Synopsis
Perform a safe head-to-toe newborn assessment, recognise findings that need immediate care rather than screening follow-up, complete the four NIPE screening elements and pulse oximetry, and coordinate vitamin K, hearing, blood-spot and repeat 6–8-week pathways.
- Offer the NIPE newborn screen to every eligible baby and complete it before or at 72 hours, preferably before discharge; repeat the four target components at 6–8 weeks.
- NIPE targets congenital cataract, critical congenital heart disease, developmental dysplasia of the hip and undescended testes; it accompanies a broader systematic physical examination.
- Review pregnancy, antenatal screening, fetal scans, gestation, delivery, resuscitation, maternal infection, blood group, medicines, substance exposure, feeding, urine and meconium before examination.
- Examine in a warm, well-lit room with the baby settled and sufficiently undressed; explain findings to parents and use a trained interpreter when needed.
- Record temperature, respiratory rate, heart rate, work of breathing, colour, weight, length and head circumference, interpreting observations by gestation, sleep state and trajectory.
- Inspect head, fontanelles, face and palate; examine red reflexes in both eyes, mouth and clavicles; auscultate heart and lungs and palpate brachial and femoral pulses.
- Inspect abdomen, cord, anus, genitalia, testes and spine; assess limb symmetry, tone, movement, reflexes and feeding behaviour.
- Perform Barlow and Ortolani separately on each hip. Asymmetric skin creases alone are no longer a positive NIPE finding.
- Use the current NIPE hip-risk pathway for breech presentation and first-degree family history and arrange ultrasound within its specified window even when examination is normal.
- Routine pulse oximetry is recommended by BAPM for asymptomatic newborns of at least 34 weeks; follow its preductal and postductal repeat or escalation pathway rather than one universal cut-off in isolation.
- Offer vitamin K: for a healthy baby at least 36 weeks, first-choice practical prophylaxis is 1 mg intramuscularly at birth; oral prophylaxis needs repeated doses and is unreliable in cholestasis or malabsorption.
- Take the newborn blood spot on day 5, with birth as day 0, for the current 10-condition English programme; follow special pre-transfusion and preterm sampling instructions.
- Complete hearing screening through the national OAE/AABR pathway, ideally before discharge or within 4 weeks; a pass does not exclude later hearing loss.
- A screen-negative result is not a lifetime guarantee. Explain jaundice, feeding, cord, stool, urine, temperature, breathing and safe-sleep warning signs and ensure follow-up ownership.
Key red flags
Central cyanosis, saturation below the local newborn pulse-oximetry pathway, a substantial preductal–postductal difference or poor response to oxygen needs urgent cardiorespiratory assessment.
Apnoea, grunting, persistent respiratory rate above 60/min, marked recession or asymmetrical breath sounds is not normal transitional variation once persistent or accompanied by distress.
Poor perfusion, weak or absent femoral pulses, differential pulses, hepatomegaly, tachycardia or bradycardia raises critical congenital heart disease or shock.
Bilious vomiting, a distended tender abdomen, absent anus, failure to pass meconium with illness, or bloody stool requires urgent neonatal and surgical assessment.
A white, absent, markedly asymmetric or partly obscured red reflex is screen positive and needs prompt ophthalmic assessment for cataract or other ocular disease.
Bilateral impalpable testes, genital ambiguity or unilateral impalpable testis with hypospadias requires urgent senior review before sex assignment, circumcision or discharge.
Seizure, profound hypotonia, asymmetric movement, tense fontanelle, microcephaly or rapidly enlarging head circumference requires neurological assessment.
Investigation priorities
Assess current wellbeing and identify structural, neurological, feeding and safeguarding concerns from head to toe.
Management branches
The newborn screen is due and the baby appears stable.
- Confirm identity, consent, gestation, antenatal findings, delivery and resuscitation details, maternal infection and medicine exposure.
- Ask about feeding, vomiting, urine, meconium, behaviour and family concerns and review previous observations and screening tasks.
- Ensure warmth, light, privacy, an interpreter when needed and a clear plan for urgent escalation if illness is uncovered.
History and initial observation permit routine assessment.
- Record physiology and anthropometry and observe colour, breathing, tone, movement and interaction before disturbing the baby.
- Examine head, eyes, mouth, chest, heart, pulses, abdomen, cord, anus, genitalia, spine, limbs, hips and neurological behaviour.
- Classify every abnormality as emergency, diagnostic referral, planned review or normal variant and explain it in accessible language.