Screening for Newborn Infant Physical Examination (NIPE) Clinical Guideline - V3.5 November 2020 - DRAFT ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Screening for Newborn Infant Physical
Examination (NIPE) Clinical Guideline
V3.5
November 2020Summary flowchart
Where possible, arrangements for the NIPE should be made with the parents on the day of
the baby’s delivery
Eligible population: All babies born in RCHT Declines: If screening
managed area or receiving post-natal care by an RCHT declined: Enter onto
employed midwife, to be offered NIPE, with parents’ SMaRT4NIPE (S4N)
consent, to be completed within 2-72 hours of age system. Decline letter
(Appendix 5)
Babies in RCHT at 2 Babies born in RCHT but Babies born in the
hours of age discharged prior to 2 hours of age community or a cross
and any baby discharged without border hospital
a NIPE examination
All NIPEs must be completed for babies on NIPEs for these babies should be
Wheal Fortune, prior to discharge. For babies completed in the community setting.
in other areas, every effort should be made to If discharged after 24 hours without a
complete NIPE prior to discharge and completed NIPE, complete Datix report.
definitely if being discharged beyond 24 hours
If midwife providing postnatal care to the baby is NIPE trained or paediatrician is
examining the baby for other reasons, the opportunity should be taken to complete
NIPE check
Screen negative: Routine child Screen positive: Refer as referral
health surveillance, NIPE at 6-8 pathway (Appendix 4)
weeks
All examinations must be entered on the S4N system at the time of the examination. If
examination is being completed in the home or at a base where S4N is not available,
the check should be documented on a paper copy and entered into the S4N system
retrospectively as soon as possible. Entering date and time the examination was
completed.
Screening for Newborn Infant Physical Examination (NIPE) Clinical Guideline V3.5
Page 2 of 231. Aim/Purpose of this Guideline
1.1. A full physical examination of the newborn (NIPE) within 72 hours after
delivery is the required Standard of the UK Public Health England Screening
Programme. The dual purpose of this examination is to confirm normality,
thereby reassuring parents and carers, and to identify and act upon any
abnormalities1
1.2. This guideline applies to all RCHT medical staff, advanced neonatal nurse
practitioners (ANNPs), neonatal nurses and midwives qualified to undertake
examination of the newborn where the Trust supports them in this role.
1.3. Full newborn examination is in addition to the initial examination undertaken
by the midwife or neonatal team member directly following delivery and in
addition to examinations for any medical concerns at birth
1.4. This guideline details who can perform a NIPE screen, timing of the NIPE
examination, details of the examination required, recording the examination
findings on the S4N system and referral pathways
1.5. This version supersedes any previous versions of this document.
1.6. This guideline makes recommendations for women and people who are
pregnant. For simplicity of language the guideline uses the term women
throughout, but this should be taken to also include people who do not
identify as women but who are pregnant, in labour and in the postnatal
period. When discussing with a person who does not identify as a woman
please ask them their preferred pronouns and then ensure this is clearly
documented in their notes to inform all health care professionals.
Data Protection Act 2018 (General Data Protection Regulation – GDPR) Legislation
The Trust has a duty under the DPA18 to ensure that there is a valid legal basis to
process personal and sensitive data. The legal basis for processing must be identified
and documented before the processing begins. In many cases we may need consent;
this must be explicit, informed and documented. We cannot rely on opt out, it must be opt
in.
DPA18 is applicable to all staff; this includes those working as contractors and providers
of services.
For more information about your obligations under the DPA18 please see the Information
Use Framework Policy or contact the Information Governance Team
rch-tr.infogov@nhs.net
2. Guidance
2.1. Information and verbal consent for routine NIPE screening should be gained
from the parent/guardian prior to the screening examination wherever
possible. If screening is declined, a decline letter (Appendix 5) should be
sent to the parents/guardians and a copy to the General practitioner (GP)
Screening for Newborn Infant Physical Examination (NIPE) Clinical Guideline V3.5
Page 3 of 23and Health Visitor (HV). A follow up examination should be offered at 6-8
weeks with the GP
2.2. Timing.
The first full physical newborn examination should be performed within 2 to
72 hours of the baby’s delivery. Acceptable delay for NIPE screening can
occur for babies whose condition is considered too premature or too
unstable for a full NIPE check e.g. a baby receiving NNU respiratory
support. These babies should be screened as soon as is feasible
2.3. If parents intend to take baby home before 2 hours of age, or baby born in
the community then the responsible midwife to arrange for the baby to be
examined in the Community setting. All babies examination findings have to
be recorded on the S4N National Database see Section 2.9
2.4. Training and maintaining competencies
2.4.1. Midwives receive training by undertaking an Examination of the
Newborn (NIPE) university accredited course. All midwives
performing Newborn Infant Physical examinations are expected to
keep their skills updated by ensuring that they undertake regular
NIPE examinations throughout the year and attend a local annual
update which will include practical and theoretical content and
assessment. The NIPE online training at e-lfh.org.uk is also
available for NIPE examiners to use as evidence of competency
maintenance.
