Newborn Exam

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The government initiatives to reduce junior doctors’ hours within the NHS Plan (DH 2000) have increased the call for midwives to expand their traditional role and take on some of the tasks that in the past have mainly been carried out by junior doctors (Kings Fund 2011). Having been working within the community setting as a midwife for the past three years I was interested in extending my role in order to provide more holistic care for my caseload of clients and their babies. Holistic care for mothers, babies and their families is highly recommended within the midwifery profession and is known to provide an improved experience for women (Changing Childbirth (DOH 1993a) NMC 2012, NICE 2006). The Newborn and Infant Physical Examination (NIPE) is one element of the UK National Screening programme and is offered to all parents for their baby within 72 hours of birth and then repeated again at 6 weeks of age, usually by their GP. This role is one of the tasks that has been highlighted where midwives can expand their role (Marshall & Raynor 2010). The trust where I work has recently introduced community clinics where parents can take their baby in order to have the newborn examination performed, therefore allowing early discharge home from the unit enabling early family bonding. With this in mind I commenced the Newborn and Infant Physical Examination course.

Screening has been used within the NHS for many decades and is a process that enables the health professional to highlight healthy members of the population that could potentially have a health related problem (UK National Screening Committee 2008). The NIPE is a head to toe examination that will enable a practitioner to detect in an apparently healthy baby any abnormality that can then be referred onto the appropriate professional for further investigation. This can then improve the newborns future health by providing early intervention and prevention of further complications (DOH 2009). It particularly focuses on the eye, heart, hips and testes in the male infant. The importance of these particular areas is of great significance to the baby’s future health. An undetected congenital cataract may lead to the child being blind in that eye. A missed heart defect may not be diagnosed until the parents present with a very unwell or even dead infant. If developmental dysplasia of the hip is not treated early enough following birth it could lead to several episodes of major surgery or even disability in the future. Bilateral undescended testes can lead to problems with future fertility. There are many issues surrounding the NIPE that are argued about within the literature Green and Oddie (2008) question whether the NIPE provides the population with and improvement to overall health or if it just gives the parents reassurance that could in the future be proved wrong, due to the NIPE being a screening tool and not a diagnostic test. Within the content of this essay I will be critically analysing the NIPE and some issues around this topic focusing particularly on the examination of the hips. Since being a midwife, and a mother, I have always found this part of the examination most difficult to watch someone perform as it appears to be uncomfortable for the baby. Therefore on commencing the course I have been aware of the discomfort it appears to give the newborn and also the distress this could in turn cause for the parents. I will also be looking into the issues regarding which professional is best qualified to be performing the examination and also if there are any benefits or risks as to the place that it is undertaken. When I am performing the examination I will mainly be alone in the community setting either at a children’s centre or within the home environment, so therefore it is imperative that I am aware of any limitations this may present for the baby, parents or me. As previously mentioned there is a growing trend within many obstetric units for midwives to carry...
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