Guidance

Newborn and infant physical examination screening standards valid for data collected from 1 April 2024

Updated 10 October 2024

Applies to England

1. NIPE-S01: coverage

1.1 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 at ≤ 72 hours of age and have a conclusive result on the day of the report.

1.2 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

1.3 Definition

Numerator – number of eligible babies screened at ≤ 72 hours of age who have a conclusive result on the day of report for each of the conditions screened.

Denominator – number of eligible babies born in the NHS trust in the reporting period:

• including babies ≤ 72 hours of age who transfer into the care of the maternity service without a screening result
• excluding babies who die at ≤ 72 hours of age without being screened

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

1.4 Performance thresholds

Acceptable level: ≥ 95.0%

Achievable level: ≥ 97.5%

1.5 Caveats

Screening may be delayed where a clinical decision is made because the baby is ‘too young’ or ‘too ill’ for NIPE newborn screening.

‘Too young’ is defined as babies born < 34 weeks gestation. Screening may be delayed until these babies reach ≥ 34 weeks and zero days (34+0) gestation.

‘Too ill’ screening should be completed as and when the baby’s condition allows.

1.6 Data collection and reporting

Data source: SMaRT4NIPE (S4N) national IT system for newborn and infant physical examination screening

Responsible for data quality and completeness: NHS trust

Responsible for submission: not applicable as extracted from S4N by national NIPE screening programme

Reported by: not applicable as extracted from S4N by national NIPE screening programme

Published by: NHS trust

This standard is also the key performance indicator NP1.

1.7 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).

1.8 Review dates

Date standard introduced: April 2016

Date standard last updated: April 2021

2. NIPE-S02: diagnosis/intervention – timeliness of intervention for babies with screen positive eye results

2.1 Description

The proportion of babies with a screen positive eye result on newborn physical examination who attend for clinical assessment by an ophthalmology specialist ≤ 2 weeks of the examination.

2.2 Rationale

To provide assurance that babies with a screen positive eye result have a timely clinical review.

2.3 Definition

Numerator: number of babies with a screen positive eye result on newborn physical examination who attend for clinical assessment by an ophthalmology specialist ≤ 2 weeks of the examination.

Denominator: number of babies born in the reporting period who have a screen positive eye result on newborn physical examination, excluding babies who die before the clinical assessment.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

2.4 Performance thresholds

Acceptable level: ≥ 95.0%

Achievable level: ≥ 99.0%

2.5 Caveats

None

2.6 Data collection and reporting

Data source: S4N

Responsible for data quality and completeness: NHS trust

Responsible for submission: not applicable as extracted from S4N by national NIPE screening programme

Reported by: not applicable as extracted from S4N by national NIPE screening programme

Published by: NHS trust

2.7 Reporting period

Annually: data to be collated between 2 and 3 months after fiscal year end

Deadline: 30 June

2.8 Review dates

Date standard introduced: April 2016

Date standard last updated: April 2021

3. NIPE-S03: diagnosis/intervention – timeliness of ultrasound scan of the hips for developmental dysplasia

3.1 Description

The proportion of babies with a screen positive newborn hip result who attend for ultrasound scan of the hips within the designated timescale.

3.2 Rationale

To provide assurance that babies who have a screen positive newborn hip result have a timely ultrasound scan of the hips.

3.3 Definition

Numerator: number of babies who attend for ultrasound scan of the hips who are between:

• 4 and 6 weeks of age for babies born ≥ 34 weeks and zero days (34+0) gestation
• 38+0 and 40+0 weeks corrected age for babies born <34+0 weeks gestation

Denominator: number of babies born in the reporting period who have a screen positive newborn hip result.

Defined as those with:

• suspected dislocated or dislocatable hip(s) at clinical examination, or
• presence of one or more national hip risk factors (see NIPE clinical handbook for list of risk factors)

Excluding babies who:

• die before the ultrasound appointment date
• are found to have ‘clicky hips’

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

3.4 Caveats

Please note that NIPE-S03 includes:

• babies born ≥ 34+0 weeks gestation who have hip ultrasound scan between ≥ 4 weeks and 0 days and ≤ 6 weeks and 0 days of age (42 days)
• babies born < 34+0 weeks gestation who have hip ultrasound scan between ≥ 38 weeks and 0 days and ≤ 40 weeks and 0 days corrected age

3.5 Performance thresholds

Acceptable level: ≥ 90.0%

Achievable level: ≥ 95.0%

3.6 Data collection and reporting

Data source: S4N

Responsible for data quality and completeness: NHS trust

Responsible for submission: not applicable as extracted from S4N by national NIPE screening programme

Reported by: not applicable as extracted from S4N by national NIPE screening programme

Published by: NHS trust

3.7 Reporting period

Annual. Data to be collated between 2 and 3 months after fiscal year end.

