Newborn and infant physical examination programme standards valid for data collected from 1 April 2018
Updated 7 March 2024
Applies to England
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NIPE-S01: coverage
Description
The proportion of babies eligible for the newborn physical examination who are tested for all 4 components (3 components in female infants) of the newborn examination within 72 hours of birth.
Rationale
This standard provides assurance that:
- screening is offered to parents of all eligible babies
- each baby (where the offer is accepted) has a conclusive screening result
Definition
Numerator: number of tested babies. This is the number of eligible babies for whom a decision about referral (including a decision that no referral is necessary as a result of the newborn physical examination) for each of the 4 conditions screened was made within the effective timeframe.
Denominator: number of eligible babies born within the maternity service in the reporting period:
- including babies less than or equal to 72 hours of age who transfer into the care of the maternity service without a screening result
- excluding babies who die within 72 hours of birth
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
It is recommended the newborn examination be undertaken before discharge from hospital (unless home birth). This maximises the opportunity for the examination to be completed within the 72-hour target.
The effective timeframe for the newborn physical examination is that a conclusive screening result should be available within 72 hours of birth.
Performance thresholds
Acceptable level: ≥ 95.0%.
Achievable level: ≥ 99.5%.
Further work is needed to make sure thresholds are appropriate for neonatal intensive care units; in particular those that are tertiary referral centres.
Caveats
Screening may be delayed where a clinical decision is made to delay the examination as the baby is too premature or too unwell to have the examination at this time. Screening should be completed as and when the baby’s condition allows. These babies should be accounted for and the reason explained in the commentary as mitigations against performance thresholds.
This standard measures coverage of babies up to 72 hours of age and therefore does not capture all babies born in England having a NIPE examination.
Data collection and reporting
Data source: SMaRT4NIPE (S4N) national IT system for newborn and infant physical examination screening
Responsible for data quality and completeness: maternity services
Responsible for submission: maternity services
Reported by: maternity services
Published by: maternity services
This standard is also the key performance indicator NP1
Reporting period
Quarterly data to be collated between 2 and 3 months after each quarter end.
Deadlines: 30 September (Q1), 31 December (Q2), 31 March (Q3), 30 June (Q4).
Review dates
Date standard introduced: April 2016
Date standard last updated: April 2018
NIPE-S02: diagnosis/intervention: timeliness of intervention for abnormality of the eye
Description
The proportion of babies who have a positive screening test (with or without risk factors) on newborn physical examination and undergo assessment by a specialist within 2 weeks of age.
Rationale
To provide assurance of timely interventions.
Definition
Numerator: number of babies with an abnormality of the eye attending an assessment appointment by 2 weeks of age. This first assessment should be with a consultant ophthalmologist/paediatric ophthalmology service.
Denominator: number of babies with an abnormality of the eye identified on newborn physical examination in the reporting period, irrespective of risk factors.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Performance thresholds
Acceptable level: ≥ 95.0%
Achievable level: 100.0%
Caveats
None
Data collection and reporting
Data source: S4N, national IT system for newborn and infant physical examination screening
Responsible for data quality and completeness: maternity services
Responsible for submission: not applicable as extracted from S4N by national NIPE
Reported by: not applicable as extracted from S4N by national NIPE
Published by: maternity services
Reporting period
Annually: data to be collated between 2 and 3 months after fiscal year end.
Deadline: 30 June.
Review dates
Date standard introduced: April 2016
Date standard last updated: April 2018
NIPE-S03: diagnosis/intervention: timeliness of intervention for developmental dysplasia of the hip (DDH)
Description
The proportion of babies who have a positive screening test on newborn physical examination and undergo assessment by specialist hip ultrasound within 2 weeks of age.
Rationale
To provide assurance of timely interventions.
Definition
Numerator: number of babies with a positive screening test on newborn physical examination who attend for specialist hip ultrasound within 2 weeks of age.