2.4.2. Exclusion criteria for midwives performing NIPE examinations are
listed in Appendix 3.
2.4.3. Junior doctors/Core trainees training in Paediatrics receive a
specific neonatal/postnatal ward induction programme which
includes supervised neonatal examinations and have the backup of
Specialist Registrars, ANNPs and Consultants.
2.4.4. ANNPs receive initial training as part of the neonatal nurse
practitioner programme and continuous practice maintains their
competence alongside attendance at the annual update sessions.
Online NIPE update training. The NIPE online training at e-
lfh.org.uk is also available for NIPE examiners to use as evidence
of competency maintenance (NEW 2020).
2.5. Examination of the Newborn
2.5.1. Before examining the baby, confirmation that there are no
antenatal or maternal concerns is required. A copy of any antenatal
plan of care for any suspected/known problems should be placed in
the neonatal notes and consulted for guidance and planning. The
mother’s electronic E3/Maxims records and handheld notes should
be accessed for additional relevant documentation.
2.5.2. Key components of the NIPE screening test are examination of the
heart, eyes, hips, and in male infants, examination of the testes
Screening for Newborn Infant Physical Examination (NIPE) Clinical Guideline V3.5
Page 4 of 23The examination should include:
Review family, maternal and perinatal history, plot birth weight and
head circumference on growth chart
Ascertain any carers anxieties and observe interaction with the baby.
Feeding method and any concerns
Undress baby completely during the examination
Check if meconium and urine (check urine stream in a boy) passed
and document failure to do so with an action plan
Observe baby’s general condition: colour, breathing, behaviour,
activity, posture and cry
Examine the exposed parts of the baby first: facial symmetry, scalp,
head, including fontanelles, nose, mouth including visualising the
palate, tongue and gums, presence of suck reflex, position and
placement of ears
Examine the baby’s eyes for size, position, absence of discharge and
red reflexes
Palpate the neck and clavicles, check limbs, hands, feet and digits,
assessing proportions and symmetry
Assess the cardiovascular system – colour, capillary refill time, heart
rate, brachial and femoral pulse volumes, auscultate heart for rate,
rhythm, and any added sounds
Undertake pulse oximetry, record and compare oxygen saturation
readings from the RIGHT hand to a reading from either foot are both
over 95% and within 3% of each other. If pulse oximetry is undertaken
between 2 and 24 hours and a full NIPE check has not been
performed it should ideally be repeated again at the NIPE
examination.
Respiratory effort and rate, listening to air entry across chest fields
Observe the baby’s abdomen – palpate to identify any organomegaly,
masses or hernia. Examine the umbilical cord
Observe the baby’s genitalia and anus, to check normal appearance,
positioning and patency
Palpate testes in male infants for presence or undescended position
Inspect the bony structures and skin of the baby’s spine, with the baby
prone
Note the colour and texture of the skin as well as any birthmarks or
rashes
Observe tone, behaviour, movements and posture to complete the
assessment of the central nervous system (CNS) If concerned, a
detailed neurological examination e.g. eliciting newborn reflexes
should be performed
Check hips, symmetry of the limbs and skin folds. Perform Barlow and
Ortolani’s tests.
Consider any specific known risks in the baby’s home, and alert
appropriate professionals to parents who may have problems in caring
for their baby
Ensuring that parents know how to assess their baby’s general
condition and access help and inform them of the next Child Health
Surveillance planned review.
Screening for Newborn Infant Physical Examination (NIPE) Clinical Guideline V3.5
Page 5 of 232.6. Abnormalities detected on screening process for referral for further
medical investigation, treatment or care if required
See Appendix 4 for specific NIPE referral system pathways for screen positive
baby. Non urgent referrals should be within normal working hours where
possible, between 9-4 pm, Urgent referrals can be made at any time
2.7. Communication and Documentation
2.7.1. A copy of any antenatal plan of care from mother’s Maxims record for
suspected/known problems should be placed in the neonatal notes
and consulted for guidance and planning.
2.7.2. The examination should be recorded onto the baby’s online S4N
record with printouts, and filed as detailed in Section 2.9
2.7.3. If a deviation from normal (screen positive) result or risk factor is
identified, the parents should be informed and any plan for
investigation, treatment or care discussed and documented in the
neonatal notes. All entries should be dated, timed and signed with
name and designation printed.
2.7.4. The baby’s S4N record should be updated, recording any referrals
made in the S4N system/Maxims discharge letter/Badger discharge
letter as appropriate. Any senior review completed also needs to be
updated on the baby’s S4N record by the NIPE examiner.
