National survey of current practice standards for the newborn and 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.

Education provision for the newborn physical examination as a post-registration module: National survey

“…The popularity of the NIPE among midwives was highlighted, with many AEIs offering a preparation programme twice a year. It was surprising, however, that despite the widespread provision and popularity of NIPE education, only 13% of UK midwives are currently NIPE-qualified (Rogers et al, 2015). One possible explanation may lie in the concerns expressed by some respondents about midwives subsequently maintaining their skills as NIPE practitioners following qualification.…”

“…Townsend et al (2004) recommended that the NIPE should become part of midwives' standard practice. Eleven years after the EMREN study's proposals, a survey of all maternity units in the UK found that these recommendations were not being met (Rogers et al, 2015) and that only 13% of UK midwives were qualified NIPE practitioners; the reasons for this were not clear. The investigators, therefore, felt it important to establish a national picture of the preparation of midwives for this role.…”

Including the newborn physical examination in the pre-registration midwifery curriculum: National survey

“…A questionnaire was developed by a team of midwifery educationalists utilising some of the content from a tool devised from phase one of this study (Rogers et al, 2015). A pilot study was undertaken in a single AEI, after which the questionnaire, accompanying letter and instructions underwent minor modifications to improve clarity and ease of completion.…”

“…Subsequent literature illustrates a growing acceptance of midwives undertaking the NIPE as part of their enhanced role (Baker K, 2010) and observes that midwives value the accountability of including the NIPE as part of their holistic provision of care (Mcdonald, 2013). However, a national survey of current NIPE practice revealed that despite the recommendations of the EMREN study (Townsend et al, 2004) only 13.7% of UK midwives are currently NIPE trained and a high proportion of these are undertaking a significant number of NIPEs (Rogers, Jay, Yearley, & Beeton, 2015). Blake (2012) explored the potential of student midwives undertaking the NIPE as a compulsory part of their preregistration programme and thus qualifying as a NIPE practitioner at the point of registration (Blake, 2012).…”

“…This was undertaken in two phases: phase one consisted of an online survey of all heads of Midwifery in the UK. A report of this has already been published (Rogers et al, 2015). Phase two comprised a national survey of all NMC AEIs in the UK undertaken between autumn 2014 and spring 2015.…”