National survey of current practice standards for the newborn infant physical examination.

Abstract

Objectives: 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). Design: In autumn 2014, an online questionnaire was sent to all heads of midwifery in the UK. Key findings: 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’. Conclusions: 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.