The death of a two-day-old baby after a locum surgeon operated on his abdomen was avoidable, a critical senior colleague of the medic told an inquest.
Baby Paul Mitchelhill died in his mother's arms after his health deteriorated following surgery at the Great North Children's Hospital in Newcastle in October 2013.
But surgeon Emmanuel Towuaghanste, known as Mr Towu, showed no regret and sought to blame others, the inquest at Newcastle's Civic Centre heard.
Paul was born with a rare defect known as exomphalos major - a weakness in the abdominal wall where the umbilical cord joins the body.
Following the emergency surgery Paul developed abdominal compartment syndrome, where increased pressure reduces blood flow to the organs.
Mr Towu's assistant Khizer Mansoor had noted the sutures on the baby's abdomen were tight following surgery.
The next day Paul's bowel was found to have died and the baby from Carlisle could not be saved.
Paediatric surgeon Bruce Jeffray, who now heads the department, told the hearing he had seen just six cases of exomphalos major in his 20 years experience.
Some surgeons operated immediately while others waited, the inquest heard.
He told the inquest: "I think this was an avoidable death."
Mr Jeffray said he would have treated the condition "conservatively" and would not have elected to perform emergency surgery on the new-born child.
Instead, he would have wrapped the defect in bandages and handed the baby to his mother as he was at no immediate risk, the inquest heard.
Mr Jeffray described compartment syndromes as "disastrous", adding: "You have converted a stable situation into uncontrolled chaos."
He only became involved in treating Paul towards the end of his life, he said, when he was showing a prospective new colleague around the intensive care unit.
By chance, three intensive care medics saw him and expressed their concerns about what had happened to Paul the previous evening.
Mr Jeffray felt it would be "wholly inappropriate" for Mr Towu to carry out a planned operation on another patient that afternoon, given what he had heard.
Later, as he prepared to go in to theatre to operate on Paul, Mr Jeffray said the locum approached him.
He said: "What really concerned me was that Mr Towu did not appear to have any inkling as to what had happened with this baby and his role in the events of the previous night.
"He seemed to be evading his role and his responsibility and to be seen to pass the blame for what happened to other intensive care staff.
"I told him I would take over and he should go home."
Mr Jaffray said baby Paul was monitored to check his condition prior to surgery and at 7pm the surgeon was told the tiny patient's condition was deteriorating.
When he heard that Paul's bowel had died he said: "I made the decision at that point that was not survivable. The only thing was to put the baby in his mother's arms and allow the baby to die."
Mr Jeffray expressed his amazement at Mr Towu's reaction to the initial operation.
He said: "There was no suggestion he had done anything out of the ordinary, that he was in any way at fault, or regretted his actions.
"I hope if that was me I would have been devastated, shown some insight. I hope I would have the integrity to admit my faults.
"I found none of that with Mr Towu."
Mr Jeffray said the events had left a mental scar, adding there was now a change of policy regarding using locums.
He said: "We have not had someone operating with us who we don't know personally."
The inquest continues.