After your baby is born, they will be offered a health check - this is all you need to know about the NIPE.
The Newborn and Infant Physical Examination (NIPE), also known as the Examination of the Newborn (EON) is a screening test offered to all babies within the first 72 hours of birth. It aims to identify and refer babies born with detectable congenital abnormalities. The NIPE is offered again by the GP at approximately 6 - 8 weeks of age, with the aim of further identifying any abnormalities that may present later or that may have been missed at the initial examination.
The NIPE involves a specially trained midwife, neonatal doctor, or GP, undertaking a thorough, holistic examination of a newborn baby. This means looking over a baby’s entire body to check for any anomalies which could be a sign of an underlying condition. It is a ‘top-to-toe’ examination where everything from the top of the baby’s head to the tip of their toes and everything in between is checked. The tools to do a NIPE are a stethoscope, an opthalmoscope, a tape measure, a tongue depressor, and a light source. The baby will also need to be on a firm surface and in a warm environment to complete the examination. It’s important to let parents know, that the baby may cry during the examination as they are exposed. Parents can soothe their baby by being close to them, stroking their head and talking to them through the examination. It may be necessary to stop the examination part way through to soothe and cuddle the baby, before resuming.
An important aspect of doing a NIPE is getting a thorough history prior to doing the check. This includes asking questions about the mother or birthing parent’s health and wellbeing(e.g. any pre-existing medical conditions), and the well-being of any other immediate family members – for example, siblings. It is important to check any ultrasound scans from the pregnancy and to note the events of labour that may be relevant, including mode of birth and how long the waters had been broken. This history taking helps to inform the overall wellbeing of a newborn baby and identify if any referrals to other specialists are needed. In addition to doing the physical check, NIPE practitioners will also ask about feeding and if there are any issues in this respect. They’ll also want to know if a newborn baby is passing urine and pooing as much as would be expected for their age.
Whilst a NIPE practitioner will be looking at the whole baby, there are four key areasincluded in the check:
1. Heart – the practitioner will listen to a baby’s heartbeat with a stethoscope to screen for congenital heart disease, which is an umbrella term meaning there is an issue with the structure or function of the heart from birth.
2. Eyes - the practitioner will shine an opthalmoscope (like a torch) into the baby’s eyes to assess for the presence of a red-eye reflex. This is to screen and detect congenital cataracts or any other eye abnormalities, such as tumours.
3. Hips – the practitioner performs two manoeuvres on the baby’s hips to identify the presence of a dislocated and/or a dislocatable hip, which may be a sign of congenital hip dysplasia.
4. Testes (in boy’s only!) – the practitioner palpates the testes to check that both have descended into the scrotum, this is to screen for unilateral or bilateral undescended testes.
The NIPE is a screening test, not a diagnostic test and any abnormalities identified will need further testing to make a diagnosis. The conditions that are screened for are all rare, but the NIPE aims to identify them early to reduce neonatal morbidity (illness) and mortality (death).The practitioner will make the appropriate referral if they identify an abnormality during the NIPE or if the baby has known risk factors for certain conditions, for example, a baby that is breech after 36 weeks of pregnancy and/or born breech is recommended to have a hip ultrasound scan as the incidence of congenital hip dysplasia is higher in breech babies. The urgency of the referral depends on the findings of the NIPE and this will be discussed with parents. A baby may need to be urgently reviewed within 24 hours or may only require follow up with the GP at the 6-8 week appointment.
If you birth in hospital, the NIPE usually takes places before you are discharged home. Some people choose to go home before it has been done and will return to the hospital the next day to have it completed. The NIPE can also be done at home – although this can depend on if there are community midwives available who have been trained to do them.
Finally, it is worth noting that the NIPE is a screening test that parents absolutely have the right to decline. It should always be offered, with an explanation of what it involves, but it is then up to parents to make an informed choice about if they want their baby to have this screening test or not.
If you would like to read more about the NIPE you can do so here.
Sophie is an independent midwife, and one half of Juno Midwives, based in Kent. She is trained to do the NIPE examination and can offer this at home. Find out more at www.junomidwives.co.uk.
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