NIPE Screening Dr Rachel Anderson and Dr Rebecca Rhodes (City Hospital NICU) 12th March 2019

Objectives Share Current Practice Current Key Performance Indicators for NIPE Quiz on NIPE and common problems Refresher on performing a NIPE

Four Questions?? How do you invite patients for screening? When do you invite them and does it correlate with maternal postnatal checks? Who performs the NIPE screening checks? What do you include in your NIPE screening appointment?

A QUICK DEMONSTRATION (Video provided by Dr James Law)

The Screening bit Eyes: approximately 2 or 3 in 10,000 babies have problems with their eyes that require treatment. The prime purpose of screening is to identify congenital cataracts. Heart: approximately 4 to 10 in 1,000 babies have a heart problem. Hips: approximately 1 or 2 in 1,000 babies have hip problems that require treatment. Testes: approximately 1 in 100 baby boys have problems with their testes that require treatment.

Current KPI’s NP1-Percentage of babies who have a NIPE performed within 72hrs of birth NP2-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. The 6-8 week check is not currently a key performance indicators.

What is expected? All eligible babies are offered screening (including those who move into the area). The examination takes place between 6 and 8 weeks of age. Any required referrals are made within the timescales outlined below. Follow-up of referrals to ensure appropriate interventions have taken place as required. If the baby is screen positive for any element of the newborn examination, the practitioner undertaking the 6 to 8 week examination should check the progress along the care pathway to ensure required actions take place.

Quiz 1. What is the normal RR in a new born baby?

2. What is the diagnosis?

3. What is this?

4. What is this?

5. What is this?

6. What will you do?

8. You can only feel one testicle 8. You can only feel one testicle. Does this require an urgent or routine surgical referral?

9. Name 3 risk factors that require a hip screen (other than clicky hips)

10. Babies are eligible for BCG vaccination if there parents or grandparents were born in a country whose incidence for TB is more than ……..per 100000

11. Injury to what causes this?

12. Does this need a surgical referral at the 6-8 week check?

13. What is the most important thing to check?

14. What is the diagnosis?

15. What must you tell the parents NOT to do?

16. What is the diagnosis?

17. You identify an inguinal hernia at a 6-8 week check, what is the appropriate next step?

18. What investigation will this baby need?

Tie Breaker What number is Elsie in the list of top 100 girls names for 2018?

Special Mention

Heart Murmurs Any other symptoms? What is the growth like? Any feeding concerns? Refer for outpatient review and ECHO unless concerning features in which case speak to on call Registrar at QMC.

Sacral Dimples Is it in the midline? Is it in the natal cleft? Is there any skin change or other associated feature?

Troubleshooting Feeding Nottingham Guidelines: Probably the most common issue and a huge topic Use other services as able Nottingham CMPA guideline and reflux gudieline are useful resources Nottingham Guidelines: Referral Information New born examination protocol

Any Questions?

Summary -Reviewed current practise -Reminder of what should be included in a 6-8 week check -Touched on some common problems -If in doubt consult the guideline