Newborn Exam

The government initiatives to reduce lower-ranking doctors hours in spite of appearance the NHS Plan (DH 2000) tole pasture increased the call for midwives to expand their handed-down role and take on some of the tasks that in the past cause mainly been carried turn unwrap by junior doctors (Kings Fund 2011). Having been working at bottom the comm unity of interests linguistic context as a midwife for the past triplet years I was interested in extending my role in guild to provide more than holistic c atomic number 18 for my encaseload of clients and their babies.Holistic c atomic number 18 for fusss, babies and their families is highly recommended deep down the midwifery profession and is k nown to provide an improved experience for women (Changing vaginal save (DOH 1993a) NMC 2012, NICE 2006). The New natural and Infant Physical Examination (NIPE) is one fragment of the UK subject Screening programme and is offered to all parents for their mishandle at midriff 72 hours of birth and then repeated again at 6 weeks of age, ordinarily by their GP.This role is one of the tasks that has been highlighted where midwives muckle expand their role (Marshall & Raynor 2010). The cuss where I work has recently introduced community clinics where parents can take their baby in order to lay down the new-sprung(a) examen performed, in that locationfore allowing proto(prenominal) discharge home from the unit enabling early family bonding. With this in intellectual I commenced the Newborn and Infant Physical Examination course.Screening has been used inwardly the NHS for many another(prenominal) decades and is a process that en ables the health professional to highlight good members of the population that could potentially have a health related bother (UK National Screening delegation 2008). The NIPE is a head to toe examen that entrust enable a practitioner to detect in an plain healthy baby any abnormality that can then be referred onto the beguile professional for further investigation.This can then improve the newborns future(a) health by providing early intervention and prevention of further complications (DOH 2009). It specially focuses on the eye, center, hips and testes in the male infant. The importance of these plowshareicular areas is of great consequence to the babys future health. An undetected inherent cataract may prevail to the child being blind in that eye. A missed heart defect may not be diagnosed until the parents present with a precise unwell or even dead infant.If developmental dysplasia of the hip is not treated early enough following birth it could lead to some(prenominal) episodes of major surgery or even disability in the future. symmetrical undescended testes can lead to problems with future fertility. There are many issues surrounding the NIPE that are argued ab prohibited inside the literature Green and Oddie (2008) interrogate whether the NIPE provides the population with and im provement to overall health or if it just plants the parents reassurance that could in the future be proved wrong, due to the NIPE being a masking 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 centering particularly on the examination of the hips. Since being a midwife, and a fetch, I have always found this part of the examination most rugged to watch someone perform as it appears to be uncomfortable for the baby. indeed on commencing the course I have been conscious(predicate) 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 playacting 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 chi ldrens centre or at bottom 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 out the NIPE examination. Within the trust that I am based midwifery lead clinics are held on the post natal ward and also within the community for the sole purpose of performing the newborn examination. Bloomfield et al (2003) discussed where the examination should take place and found differing opinions. The benefits of being in hospital were noted to be that medical back up was available and it was more at ease for further immediate referral process.Community examinations were thought to be more likely to enable the parents to ask questions and mention concerns due to the relaxed environment. Following the Maternity Matters report (DOH 2007) advocating that women should have a greater choice for place of birth the home bi rth rate has increased and is continuing to do so. It is therefore ideal for community based NIPE facilities so that women do not have to attend hospital at all following a home birth.On reflection the examinations that I have witnessed and performed unfortunately seem to have been a way to speed up the postnatal discharge procedure therefore freeing up beds within the unit and not due to providing a more continual midwifery led experience for the parents and baby as Hutcherson (2010) found. The ideal item would be to perform the examination on the newborn belonging to the mother you have seen through antenatal care and will be feel for for post natally therefore providing continuous care for your personal caseload of clients, as discussed by Baston & Durward (2010).The patient satisfaction and overall job satisfaction in this case scenario would be high for all involved but unfortunately I feel in practice will be a rarified slide byrence. Eventually I believe that in our tru st when there are enough teach midwives within each geographical area the orifice of a midwife performing newborn examinations on babies within the teams caseload is possible. This furthermost-off from being the ideal scenario is the closest it will probably get to the holistic care sought after by myself and many other midwives.The EMREN (Evaluation of accoucheuse Role extension in the routine Examination of the Newborn) study carried out by Townsend et al (2004) looked into