baby, known as Child I, Manchester Crown Court was told on Thursday.
Letby, 33, from Hereford, is accused of trying to kill the baby three times before succeeding on a fourth attempt on 23 October 2015.
She denies murdering seven babies - five boys and two girls - and attempting to murder another 10 babies (five boys and five girls) between June 2015 and June 2016.
She worked in the neonatal unit at the Countess of Chester Hospital in Chester at the time.
The court heard on Thursday that she took a photo on her phone of the sympathy card on the morning of 10 November after finishing a night shift, just hours before Child I's funeral.
Letby is accused of murdering her by injecting air into her stomach via a feeding tube.
Letby wrote in the card: “There are no words to make this time any easier.
“It was a real priviledge (sic) to care for (Child I) and get to know you as a family – a family who always put (Child I) first and did everything possible for her.
“She will always be a part of your lives and we will never forget her.
“Thinking of you today and always – sorry I cannot be there to say goodbye. Lots of love Lucy x.”
The card contained the printed message: “Your loved one will be remembered with many smiles.”
Opening the prosecution case last October, Nick Johnson KC said the defendant later told detectives it was “not normal” for a nurse to send such a card.
She added it was the only time she had done it – but it was “not often the nurses got to know a family as well”, he told the court.
Giving evidence, nurse Ashleigh Hudson said she was responsible for the care of Child I on 22 and 23 October and thought the baby appeared “very stable” at the beginning of the shift.
Ms Hudson responded to cries from the youngster’s incubator in nursery room 1 just before midnight but could not settle her.
“It was the type of cry I had not myself experienced her make before," she said.
“It was very loud. It was relentless, almost constant. There was no stopping or starting, no fluctuating and constantly very loud.”
Letby came to her assistance when she shouted for help, Ms Hudson said.
She said doctors were then “crash bleeped” when there was no initial response from Child I who later quickly recovered after being placed on a ventilator.
She said she was close to room 1 at 1.06am when she was alerted by either a monitor alarm sounding or Child I crying again.
She told the court: “I re-entered the nursery at which point Lucy was already there trying to comfort her, trying to settle her.”
Ms Hudson said Letby had her hands in the incubator and was offering a dummy but crying Child I was “not interested”.
She went on: “My concern was this cry was the same and she was going to have another episode.
“That’s when I said something along the lines of ‘she is going to do it again, it’s the same cry’.
“I think Lucy was trying to reassure me and she said she just needs to settle.”
She said Child I’s heart rate and blood oxygen levels “began to drift down” and she ran through the double doors of the adjoining labour ward theatre to fetch a doctor.
A prolonged period of resuscitation attempts from medics followed – lasting up to an hour – before Child I was pronounced dead at 2.30am.
On the afternoon of 23 October, Letby messaged a colleague: “Dr Gibbs (consultant) was great, we tried everything. Just don’t think she was strong enough this time. Sad isn’t it.”
The prosecution say the defendant made earlier bids to deliberately harm Child I on 30 September and on 13 and 14 October.
Child I was transferred from the Countess of Chester Hospital to Wirral’s Arrowe Park Hospital on 15 October where she improved before she returned on 17 October.
Letby was absent from work from 17 October until the night of Child I’s fatal collapse, the court heard.
The trial continues on Friday.
Watch: Nurse Lucy Letby accused of murdering seven babies starts trial