2.8. SMaRT 4 NIPE (S4N) system
2.8.1. Training
It will be the responsibility of the Health Professional undertaking the
examination to record the findings of the examination on the S4N IT
system.
All staff undertaking NIPE will receive training in the S4N system
through either group sessions, one to one session with an
experienced smart user or by online training. Contact screening team
for details.
2.8.2. Accessing S4N
Once training has been received, the S4N application should be down
loaded on to your desktop from the RCHT applications catalogue.
2.8.3. Password generation
To generate your user name you will need to provide your NHS.net
email address and NMC/GMC number and for doctors in training, the
date you expect to finish your paediatric allocation. Most staff will
be entered in advance onto the system. If you are not registered on
the database, password generation can be done either by a
member of the screening team, rch-tr.screening@nhs.net or by a
S4N super user.
Type in your username and then select ‘forgotten password’ and follow
the instructions.
Screening for Newborn Infant Physical Examination (NIPE) Clinical Guideline V3.5
Page 6 of 232.8.4. Documentation
The NIPE examination should be done at a site with access to the
S4N system, and entered real time. If not possible, the examination
should be documented on the Infant Record form and details entered
onto the S4N system, as soon as reasonably possible, remembering
to add date and time the examination was completed.
Once the examination is complete the following documentation should
be generated.
2.8.5. Babies who screen negative and without risk factors:
NIPE Examiner print 1 X A5 forms and one A4 form
A5 forms:
To be inserted into the Personal Child Health Record (PCHR) ‘red
book’ to be inserted by NIPE examiner or handed to parent if book not
available.
A4 form:
To be inserted in the baby’s medical records by NIPE examiner. If
examination completed in the community, the A4 form should be sent,
the same day, to the ward clerk, Wheal Fortune, who will insert it into
the baby notes.
2.8.6. Babies who screen positive or have risk factors for hip, heart,
testes or eye follow guidance in NIPE Referral Pathway, see
Appendix 4
2.9. Daily NIPE check list
The UK National Screening Committee (UKNSC) policy for NIPE is
that all eligible babies will be offered screening. The screening should
be offered and completed within 72 hours of birth.
The midwife caring for the woman and her baby should ensure the
examination is completed within the 72 hour threshold.
2.9.1. Babies 2-48 hours old:
These babies are between birth and 48 hours old. Any babies in this
group and over 2 hours old and still in hospital should be added to the
daily work list.
If baby is in the community, midwife should arrange for examination to
be completed asap
2.9.2. Babies 48-72 hours old:
These babies are between 48-72 hours old and it is the responsibility
of midwife caring for woman and baby to ensure that the NIPE check
is done before they are 72 hrs old.
If baby is in NNU and their condition does not allow for the NIPE
examination, mark this on the S4N system.
2.9.3. Babies over 72 hours old
These babies are over 72 hours old and have breached the 72 hour
standard.
Screening for Newborn Infant Physical Examination (NIPE) Clinical Guideline V3.5
Page 7 of 23 If baby is in hospital and their condition allows, ensure baby is
examined the same day/as soon as possible
If baby is in the community setting midwife must make arrangements
for baby to be examined asap, either in the community setting or the
hospital setting. This check must take priority.
2.10. Declines (see Appendix 5)
If parents decline a NIPE examination for their baby, ensure this is recorded in
the S4N system by:
Selecting decline
Complete reason
Save (directly from risk factor tab)
Then press ‘save and exit’
2.11. In the event of a baby who is deceased
Ensure this is recorded in S4N system to prevent any further distress to parents
as they may be contacted to arrange screening
2.12. Screening failsafe
Daily: Monday - Friday the screening team will check that no babies
are about to breach 72 hours. Communication to take place with the
wards or the on call midwife for the area to ensure arrangements are
in place for the examination.
Weekly: A weekly report of all births for the preceding week is
downloaded and added to the NIPE tracker, this is cross checked with
the S4N system.
All screen positive babies are identified on the tracker and checked
against the RCH appointment system to ensure that baby has been
entered into care.
Monthly: Outcomes for screen positive babies are reviewed and
entered into S4N system by the screening team
2.13. Key Performance Indicators (KPI’s)
These are national standards set by the national screening committee.
Standard 1: Identify the population and coverage. This standard
provided assurance that screening is offered to all eligible babies and
a conclusive screening result is available by 72 hours of birth.
Acceptable performance is 95% and the achievable performance is
99.5%.
Standard 2: Timeliness of intervention (abnormality of the eye) To
ensure that any baby with a positive screen test for an abnormality of
the eye receives and assessment by a specialist within 2 weeks of life.
Acceptable performance 95% and achievable performance is 100%.