aspects of the NIPE one of them being whether a midwife was as capable as a senior house officer when carrying out the NIPE and discovered not only that this was the case but that the mothers satisfaction aim may be increased if a midwife performed the NIPE and that also property may be saved by the NHS.Having observed SHOs, appropriately trained midwives and advanced neonatal practitioners (ANP) performing the NIPE I felt that the midwives and ANPs communicated far more effectively with both the baby and parents therefore better fulfilling the confabulation aspect of the competencys indicated by the UK National Screening mission (2008). They also provided more detailed in governance on parenting and public health issues during the examinations which should be an integral part of the NIPE (Baston & Durward 2010).There has been much interest recently into whether pulse rate oximetry should be part of the newborn screening for congenital heart defects. The UK National Screening Committee is at the present time looking into whether this should be included within the NIPE as part of the screening for congenital heart defects in the newborn. It has been recommended in recent studies and has found to increase the detection rate of congenital heart defects (Ewer et al 2011, Chang 2009). Within our trust I have seen this performed on three ewborns following their NIPE, due to nasal flaring, slight cyanosis and a raised respiratory rate, all have proved to be within the normal range. The saturation monitors are present in the units clinic rooms where newborn examinations are performed but the community midwives working in childrens centres or at home do not have access to a monitor. Therefore this could be cause for concern for parents of babies that are being examined in the community. This then presents the ethical dilemma that newborns are being offered a varied aspect within the NIPE depending on where it is carried out.Powell et al (2013) found that parents were happy more or less having the pulse oximetry screening carried out on their newborn but questions submit to be asked if they would prefer to not have it done in favor of the NIPE being performed more conveniently within the community. Ewer (2012) discusses the benefits of introducing pulse oximetry supervise but without any mention of community based NIPE, or newborns that were born in the home environment. Another concern that I have witnessed and am aware of is not having access to all the antena tal notes of the mother within a community setting.On two occasions the mother has been discharged without the appropriate paper work or has not brought it to the clinic appointment. Obviously within the unit the antenatal and labour notes are easily accessible, within the community if the mother hasnt the appropriate information then the parents word must be taken. Having all information relating to the antenatal and interpartum periods is an essential part of the midwives role when performing the NIPE. The practitioner must be aware of antenatal and interpartum occurrences to be able to fulfil the competence set by the UK National Screening Committee (2008).When low undertaking the NIPEs I found the examination of the hips the hardest part of the procedure, mainly because the baby would quite often cry and struggle a little and this would cause the parents to be distressed and concerned. I also, in the past, as a midwife and mother observing this procedure felt uncomfortable. Hav ing now done a larger amount of these examinations and reading and understanding the relevant literature find them easier to perform. Screening for developmental dysplasia of the hip is based n the fact that if not picked up in the newborn could create the emergency for major surgical procedures in later life also with a poorer future outcome, Dezateux & Rosendahl (2007). Developmental dysplasia of the hip used to be widely cognise as congenital dislocation of the hip but has been renamed since the 1990s. The factors behind this metamorphose are that it is now recognised that the condition is not always congenital and rarely dislocated and more likely to be displaced, Bracken et al (2012).The definition of developmental dysplasia of the hip is very obscure as there are varying degrees and it quite often develops after birth, overall it describes a disorder where the hip juncture is unstable and occasionally dislocated. The hip stick consists of the femoral head, the rounded end of the bone which sits within the cartilage of the socket joint known as the acetabulum. There are thought to be diametrical factors as to why the hip joint becomes unstable. At around vii weeks gestation hip formation has already begun, problems can start to occur then.If the femoral head is wrongly positioned from the start it could result in the formation of a too shallow socket. During pregnancy the hip joint can be affected by external and internal forces, for example oligohydramnios, need of foetal movement due to foetal conditions, breech presentation (Hurley 2009, McDonald & Jenkins 2008). The incidence of developmental dysplasia of the hip varies in the literature, at birth it is thought to be 1-20 in 1000 but the majority of these stabilize without any interposition within the first few weeks of life, bringing the incidence down to 1-2 in 1000 (Campion & Benson 2007).The incidence is higher in womanish babies, it is believed due to the female newborn being more susce ptible to the maternal hormones therefore the joints are more relaxed, Hurley 2009. It is also more prevalent if a sibling or parent has had developmental dysplasia of the hip, McCarthy et al (2005) and McDonald & Jenkins. Other factors mentioned by McDonald & Jenkins (2008) include first born infants, multiple gestation and occurring in the left hip more frequently than the right.