National survey of current practice standards for the newborn and infant physical examination
To determine compliance with recommended standards for the newborn and infant physical examination (NIPE), identify which professionals were performing the NIPE and determine standards for screening and management of babies at risk of developmental dysplasia of the hip (DDH) or congenital heart disease (CHD).
In autumn 2014, an online questionnaire was sent to all heads of midwifery in the UK.
Completed questionnaires were returned from 64.3% (n=99/154) of targeted NHS Trusts. The main professionals performing the NIPE were paediatricians, midwives and neonatal practitioners. 95% of responding Trusts employed midwives qualified to perform the NIPE, with 13.7% of midwives employed in the UK NIPE-qualified. Midwives performed over 50% of NIPEs in more than 20% of Trusts where babies were born in the consultant-led delivery suite, and 70% of Trusts where babies were born in a midwifery-led setting. All respondents believed the optimum time for the NIPE was before 72 hours, and all but one Trust usually achieved this. Overall, nearly 80% of respondents rated the value of NIPE as a screening tool as ‘good’ or ‘excellent’.
Despite evidence for the safety and cost-effectiveness of midwives examining the newborn, plus previous recommendations for expanding NIPE training, the number of NIPE-qualified midwives remains low. Considerable variation was found between Trusts for screening for DDH and CHD.
Implications for practice:
The few midwives with NIPE training are examining far more babies than those in their caseload, which undermines the principles of continuity of care. There is scope for improvement in the quality and consistency of information to parents and follow-up processes. There is a need for the development of more robust guidelines for practice and improved screening for neonates.
The newborn and infant physical examination (NIPE) is an integral part of child health surveillance in the UK, with current standards recommending all babies have a NIPE performed within 72 hours of birth and again at 6-8 weeks of age (Hall and Elliman, 2003; National Institute for Health and Care Excellence (NICE), 2006; UK National Screening Committee (UKNSC), 2008).
Traditionally, the NIPE was performed by paediatric senior house officers (SHOs); however, changes to the organisation and provision of maternity services provided the impetus for other professionals, particularly midwives developing their practice, to include responsibility for NIPE within their professional scope. The cost-effectiveness of developing the midwife's role to include the NIPE was demonstrated in a study by Townsend et al (2004). This study comprised several arms, including a randomised trial of 826 mother-and-baby pairs (Wolke et al, 2002; Bloomfield et al, 2003a; 2003b; Hayes et al, 2003; Rogers et al, 2003; Townsend et al, 2004), to either a midwife examination or an examination by a SHO; a comparative study of the appropriate referral rates; and a video assessment comparing the quality of midwives' and SHOs' examinations (Bloomfield et al, 2003b). The study reported significantly greater maternal satisfaction with neonatal examinations performed by midwives than by SHOs (OR 0.54, 95% CI 0.39-0.75, P<0.001), and concluded that developing the role of the midwife to include the NIPE would not only increase maternal satisfaction with the NIPE, but would also result in improved quality of the examination and a reduction in health service costs (Townsend et al, 2004). Practice recommendations arising from the study included extending the midwife's role to include the NIPE and expanding the criteria for babies suitable for midwives' examination. Consideration to include the NIPE as part of the pre-registration education of midwives was also recommended (Wolke et al, 2002; Bloomfield et al, 2003a; 2003b; Hayes et al, 2003; Rogers et al, 2003; Townsend et al, 2004).
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