Deadline: 30 June

3.8 Review dates

Date standard first introduced: April 2021

Date standard updated: April 2024

4. NIPE–S04: diagnosis/intervention – timeliness of hip clinical assessment or discharge

4.1 Description

The proportion of babies with a screen positive newborn hip result at newborn physical examination for whom an outcome decision was made within the designated timescale.

4.2 Rationale

To provide assurance that babies referred after a screen positive newborn hip examination have timely discharge or entry into the treatment pathway.

4.3 Definition

Numerator – number of babies for whom an outcome decision was made by:

• 6 weeks of age for babies born ≥34 weeks and zero days (34+0) gestation
• 40+0 weeks corrected age for babies born <34+0 gestation

An outcome decision is either:

• discharge from the hip screening pathway after review of normal hip ultrasound scan results
• attendance for clinical assessment by orthopaedic specialist

Denominator – number of babies born in the reporting period who attend for ultrasound scan of the hips after screen positive newborn hip referral.

Babies who are found to have ‘clicky hips’ are not included in this standard.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

4.4 Caveats

Please note that NIPE-S04 includes:

• babies born ≥ 34+0 weeks gestation who have an outcome decision made ≤ 6 weeks and 0 days of age (42 days)
• babies born < 34+0 weeks gestation who have outcome decision made ≤ 40 weeks and 0 days corrected age

4.5 Performance thresholds

From 1 April 2024:

Acceptable level: ≥ 90.0%

Achievable level: ≥ 95.0%

4.6 Data collection and reporting

Data source: S4N

Responsible for data quality and completeness: NHS trust

Responsible for submission: not applicable as extracted from S4N by national NIPE screening programme

Reported by: not applicable as extracted from S4N by national NIPE screening programme

From 1 April 2024, this standard is also the key performance indicator NP4

Published by: NHS trust

4.7 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)

4.8 Review dates

Date standard first introduced: April 2021

Date standard updated: April 2024

5. NIPE-S05: diagnosis/intervention – timeliness of intervention for babies with screen positive testes results requiring urgent review

5.1 Description

The proportion of babies identified with screen positive testes results detected on the NIPE newborn screening examination which require urgent review (seen by a senior paediatrician (defined as paediatric consultant or experienced tier 2 paediatric trainee (ie registrar) or equivalent) ≤ 24 hours of the NIPE newborn screening examination).

5.2 Rationale

To provide assurance of timely interventions for babies who have screen positive testes results requiring urgent review.

5.3 Definition

Numerator: number of babies identified in the reporting period with screen positive testes results requiring urgent review and who are seen for assessment by a consultant paediatrician or associate specialist ≤24 hours of the NIPE newborn examination.

Denominator: number of babies who are identified in the reporting period with screen positive testes results requiring urgent review. We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

Screening results requiring urgent review are defined as

a)       bilateral impalpable testes 

b)       unilateral impalpable testis with or without hypospadias

c)       unilateral palpable testis not located in the scrotum, with hypospadias

d)      disorders of sexual development (previously known as ambiguous genitalia and    sometimes referred to as disorders of sexual differentiation)

5.4 Performance thresholds

Acceptable level: 100%

Only one threshold is set for this standard.

5.5 Caveats

None

5.6 Data collection and reporting

Data source: S4N, national NIPE IT system

Responsible for data quality and completeness: NHS Trust

Responsible for submission: not applicable as extracted from S4N by national NIPE screening programme

Reported by: not applicable as extracted from S4N by national NIPE screening programme

Published by: NHS Trust

5.7 Reporting period

Annual. Data to be collated between 2 and 3 months after fiscal year end. Deadline: 30 June.

5.8 Review dates

Date standard introduced: April 2016

Date standard last updated: April 2024