Screening for Newborn Infant Physical Examination (NIPE) Clinical Guideline V3.5
Page 8 of 23 Standard 3: Timeliness of intervention (Developmental Dysplasia
of Hips -DDH). Those babies with a screen positive test for DDH,
have an assessment by specialist hip ultrasound by 2 weeks of age.
Acceptable performance 95% and achievable performance 100%.
Standard 4: Timeliness of intervention (Developmental Dysplasia
of the Hips-DDH-risk factors). That babies with a negative screen
test but have identified risk factors, undergo an assessment by
specialist hip ultrasound within 6 weeks of age. Acceptable
performance 90% and achievable performance 95%
Standard 5: Timeliness of intervention (bilateral undescended
testes). That all babies identified with bilateral undescended testes
are seen by a consultant paediatrician/associated specialist within 24
hours of the NIPE examination. Acceptable performance threshold
100%. Please note: Local management is that only babies with
bilateral undescended unpalpable testes to be referred within 24 hours
3. Monitoring compliance and effectiveness
Element to be Babies who screen positive or with suspected abnormalities of the
monitored eyes, heart, hips and testes have been referred in line with the local
and national standards and guidance
Lead Screening team
Tool Screen positive/suspected eyes abnormalities seen in line
with the referral pathway
Screen positive/suspected hip abnormalities/risk factors
seen in line with the referral pathway
Screen positive/suspected cardiac abnormalities/risk factors
seen in line with the referral pathway
Screen positive/suspected testes abnormalities/risk factors
seen in line with the referral pathway
Frequency Quarterly check as part of KPI process
Reporting A bi-annual report will be presented at the post-natal operations group
arrangements and included in the bi annual report at the Antenatal and New-born
screening board and the Annual report.
A Screening assurance report is presented annually to the Women’s
and Children’s Care Group Meeting.
Results from this compliance monitoring will be included in these
reports
Acting on Any deficiencies identified will be discussed at the post-natal
recommendations operations group and an action plan agreed
and Lead(s) Action leads will be identified and a time frame for the action to be
completed by
The action plan will be monitored by the postnatal operations group
Screening for Newborn Infant Physical Examination (NIPE) Clinical Guideline V3.5
Page 9 of 23Change in Required changes to practice will be identified and actioned within a
practice and time frame agreed on the action plan
lessons to be A lead member of the group will be identified to take each change
shared forward where appropriate.
The results of the audits will be distributed to all staff through the news
letters and team/ward meetings
4. Equality and Diversity
4.1. This document complies with the Royal Cornwall Hospitals NHS Trust
service Equality and Diversity statement which can be found in the 'Equality,
Inclusion & Human Rights Policy' or the Equality and Diversity website.
4.2. Equality Impact Assessment
The Initial Equality Impact Assessment Screening Form is at Appendix 2.
Screening for Newborn Infant Physical Examination (NIPE) Clinical Guideline V3.5
Page 10 of 23Appendix 1. Governance Information
Screening for Newborn Infant Physical
Document Title
Examination (NIPE) Clinical Guideline V3.5
This document replaces (exact title of Screening for Newborn Infant Physical
previous version): Examination (NIPE) Clinical Guideline V3.4
Date Issued/Approved: September 2020
Date Valid From: November 2020
Date Valid To: 7th March 2022
Jan Clarkson and Jenny Stevenson,
Directorate / Department responsible
Antenatal and Newborn Screening
(author/owner):
Coordinators
Contact details: 01872 253092
Performing a newborn examination, using
Brief summary of contents the NIPE Smart database system, referral
pathways, NIPE clinics
Newborn. Neonatal. NIPE. NIPESmart.
Suggested Keywords:
Midwife examination. Referral
RCHT CFT KCCG
Target Audience
Executive Director responsible for Medical Director
Policy:
Maternity Guidelines Group
Approval route for consultation and
Care Group Board
ratification:
PRG
General Manager confirming approval
Mary Baulch
processes
Name of Governance Lead confirming
approval by specialty and care group Name: Caroline Amukusana
management meetings
Links to key external standards None
1. Newborn and Infant Physical
Examination Screening Programme
Standards (2016/17) Public Health
England. April2016 PHE publications
gateway number: 2015772
Related Documents: https://gov.uk/government/collections/
nhs-population-screening-
programme-standards
2. National Institute for Health and
Clinical Excellence (2006) CG 37
Screening for Newborn Infant Physical Examination (NIPE) Clinical Guideline V3.5
Page 11 of 23Postnatal care: routine postnatal care
of women and their babies
London:NICE www.nice.org.uk
3. National Screening Committee:
Newborn and Infant Physical
examination guidance (2016)
https://www.gov.uk/government/colle
ctions/newborn-and-infant-physical-
examination-clinical-guidance
4. Lee T., Skelton R.,Skene,C. (2001)
Routine neonatal
examination:effectiveness of trainee
paediatrician compared with
advanced neonatal nurse practitioner
Archives of Disease in Childhood:
Fetal and Neonatal edition Vol85.no 2
pp F100-104
5. Lomax,A (2001) Expanding the
midwife’s role in examining the
newborn British Journal of Midwifery
Feb, vol 9.no 2 pp 10-102
Yes, accredited course/module for
Training Need Identified?
