Screening for Newborn Infant Physical Examination (NIPE) Clinical Guideline - V3.5 November 2020 - DRAFT ...

Page created by Kevin Flores
 
CONTINUE READING
Screening for Newborn Infant Physical
Examination (NIPE) Clinical Guideline

                V3.5

           November 2020
Summary 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 23
1. 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 23
and 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 23
The 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 23
2.6. 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 23
2.8.4.     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 23
Change 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 23
Appendix 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 23
Postnatal 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 23
Jenny 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 23
Appendix 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 23
7. 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 23
Appendix 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 23
Appendix 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 23
NIPE 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 23
Abnormal             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 23
Stridor              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 23
Abnormal             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 23
Fixed 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 23
Appendix 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 23
You can also read