Introduction

Anne Lomax

Frontline staff, who perform the examination of the newborn, are in an ideal position to influence health choices made by women and their families to help ensure good maternal health and, in the longer term, optimum life chances of newborn babies. Newborn screening has the potential to prevent infant deaths by detecting certain congenital anomalies or conditions that contribute to long-term illness (PHE 2017). Moreover, it can provide a valuable opportunity to advise women on health promotion issues such as nutrition and feeding, smoking, sudden unexpected death in infancy and immunisation programmes.

Political drivers for examination of the newborn - past and present

In 2004, the Department of Health published the National Service Framework for Children, Young People and Maternity Services (DH 2004). This highlighted that high-quali maternity care can ensure a healthy start for the baby and help parents become skilled in parenting. The document set out a 10-year programme for improvement. Other government initiatives have provided the platform for changes in the way National Health Service (NHS) staff work, to reduce waiting times and deliver modern patient-centred care. These initiatives include the following: European Working Time Directive (DH 2002), the NHS Changing Workforce Programme (DH 2003) and, more recently, the NHS Long Term Plan (DH 2019). The resulting reduction in junior doctors' hours has contributed to the need for different ways of working to provide maternity care, in particular that team midwifery and more specialised services may need to be concentrated in fewer facilities.

The Royal College of Obstetricians and Gynaecologists (RCOG) and the National Institute for Health and Care Excellence (NICE) have provided expert clinical guidance on all aspects of provision of maternity care (NICE 2015; RCOG 2016). Alongside this is the recognition that midwifery services will need to be strengthened in the community, which, it could be said, is the most appropriate setting for straightforward low-risk women (DH 2019).

A change in professional boundaries has been inevitable, and midwives have undertaken additional training to enhance their midwifery role (DH 2000). With regard to examination of the newborn, many midwives view this as a natural extension of their traditional role (Lomax and Evans 2005).

A growing body of evidence suggests that midwives are ideal candidates to undertake this enhanced training; however, the literature does indicate that a practitioner who is adequately trained, experienced, skilled and competent is more important than professional background; also that the standard quality and content of the examination should be consistent throughout the United Kingdom (Wolke et al. 2002a; 2002b; Townsend et al. 2004; Williamson et al. 2005; Hall and Elliman 2006; Rogers et al. 2015).

Ensuring best practice

Mothers and babies should have access to a practitioner who provides a flexible but informed attitude to a package of care that is designed to meet their individual needs (DH 2004). Above all, midwives must be committed to this concept, as difficult as this may be, against the backdrop of a service that is still dealing with large numbers of hospital-based low-risk women.

The Midwifery 2020 document (DH 2010) emphasised the unique and essential role of the midwife in the care of both low-risk and high-risk women. It recognizes the important role that midwives play in communicating key public health messages to these women throughout the childbearing continuum. Midwifery 2020 calls for the inclusion of examination of the newborn, prescribing, suturing and intravenous cannulation skills to be included in pre-registration midwifery curricula to ensure that all newly qualified midwives are proficient in caring for women in all risk categories. This concept has been more recently endorsed in the National Maternity Review Better Births document (NHS 2016).

The impetus for including examination of the newborn training within the midwifery undergraduate programmes has now gained much ground in keeping with the philosophy and ethos of autonomous low-risk midwifery care. Providing this kind of undergraduate education helps meet the service need by enabling Trusts to provide responsive midwifery care (Yearley et al. 2017). This aspect will be discussed in more detail in Chapter 10.

The UK National Screening Committee

The UK National Screening Committee (UKNSC) launched the national standards for the newborn infant examination in 2008. This was part of a wider announcement on the Child Health Promotion Programme (CHPP). The document The Child Health Promotion Programme, Pregnancy and the First Five Years of Life (DH 2008) is an update of standard one of the National Service Framework for Children, Young People and Maternity Services and sets the context for neonatal examinations. The CHPP was updated and replaced by the Healthy Child Programme (HCP) (DH 2009).

In April 2013, the UK National Screening Programmes became part of Public Health England (PHE). Public Health England is the expert national public health agency working on behalf of the Secretary of State to protect health and health inequalities and promote the health and well-being of the nation. More information on PHE can be found here: https://wwwgovuk/government/organisations/public-health-england.

Key documents

Historically, the standards set out within the UKNSC's document Newborn and Infant Physical Examination (NIPE) (UKNSC 2008) included standards for both 72 hours and 6-8-week screening elements of the examination. The current standards can be found at https://www.gov.uk/government/publications/newborn-and-infant-physical-examination-screening-standards/newborn-and-infant-physical-examination-programme-standards-valid-for-data-collected-from-1-april-2018.

It is important to note that following stakeholder consultation in 2018 the NIPE programme team are planning changes to the current standards. These will come into effect across England in April 2021. More information can be found on the following link: file:///C:/Users/aloma/AppData/Local/Packages/microsoft.windowscommunicationsapps_8wekyb3d8bbwe/LocalState/Files/S0/1/Attachments/Communication%20to%20Stakeholders%20Changes%20to%20NIPE%20National%20Standards%20and%20Pathways%20October%202020[1048].pdf

The standards should be read alongside the updated NIPE Programme Handbook which has now been published (PHE 2020). Some of the changes include: amended guidance for when consent for the NIPE examination is declined; updated guidance around dealing with the baby who is deemed 'too ill' for the newborn examination; updated guidance regarding the transfer of babies between Trusts, and some changes to the screen positive criteria for examination of the hips. The new handbook also provides further clarification on training for practitioners along with guidance for student midwives undertaking pre registration training. The PHE NIPE Programme Handbook (2020b), informs and supports best clinical practice whilst undertaking the examination (https://www.gov.uk/government/publications/newborn-and-infant-physical-examination-programme-handbook/newborn-and-infant-physical-examination-screening-programme-handbook). In additon, the current PHE NHS National Service Specification 21 Newborn and Infant Physical Examination Screening Programme (PHE 2019/20) ensures consistency in approach to the newborn and infant examinations and will be used to commission and monitor provision of NIPE services across England (https://www.england.nhs.uk/wp-content/uploads/2017/04/Service-Specification-No.21-NIPE.pdf). Screening programmes fall under the remit of the agreement (PHE 2019/20), which allows responsibility for commissioning some of the public health budget. It also ensures that decisions are made by those with subject expertise, that a collaborative and strategic leadership approach is adopted and that screening programme boards are in place. The service specification defines the kind of NIPE service that should be provided within Trusts and outlines the requirements for commissioning of a safe and effective screening programme.

SMaRT 4 NIPE

Alongside this, the NIPE programme requires a robust information support system to assure quality and provide a failsafe element to the newborn examination to help detect and prevent late or missed examinations and to track babies along the screening pathway. Information sharing and provision of a sound data base are central to the continued success of the programme. In 2014, the NIPE programme team began to roll out the use of the recommended NIPE Screening Management and Reporting Tools (NIPE SMART). IT system SMART provides a consistent means of gathering important data from the newborn examination. The system can also help with audit of performance against national standards and key performance indicators and can ensure a local and national failsafe. Since then, uptake across...