accreditation for midwife NIPE checks
Publication Location (refer to Policy
Internet &
on Policies – Approvals and Intranet Only
Intranet
Ratification):
Document Library Folder/Sub Folder Clinical/Midwifery and Obstetrics
Version Control Table
Version Changes Made by
Date Summary of Changes
No
August Initial Issue. Neonatal Referral Pathway M.Denholm, Newborn
V1.0
2013 (NIPE) clinical guideline Screening
Addition of full newborn examination, NIPE Judith Clegg, ANNP
14th March
V2.0 Smart system, clinic information and Jan Clarkson,
2017
updated referral pathways Newborn screening
Clarification of referral pathways and use of
th NIPE Smart records/forms/letters (Appendix Judith Clegg, ANNP
8 Feb
V3.0 5) Jan Clarkson,
2018
Alteration of criteria for midwife NIPE Newborn Screening
(Appendix 3). Amended Appendix 4
Undertake
pathways pulse oximetry , record and
10th August compare oxygen saturation readings from Clare Sizer
V3.1 the RIGHT hand to a reading from either
2018 Patient safety Midwife
foot are both over 95% and within 3% of
each other
Screening for Newborn Infant Physical Examination (NIPE) Clinical Guideline V3.5
Page 12 of 23Jenny Stevenson and
5th Feb Change to the title to add ‘Screening for’ at Jan Clarkson
V3.2
2019 the beginning. Antenatal Screening
Midwives.
Change to training section to include annual
updating sessions Jan Clarkson
9th January Change to referral process for family history Antenatal and
V3.3
2020 of cardiac condition Newborn Screening
Change to physio referral process from Midwife
paper referral to maxims referral
Jan Clarkson
Changes to exclusion criteria
6th August Antenatal and
V3.4 Changes to physio referral services
2020 Newborn Screening
Changes to declines process
Midwife
Jan Clarkson
September Timeframe for NIPE reduced from 6 hours to Antenatal and
V3.5
2020 2 hours throughout. Newborn Screening
Midwife
All or part of this document can be released under the Freedom of Information
Act 2000
This document is to be retained for 10 years from the date of expiry.
This document is only valid on the day of printing
Controlled Document
This document has been created following the Royal Cornwall Hospitals NHS Trust
Policy for the Development and Management of Knowledge, Procedural and Web
Documents (The Policy on Policies). It should not be altered in any way without the
express permission of the author or their Line Manager.
Screening for Newborn Infant Physical Examination (NIPE) Clinical Guideline V3.5
Page 13 of 23Appendix 2. Initial Equality Impact Assessment
Section 1: Equality Impact Assessment Form
Name of the strategy / policy /proposal / service function to be assessed
Screening for Newborn Infant Physical Examination (NIPE) Clinical Guideline V3.5
Directorate and service area: Is this a new or existing Policy?
Obs & Gynae Directorate Existing
Name of individual/group completing EIA Contact details:
Jenny Stevenson, Antenatal Screening Midwife 01872 253092
1. Policy Aim
Who is the To give all RCHT medical staff, advanced neonatal nurse practitioners
strategy / policy / (ANNPs), neonatal nurses and midwives qualified to undertake
proposal / service examination of the Newborn guidance on the full examination of the
function aimed at? Newborn
2. Policy Objectives To ensure that all new-borns, examined by staff employed by RCHT,
receive a full physical examination in line with the national screening
standards.
3. Policy Intended
Outcomes
To identify and review any suspected or actual Newborn abnormalities
4. How will
you measure
Compliance monitoring tool
the outcome?
5. Who is intended
to benefit from the Newborn babies and their parents
policy?
6a). Who did you Local External
Workforce Patients Other
consult with? groups organisations
X
b). Please list any Please record specific names of groups:
groups who have Clinical Guideline Group
been consulted Obstetrics and Gynaecology Directorate
about this procedure.
c). What was the
outcome of the
consultation? Guideline agreed.
Screening for Newborn Infant Physical Examination (NIPE) Clinical Guideline V3.5
Page 14 of 237. The Impact
Please complete the following table. If you are unsure/don’t know if there is a negative impact
you need to repeat the consultation step.