Denominator: number of babies with a positive screening test of the hips on newborn physical examination in the reporting period, this includes babies who are found to have dislocated or dislocatable hips on newborn physical examination. The following babies should be excluded:
- those who have previously noted risk factors but normal physical examination (as referral timescales are different)
- those found to have ‘clicky hips’ on physical examination (they should be managed and referred as per local arrangement)
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Performance thresholds
Acceptable level: ≥ 95.0%
Achievable level: 100.0%
Caveats
None
Data collection and reporting
Data source: S4N, national IT system for newborn and infant physical examination screening
Responsible for data quality and completeness: maternity services
Responsible for submission: maternity services
Reported by: maternity services
Published by: maternity services
This standard is also the key performance indicator NP2
Reporting period
Quarterly data to be collated between 2 and 3 months after each quarter end.
Deadlines: 30 September (Q1), 31 December (Q2), 31 March (Q3), 30 June (Q4).
Review dates
Date standard introduced: April 2016
Date standard last updated: April 2018
NIPE-S04: diagnosis/intervention: timeliness of intervention for DDH risk factors
Description
The proportion of babies who have a negative screening test on newborn physical examination but have identified risk factors and undergo assessment by specialist hip ultrasound within 6 weeks of age.
Rationale
To provide assurance of timely interventions.
Definition
Numerator: number of babies with an indication for specialist hip ultrasound based on risk factors only who attend for specialist hip ultrasound within 6 weeks of age.
Denominator: number of babies who have a negative screening test on newborn physical examination in the reporting period but have identified risk factors for DDH, excluding:
- babies with a hip abnormality identified on newborn physical examination, such as babies found to have dislocated or dislocatable hips on physical examination with or without risk factors (screen positive)
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
NIPE hip risk factors are:
-
first degree family history of hip problems in early life (this includes baby’s parents or siblings who have had a hip problem that started as a baby or young child that needed treatment with a splint, harness or operation)
-
breech presentation at or after 36 completed weeks of pregnancy, irrespective of presentation at birth or mode of delivery; this includes breech babies who have had a successful external cephalic version (ECV)
-
breech presentation at the time of birth between 28 weeks gestation and term
For babies with any of the above risk factors, hip ultrasound examination should be arranged. In the case of multiple births with these risk factors, all babies in this pregnancy should have a hip ultrasound examination.
Performance thresholds
Acceptable level: ≥ 90.0%
Achievable level: ≥ 95.0%
Caveats
None
Data collection and reporting
Data source: S4N, national IT system for newborn and infant physical examination screening
Responsible for data quality and completeness: maternity services
Responsible for submission: not applicable as extracted from S4N by national NIPE
Reported by: not applicable as extracted from S4N by national NIPE
Published by: maternity services
Reporting period
Annually: data to be collated between 2 and 3 months after fiscal year end.
Deadline: 30 June.
Review dates
Date standard introduced: April 2016
Date standard last updated: April 2018
NIPE-S05: diagnosis/intervention: timeliness of intervention for bilateral undescended testes
Description
The proportion of babies identified with bilateral undescended testes detected on newborn physical examination and seen by a consultant paediatrician/ associate specialist within 24 hours of the newborn examination.
Rationale
To provide assurance of timely interventions.
Definition
Numerator: number of babies with bilateral undescended testes who are seen for assessment by a consultant paediatrician/ associate specialist within 24 hours of the newborn examination.
Denominator: number of babies who are identified with bilateral undescended testes on the newborn physical examination in the reporting period.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Performance thresholds
Acceptable level: 100%
Only one threshold is set for this standard.
Caveats
None
Data collection and reporting
Data source: S4N, national IT system for newborn and infant physical examination screening
Responsible for data quality and completeness: maternity services
Responsible for submission: not applicable as extracted from S4N by national NIPE
Reported by: not applicable as extracted from S4N by national NIPE
Published by: maternity services
Reporting period
Annual. Data to be collated between 2 and 3 months after fiscal year end. Deadline: 30 June.
Review dates
Date standard introduced: April 2016
Date standard last updated: April 2018