Routine neonatal examination: effectiveness of trainee paediatrician compared with advanced neonatal nurse practitioner

Abstract

Objective-To compare the eVectiveness of routine neonatal examination performed by senior house oYcers (SHOs) and advanced neonatal nurse practitioners (ANNPs). Design-A prospective study of all infants referred to specialist orthopaedic, ophthalmology, and cardiology clinics. A standardised proforma was used to record details of the professional performing the neonatal check, any abnormalities discovered, source of ultimate referral to the specialist clinic, and specialist findings. Results-527 eligible infants were recruited. For hip abnormalities, ANNPs displayed greater sensitivity than SHOs (96% v 74%; p < 0.05). Similarly for eye abnormalities, ANNPs were more sensitive (100% v 33%; p < 0.05). There were no significant diVerences between ANNPs and SHOs in terms of positive predictive values or eVectiveness of detecting cardiac abnormalities. There was no diVerence in underlying incidence of abnormalities between the two hospitals. Conclusion-ANNPs are significantly more eVective in detecting abnormalities during the neonatal check. This has implications both for future workforce planning and current methods of medical training. (Arch Dis Child Fetal Neonatal Ed 2001;85:F100-F104)

Screening for Developmental Dysplasia of the Hip: A Systematic Literature Review for the US Preventive Services Task Force

“…64,65 Additional studies show that well-trained nonphysicians, including physiotherapists and neonatal nurse practitioners, perform at least as well as physician examiners and better than physician trainees. [66][67][68] In 1 single-site longitudinal study, as the number of pediatricians involved in screening infants increased (holding steady the overall number of newborns screened), a greater number of cases of DDH were missed despite an increased rate of suspected cases identified. 69 In other words, both sensitivity and specificity suffered when there was less centralized oversight of the newborn screening program and when fewer infants were screened, on average, by each pediatrician.…”

Routine examination of the newborn: the EMREN study. Evaluation of an extension of the midwife role including a randomised controlled trial of appropriately trained midwives and paediatric senior house officers

“…It is open to health visitors, midwives and doctors, and is the only course specifically for the routine examination, although preparation for the examination is included also as part of the advanced course for neonatal practitioners. 12 …”

A qualitative study exploring junior paediatricians', midwives', GPs' and mothers' experiences and views of the examination of the newborn baby

“…It is evident from many of the professionals interviewed that the SHOs do not receive formal training in the newborn examination and this accords with other research (El-Shazley, 1994). Recent findings have suggested that neonatal nurse practitioners were significantly more effective than SHOs in detecting abnormalities during the neonatal examination (Lee, 2001). Training in the newborn examination, possibly as an integral part of pre-registration midwifery programmes, alongside the current post registration training, would increase the number of midwives trained in the newborn examination.…”