Are there concerns that the policy could have a positive/negative impact on:
Protected
Yes No Unsure Rationale for Assessment / Existing Evidence
Characteristic
Age All women in threatened or established pre-term
X
labour
Sex (male, female
non-binary, asexual All women in threatened or established pre-term
X
etc.) labour
Gender All women in threatened or established pre-term
reassignment X labour
Race/ethnic All women in threatened or established pre-term
communities X labour
/groups
Disability All women in threatened or established pre-term
(learning disability, labour
physical disability,
sensory impairment,
X
mental health
problems and some
long term health
conditions)
Religion/ All women in threatened or established pre-term
other beliefs X labour
Marriage and civil All women in threatened or established pre-term
partnership X labour
Pregnancy and All women in threatened or established pre-term
maternity X labour
Sexual orientation All women in threatened or established pre-term
(bisexual, gay, X labour
heterosexual, lesbian)
If all characteristics are ticked ‘no’, and this is not a major working or service
change, you can end the assessment here as long as you have a robust rationale
in place.
I am confident that section 2 of this EIA does not need completing as there are no highlighted
risks of negative impact occurring because of this policy.
Name of person confirming result of initial Jan Clarkson
impact assessment: Antenatal and Newborn Screening Midwife
If you have ticked ‘yes’ to any characteristic above OR this is a major working or
service change, you will need to complete section 2 of the EIA form available here:
Section 2. Full Equality Analysis
For guidance please refer to the Equality Impact Assessments Policy (available
from the document library) or contact the Human Rights, Equality and Inclusion
Lead debby.lewis@nhs.net
Screening for Newborn Infant Physical Examination (NIPE) Clinical Guideline V3.5
Page 15 of 23Appendix 3. Midwifery Staff Examination of the Newborn
The following exclusion criteria apply for midwife examinations.
Exclusion criteria for midwife examination:
Under 35 +0 gestation
Please note: Between 35 - 36+6 examinations to be completed in hospital by a
NIPE examiner
Midwives can refer any baby to a more experienced practitioner if they have
concerns about performing the examination.
Screening for Newborn Infant Physical Examination (NIPE) Clinical Guideline V3.5
Page 16 of 23Appendix 4. Referral pathways for possible anomalies
Referral Pathways for possible anomalies noted at the NIPE Check
If the healthcare professional performing the newborn examination identifies any deviation
from the norm, a referral should be made to the appropriate neonatal team member who will
be able to provide advice for further referral/review. Do not make the referral to the junior
doctor on the postnatal ward. The person performing the newborn examination who identifies
any deviation from normal (screen positive result) should consult the referral pathway and
contact the Registrar/SHO/ANNP on Neonatal Bleep/ via switchboard for advice.
Contact with the neonatal team should be made as soon as possible and within usual
clinic working hours where possible, 9-4pm
Community referrals, check referral pathway guidance and Bleep Neonatal SpR via
switchboard within above working hours as appropriate
Any baby with a NORMAL NIPE examination but a 1st degree relative history of the
following cardiac conditions should have a referral made by their GP, for a routine
review, to a Paediatrician with expertise in Cardiology.
o Bicuspid aortic valve
o Channelopathies- Long QTsyndrome, Brugada syndrome, CPVT
o Cardiomyopathies- Hypertrophic Cardiomyopathy, Dilated Cardiomyopathy, ARVC
o Neuromuscular disease
o Muscular dystrophies
o Myotonic dystrophy
o Mitochondrial myopathies
o Marfan syndrome
o Ehler Danlos syndrome
GPs should be able to access the referral criteria at
(http://rms.kernowccg.nhs.uk/rms/primary_care_clinical_referral_criteria/rms/primary_care_clinical
_referral_criteria/paediatrics/cardiology) (NEW 2020)
Referrals for hip scans, physio, undescended testes, hypospadias and ophthalmology
should be made by the NIPE examiner via maxims internal referral system (NEW 2020)
The baby’s S4N record should be marked that a referral has been made, a senior
review or referral to the GP has been requested (NEW 2020). The reviewer then has
responsibility to amend the record once further examination/plan of care is made
Any baby who appears unwell or raises concern must be immediately discussed with a
senior neonatal team member, SpR or above, and assessed for potential admission/
immediate review. If a deviation from the normal is identified the parents will be informed
immediately and any plan for investigation, treatment or care will be discussed and developed
