Congenital screening for newborns and infants

Dr David Elliman discusses the role of NIPE in the early diagnosis of congenital disorders.

The Newborn and Infant Physical Examination includes checking the baby's hips for any abnormalities
The Newborn and Infant Physical Examination includes checking the baby's hips for any abnormalities

Early diagnosis of congenital disorders reduces the likelihood of morbidity and mortality, as well as the associated severe treatment options and risk of long-term disability.

Newborn and infant physical examinations have been carried out by healthcare professionals, such as doctors and specially trained midwives and nurses, for many years.

NICE has issued overall guidance on postnatal care, including that of the baby in early infancy, and in March 2008, defined standards and competencies were set out in relation to the screening components of the examinations.

However, there was little national guidance on what was required to deliver a good service.

The role of the NIPE

The NHS Newborn and Infant Physical Examination Programme (NIPE) was established by the UK National Screening Committee, the body that makes screening policy recommendations to ministers in the four UK countries and oversees implementation in England.

Its aim is to promote improvement and consistency in the screening components of newborn and infant physical examinations.

NIPE was set up to support the implementation of a national set of standards across local NHS organisations and healthcare professions and to facilitate improvement in the early identification, diagnosis and treatment of children with congenital conditions of the heart, eyes, hips or testes.

The programme sits within a family of six antenatal and newborn screening programmes that are now a part of the remit of Public Health England (PHE).

The programme offers parents of newborns in England the opportunity for their baby to have a head-to-toe physical examination to check for problems or abnormalities. The examination is carried out within 72 hours of birth and then again at six to eight weeks of age, as some conditions can develop or become apparent later.

The examination includes a general all-over physical check, as well as specific screening examination of the baby's eyes, heart, hips and testes.

As part of its implementation, the programme will be offering support to commissioners and providers in England, to ensure that robust screening and referral pathways are in place.

An elearning module

To strengthen the roll-out of the programme, NIPE launched a state-of-the-art elearning module in November 2013.

Developed with the assistance of a number of professionals, including representatives from the RCGP, the module uses film clips and animations to illustrate best practice and covers the four screening aspects of the examination.

It is free, quick to register and easy to use, offering condensed or full versions, depending on the amount of time available (see Resources, below).

During the pilot phase, many users described the resource as an excellent refresher for established practitioners and an essential learning resource for new doctors.

In particular, GPs are likely to appreciate the detailed animation of the Ortolani and Barlow manoeuvres for examining infant hips.

Data capture

NIPE will assist providers in capturing data to monitor and improve service performance and programme delivery.

This includes the NIPE Screening Management and Reporting Tool (SMART) IT system, designed to highlight late or missed examinations and enable timely referrals if further monitoring, investigation or treatment is needed.

While the initial focus of SMART is on maternity units, NIPE is working alongside GPs to test and develop the IT screening management system that will, in time, link maternity services and GP practices and enable electronic linkage of the newborn and six-to-eight week examination data.

NIPE recognises the important part that GPs and other primary care colleagues play in this screening programme and their work to deliver the highest standards of care on a day-to-day basis. It is recommended that all who undertake the NIPE examination should make use of the elearning resource to update their knowledge and skills.

  • Dr Elliman is clinical director of the NHS Newborn Infant and Physical Examination Programme

Resources

NHS Newborn Infant and Physical Examination Programme. e-learning. newbornphysical.screening.nhs.uk/elearning

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