Nurse Lucy Letby was "completely out of control" when she returned from a vacation in Ibiza and attacked three infants, a court docket has heard.

Prosecutor Nick Johnson KC mentioned the 33-year-old had "got away with so much" at that time it gave her the "misplaced confidence that she could pretty much do whatever she wanted" on the Countess of Chester Hospital's neonatal unit.

Letby is alleged to have murdered seven infants and tried to homicide 10 others between June 2015 and June 2016.

On three successive days in June 2016 she is claimed to have murdered two triplet boys, Child O and Child P, and tried to homicide one other child boy, Child Q.

The crown say Letby murdered Child O by injecting him with air intravenously and through a nasogastric tube, in addition to utilizing "significant force" to inflict a liver harm.

In his closing speech at Manchester Crown Court, Mr Johnson advised the jury Child O's case had similarities to Letby's alleged homicide of Child E, a twin boy who bled profusely earlier than his dying in August 2015.

"In (Child O's) case she combined all three methods she had used to such devastating effect on all the other children in the case," he mentioned.

"In order to try to cover up what she did, she falsified the notes.

"We say, frankly, by this stage she was fully uncontrolled and was decided to mete out the identical remedy to (Child P) the very subsequent day."

'Back with a bang'

Mr Johnson mentioned Letby returned from her break in Ibiza with two associates shortly after the delivery of the naturally conceived triplets on 21 June 2016.

On the afternoon of twenty-two June, Letby texted a good friend: "Probably be back in with a bang lol."

Discussing the case of Child P, Mr Johnson reminded the jury concerning the proof from a health care provider and a comment allegedly made by Letby because the deteriorating toddler awaited a switch to a distinct hospital.

The physician, who can't be recognized for authorized causes, mentioned Letby mentioned to her "he's not leaving here alive, is he?"

Letby had advised the court docket she couldn't recall the dialog on the afternoon of 24 June.

Letby 'knew the tip recreation'

Mr Johnson mentioned: "Ladies and gentlemen, she did say it. But why did she say it? There is only one answer - because she knew the end game.

"She knew what was going to occur. She was controlling issues. She was having fun with what was happening and fortunately predicting what she knew was going to occur.

"She was in effect playing God."

Less than half an hour later Child P collapsed once more as a result of Letby moved his respiration tube, Mr Johnson mentioned, and he died quickly after.

Letby denies all of the allegations.

The trial continues on Wednesday