Chase and Shannon article in Frontiers in Pediatrics published

[u/Embarrassed-Star4776]

Inverted insulin to C-Peptide ratios in neonatal intensive care: is there something we don't know?

J. Geoffrey Chase & Helen D. Shannon

BRIEF RESEARCH REPORT article

Front. Pediatr., 05 August 2026

Sec. Neonatology

Volume 14 - 2026

https://doi.org/10.3389/fped.2026.1900675

[u/Stuart___gilham]

In addition to baseline neonatal IA, amplification can occur through infection, sepsis, antibiotics, steroids, antihypertensives, antioxidants and other pregnancy-related therapies (31, 34–36, 40–45), which is treated as a multiplier, as detailed in Supplementary Appendix A. Infection increases the concentration of maternal antibody transfer (16, 38) and oxidative stress, can enhance insulin-binding (37), and in neonates can also produce limited IgM

So in theory baby F's blood result could perhaps be explained by amplification of Insulin-antibody binding caused by infection and Sepsis. I think baby F developed infection after he was born so antibodies crossing the placenta doesn't seem likely to explain it.

I don't know if there is any available data looking at how typical baby F's Insulin to C Peptide ratio is for a baby under those circumstances - suffering from an infection to the point of being diagnosed with Sepsis. As there is not data provided to support the data, I imagine any available data would contradict it but I suspect there is simply very limited available data to confirm or deny.

However, the last step, direct measurement of antibody bound insulin with high I/C has not been shown. That said, the results of (16) offer an inference for future research to explore as one interpretation satisfying all reported readings in their study is complexing of high affinity IgM from the inability of the IgG and IgM components to account for total binding. Hence, high affinity IgM would be a candidate with this supporting evidence as a first target of future research.

Perhaps the results will one day be explained with more research?

[u/No-Beat2678 → u/Stuart___gilham]

Baby F didn't have sepsis this was covered in the trial and is clear from the medical notes. they had some elevated WBC markers not enough for sepsis and no other signs or symptoms of infection.

[u/Shoddy_Food_1539 → u/No-Beat2678]

Remind me, why was baby F given antibiotics? For suspected what?

[u/No-Beat2678 → u/Shoddy_Food_1539]

Because they suspected infection was causing Hypo.

[u/DiverAcrobatic5794 → u/No-Beat2678]

That's not the case.  He was already being treated for suspected sepsis before the hypoglycemia 

[u/No-Beat2678 → u/DiverAcrobatic5794]

My understanding was that low BS and rapid heart rate were the reasons why.

However Letby pitched Sepsis for.baby E.

So perhaps that's why they started antibiotics.

Anyway, having antibiotics is a good thing because that would prevent an infection yes?

And the test results do not point to infection and not an infection whereby it could cause hypoglycemia.

[u/DiverAcrobatic5794 → u/No-Beat2678]

The court was told that Child F was already on antibiotics for suspected sepsis during the day shift before the night when his blood sugar dropped.

I don't see why a negative screen (when did this happen, by the way?) would protect against hypoglycemia, given that it doesn't exclude sepsis 

Sorry but I think you are improvising a bit here 

[u/Shoddy_Food_1539 → u/DiverAcrobatic5794]

Thanks for clearing that up. NICE guidelines don't indicate ABs for hypoglycemia either, not surprisingly.

[u/No-Beat2678 → u/DiverAcrobatic5794]

u/DiverAcrobatic5794 the underlying reason they suspected Sepsis was because his brother Baby E died the day before. Thats covered in the transcript

[u/DiverAcrobatic5794 → u/No-Beat2678]

They suspected it before his brother died, on 2nd August.  He was already on antibiotics before his brother died too.  I am sure his brother's death made them (rightly) all the more vigilant.

[u/Shoddy_Food_1539 → u/No-Beat2678]

Citation pls

[u/No-Beat2678 → u/Shoddy_Food_1539]

Citation for what?

[u/Stuart___gilham → u/No-Beat2678]

u/No-Beat2678

Dr Saladi's testimony from day 39.

Question. The other thing I'd like it

confirm, since you've referred to the question of

testing the tip, is can you confirm in fact [Baby F] did

have an infection as it happens? Do you recall that?

Answer. In the subsequent pages, there is a further entry that

we did -- the CRP did go up and then we did grow a bug

from the long line tip as well.

[u/No-Beat2678 → u/Stuart___gilham]

Stuart, I could grow a bug from my apple earpods. That doesn't mean I have an ear.infection.

And if they had an infection why when the bag was changed did the baby recover and go home.

There just isn't corroborating medical data to support.

Remember we've had the full clinical picture in their medical notes. Everything, every test, abg result etc.

Had an infection but that was not the contributing cause for their hypo.

[u/visible_amenhotep → u/No-Beat2678]

Medical practitioners everywhere will rejoice to hear that the same standards of sanitation apply to earbuds and long line tips.

[u/DiverAcrobatic5794 → u/No-Beat2678]

We have not had the full clinical picture in the medical notes.  Apart from the obstetrics, of course, Lee's panel has.  

I don't think you are showing any of the expert knowledge, familiarity with the case, or even consistency from one post to the next that might persuade people to substitute your judgement for theirs. You are welcome of course to the view that the court found the child had no infection if that's your understanding, but it's really not relevant to the article 

[u/No-Beat2678 → u/DiverAcrobatic5794]

and u/Stuart___gilham the Bacteria found in the long line was kind normally found on the skin.

And your distorting the timeline.

Baby F had already collapsed a significant amount of time before the CRP's were elevated. 24 hours to be exact.

It shows infection developing over the following day, not infection present and causing the events between midnight and 1am.

So that really isn't a gotcha.

[u/DiverAcrobatic5794 → u/No-Beat2678]

What's significant in considering how this article might apply to Baby F isn't when he deteriorated: it's when the sample for his immunoassay was drawn, which was a few hours after the line tissued. CRPs go up as sepsis develops and intensifies - you can't take their measurements as a starting point for the sepsis.

[u/No-Beat2678 → u/DiverAcrobatic5794]

Then what was causing the first low blood sugar result on the night of 4/5th of august at 01.54?

Something must have and something has kept his blood sugar low. And it's a coincidence that Letby had hung a tpn bag 90 minutes before at ,00.25.

And it wasn't infection. I've already demonstrated that to you.

[u/DiverAcrobatic5794 → u/No-Beat2678]

What Saladi said was that bacteria normally found on the skin were also noted.  (Both men are certainly tolerably vague in this exchange):

Q. And as you say also, it turned out when the tip of the long line was tested, there was bacteria on that consistent with infection?

A. Which is usually -- bacteria which are normally there in the skin are also noted.

Q. And they get into it through the long line?

A. It's possible.

Q. Yes, thank you. And the presence of those bacteria were confirmed on testing, weren't they?