with them Any referrals should be clearly documented in the baby’s notes, S4N system
and PCHR Red Book
Screening for Newborn Infant Physical Examination (NIPE) Clinical Guideline V3.5
Page 17 of 23NIPE PATHWAYS FOR HOSPITAL AND COMMUNITY REFERRALS
Abnormal Timeframe
examination for referral Hospital referral Community
finding (maximum) Further action method referral
method
DYSMORPHIC
Abnormal/ 2 hours No baby to be Neonatal
dysmorphic discharged home SpR Bleep SpR bleep
appearance without review by via
SpR/ Consultant switchboard
Abnormal Timeframe Hospital referral Community
examination for referral method referral
finding (maximum) Further action method
HEAD SHAPE
Plot head In hours
Within 24 circumference Midwife to Neonatal
Abnormal head hours Consider review Neonatal SpR bleep
shape after 2-3 days SHO/ANNP/SpR via
switchboard
Severe or large Plot head
haematoma/ 2 hours circumference Midwife to Neonatal
swelling Neonatal SpR bleep
crossing cranial Monitor SHO/ANNP/SpR via
suture line, not Jaundice switchboard
considered to be SpR review
caput
Abnormal Timeframe Hospital referral Community
examination for referral method referral
finding (maximum) Further action method
FACE/EARS
Facial Before Ensure baby able Midwife to ANNP/
asymmetry discharge to close eyes and Neonatal neonatal
or next suck/latch to feed ANNP/SHO SHO bleep to
working day NNU clinic
if no
eye/feeding
concern
Abnormality of ANNP/
the ear, pits or Refer to hearing Midwife to neonatal
tags 24 hours screening Neonatal SHO bleep
(if baby is guideline ANNP/SHO for advice
dysmorphic – then refer as
same day Refer as needed
referral) appropriate to Minor tags -
audiology midwife to
send letter
NO renal scan referral to
needed GP for 6-8
week check
Screening for Newborn Infant Physical Examination (NIPE) Clinical Guideline V3.5
Page 18 of 23Abnormal Timeframe Further action Hospital referral Community
examination for referral method referral
finding (maximum) method
MOUTH
Referral letter to Midwife to SpR via
Natal teeth Before maxillofacial Neonatal switchboard
discharge team. Maxims SHO/ANNP/SpR
or within internal referral
24hrs
*Check tooth
stability
Cleft lip +/- Same day Admit to Midwife to Neonatal
palate postnatal ward Neonatal SpR via
Same day referral SHO/ANNP/SpR switchboard,
to Bristol and admit
Orthodontic team Contact RCH
RCH orthodontist by
Monitor feeding phone/sec plus
ability inform Bristol
Refer to hearing team same day
screening
Abnormal Timeframe Hospital referral Community
examination for referral method referral
finding (maximum) Further action method
EYES
Refer Neonatal Neonatal
Small or absent Ophthalmologist SHO/ANNP/SpR SpR via
eye Within via Maxims for a bleep switchboard
24hrs 1 week review
Refer Via Maxims Via Maxims
Absent red Ophthalmologist
reflex Within 24 via Maxims for a
hours 1 week review
Abnormal Timeframe Further action Hospital referral Community
examination for referral method referral
finding (maximum) method
EYES
continued
Refer to Neonatal Neonatal
Abnormality of Within 1 Ophthalmologist SHO/ANNP/SpR SpR via
iris week within 1 week switchboard
Abnormal Timeframe Further action Hospital referral Community
examination for referral method referral
finding (maximum) method
RESPIRATION
Signs of immediate Review for NNU Midwife to Neonatal
respiratory admission Neonatal SpR/SHO/AN
distress SHO/ANNP NP via
Bleep switchboard
or
emergency
ambulance
Screening for Newborn Infant Physical Examination (NIPE) Clinical Guideline V3.5
Page 19 of 23Stridor immediate Review for Midwife to
NNU/Polkerris Neonatal Neonatal
admission SHO/ANNP SpR
Abnormal Timeframe for Hospital referral Community
examination referral Further action method referral
finding (maximum) method
HEART
For normal Routine Via GP Via GP
NIPE but 1st
degree cardiac
family history
see Appendix 2
Cyanosis/under immediate NNU admit Midwife to 999
90% oxygen Neonatal ambulance
saturations SHO/ANNP transfer
Bleep Bleep NNU
SpR
Murmur, SpR discuss Midwife to Neonatal
otherwise well Same day As per heart Neonatal SpR/SHO/AN
murmur guideline SHO/ANNP NP via
switchboard
Murmur + immediate Consultant review NNU SpR Bleep 999/
concern review Neonatal
As per heart SpR via
murmur guideline switchboard
Absent or weak Immediate SpR review/ NNU Neonatal
femoral pulses Consultant SpR/SHO/ANNP SpR
or >3% Bleep /SHO/ANNP
difference in pre As per RCH heart via
and postductal murmur guideline switchboard
saturations
Abnormal Timeframe Hospital referral Community
examination for referral Further action method referral
finding (maximum) method
ABDOMEN
Abdominal mass SpR and NNU Neonatal
2 hours Consultant review SHO/ANNP/SpR SpR via
Bleep switchboard
Abdominal wall Sterile NNU 999+
defect immediate bag/clingfilm SHO/ANNP/SpR Neonatal
Consultant review Bleep SpR via
switchboard
