Newborn and infant physical examination
The Newborn and Infant Physical Examination (NIPE) is part of Public Health England’s National Screening Programme, who provide national standards for the newborn examination that is offered to parents within the first 72 hours of birth. Part of this requires gaining informed consent prior to the examination and ensuring detailed records are completed afterwards to ensure appropriate referral and action is taken.
The aim is to detect deviations from the normal that may lead to long-term morbidity or even neonatal/infant death. Currently, midwives who have undertaken additional training can do this examination. NIPE is now also part of undergraduate midwifery education.
NIPE is a holistic examination that is ideally undertaken by the midwife who delivered the baby as part of postnatal care. The midwife will have insight into the maternal, neonatal and family history. The examination includes taking a comprehensive medical, family, and social history as well as gaining information regarding the antenatal, intrapartum and early postnatal periods. Some services run NIPE clinics and the midwife must be vigilant in taking a thorough history, particularly if they have not met the family before.
Midwives are not required to diagnose specific abnormalities but to recognise deviations from the normal and refer appropriately. A further examination will be performed by the General Practitioner at 6–8 weeks of age, enabling a second opportunity to screen for deviations from the normal.
Four key areas are screened as part of the NIPE standards:
Eyes: Observe the position of the eyes, that they are open and symmetrical. This examination is performed using an ophthalmoscope to visualise the red reflex as well as to detect conditions such as congenital cataracts and retinoblastoma. The maternal history is important when looking for congenital conditions or infections that may affect the development of the eyes.
Heart and chest (Figure 39.1