Large liver or Within 24 Discuss with NNU SpR Bleep Neonatal
spleen hours Consultant SpR via
switchboard
Imperforate 2 hours Neonatal
anus or Consultant review NNU SpR Bleep SpR via
abnormally Paediatric switchboard
positioned anus Surgical referral to admit
Screening for Newborn Infant Physical Examination (NIPE) Clinical Guideline V3.5
Page 20 of 23Abnormal Timeframe Hospital referral Community
examination for referral Further referral or method referral
finding (maximum) action method
GENITALIA
Hypospadias 72 hours Refer to Plastic Via Maxims Via Maxims
with palpable surgeon, Mr
testes and good McKenzie
urine stream Via Maxims
internal referral
system
Ambiguous Consultant Midwife to Neonatal
genitalia/ 2 hours review, Neonatal SpR SpR via
bilateral URGENT blood, urine, USS switchboard
unpalpable investigations to review
testes Discuss with immediately
Paediatric
endocrinologist
Unilateral 2 weeks Referral to RCH Via Maxims Via Maxims
undescended surgeons via
testes Maxims internal
referral system
Bilateral Referral to RCH Via Maxims Via Maxims
undescended surgeons via
but palpable 2 weeks Maxims internal
testes referral system
Abnormal Timeframe Further action Hospital referral Community
examination for referral method referral
finding (maximum) method
LIMBS
DDH Hips Same day Referral for Urgent Maxims Urgent
dislocated/ urgent Paediatric physio referral for hip Maxims
dislocatable to see after hip ultrasound and referral for
scan done physio referral via hip
Urgent Hip scan 2 maxims ultrasound
weeks via maxims
and physio
referral via
maxims
Clicky hip/s, Within 48 Hip scan 6 weeks Maxims referral Maxims
ligamentous hours Via maxims referral
referral
6 week hip scan Maxims referral Maxims
Positional talipes Within 48 and physio for hip ultrasound referral for
hours appointment and physio hip
referral via ultrasound
maxims and physio
referral via
maxims
Screening for Newborn Infant Physical Examination (NIPE) Clinical Guideline V3.5
Page 21 of 23Fixed talipes Referral to Urgent maxims Urgent
Same day Paediatric physio referral for 2 maxims
urgent for 1 week review week hip scan referral for 2
Hip scan 2 weeks and urgent physio week hip
referral via scan and
maxims urgent physio
referral via
maxims
Additional digits Plastic surgeon Midwife to Letter to GP
72 hours OPA 3-6 months Neonatal to refer to
SHO/ANNP surgeon
Letter to GP for
their referral to
surgeon
Brachial/ Arm Review, +/- XRay Midwife to Discuss with
palsy, suspected 24 hrs parent info leaflet Neonatal SpR for
± clavicle pain relief. Paed SHO/ANNP review
fracture physio referral
Letter to Physio
and GP
Abnormal Timeframe Further referral or Hospital referral Community
examination for referral action method referral
finding (maximum) method
SKIN
Skin tags 6-8 weeks GP referral to Midwife to Letter to GP
plastic surgeon Neonatal to review at
SHO/ANNP 6-8 week
check
Letter to GP
Birth marks 24hrs SpR/Consultant Midwife to Discuss with
review dependent Neonatal SpR/+/-
on size, nature SHO/ANNP review
and position of Letter to GP
lesion Record on
Record on NIPE NIPE check
check
Vesicular rash 2 hours Urgent review and Midwife to Neonatal
antiviral therapy Neonatal SpR via
as guideline SHO/ANNP switchboard
SpR review to admit
Rash of concern 2 hours Hospital SpR Midwife to Bleep NNU
review Neonatal SHO/ANNP
SHO/ANNP
Screening for Newborn Infant Physical Examination (NIPE) Clinical Guideline V3.5
Page 22 of 23Appendix 4. Pathway for declined NIPE examination
Pathway when parents decline the Newborn NIPE examination for their
baby
Screening providers should use information in ‘screening tests
for you and your baby’ to inform parents about the Newborn and
6-8 week physical examination.
During the Antenatal period
Before the Newborn examination is offered
Parents who decline the Newborn examination should be
informed that the optimum time for the examination is within 72
hours, however, it can be completed up to 6 weeks.
After 6 weeks the examination offered will be the 6-8 week
infant examination
The NIPE screener, offering the test, should ensure parents have
contact details should they wish to take up the offer of the
Newborn examination. This decision should be recorded in:
SMaRT4NIPE
PCHR red book
In the child records on E3
A member of the screening team will identify any baby who has a
decline status in SMaRT4NIPE
Using the locally agreed template, a letter to the parents will be
created in maxims, outlining the purpose of the examination, the
parents right to decline and contact details should they change
their minds.
A copy of the letter should be sent to
Community Midwife
Health Visitor via coco.childrenscmc@nhs.net
GP
Record action taken in the comments section of the
Newborn Tracker against baby’s details
Screening for Newborn Infant Physical Examination (NIPE) Clinical Guideline V3.5
Page 23 of 23You can also read
