The document provides an agenda and details for a regional event on the Newborn and Infant Physical Examination (NIPE) Screening Programme. The event will include updates on the NIPE programme and NIPE SMART system, as well as sessions on using NIPE SMART and quality assurance.

1. Welcome to the
Newborn and Infant Physical
Examination (NIPE) Screening
Programme
Regional Event 2017

2. Programme
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09.30 Registration and Refreshments
10.00 Welcome and Setting the Context
10:10 NIPE Programme Update
11:00 Screening Quality Assurance Service Update and NIPE Incidents
11:30 NIPE SMART User Group
11:45 Becoming smarter with NIPE SMART – Back to Basics
NIPE SMART User Guide
12:15 Questions and Answers
12:30 Lunch
13:15 Becoming smarter with NIPE SMART – Back to Basics (Continued)
NIPE SMART User Guide
14:45 Questions and Answers
15:00 Closing Comments

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4. NIPE Programme Update
Jill Walker SRNRMMSc(PH)
NIPE Programme Manager
Public Health England leads the NHS Screening Programmes

5. National NIPE programme team
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Screening systems
and data manager

6. Overview of presentation
NIPE team
Programme update:
• Important key messages
• National clinical and commissioning guidance
• NIPE SMART implementation progress
• Pulse oximetry pilot update
• KPI guidance
• Interoperability and NIPE SMART redesign
• Completed , existing and forthcoming work streams
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7. 7 NIPE Update Regional Events 2017

8. NIPEAdvisory Group
Chair: Dr Nigel Ruggins (Consultant paediatrician Derby Hospitals NHS Foundation
Trust)
meets 3 times a year
Members :NIPE team and QA , NIPE Clinical Advisor, Senior Midwifery / Neonatal
Lecturer, Supervisor, Consultant Neonatologists , NIPE practitioners incl. Public
Health Midwife Advanced Neonatal Nurse Practitioners, PHE Consultant Lead
Screening and Immunisations
• Royal Colleges : RCPCH representation , Practising GP RCGP, Royal College of
Midwives
• Charities : STEPS, Children’s Heart Federation, National Blind Children’s Society
• advise on the development of the screening programme
• monitors effectiveness and efficiency
• advises on programme standards and guidance education and training,
information, quality assurance
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9. The Newborn and Infant Physical Examination
(NIPE) Programme
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9
The NHS NIPE Programme’s main aim is to identify
and refer all children born with congenital
abnormalities of the eyes, heart, hips, and testes,
where these are detectable, within 72 hours of birth;
To further identify those abnormalities
that may become detectable by 6-8
weeks of age, at the second physical
examination, and thereby reduce
morbidity and mortality

10. Where we are with the programme ?
Service specification in place covering both elements of the
programme
Newborn examination
• implementation of NIPE SMART
• national standards and guidance in place
6-8 week examination
• national guidance only
• no plans to implement NIPE SMART at present
Further clarity about ‘where screening ends’
Newborn screening pathway to be amended
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11. NIPE Standards
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NIPE
Standard 1
Identify the population and coverage - babies eligible for the
newborn physical examination who are tested for all four
components (three components in female infants) of the newborn
examination within 72 hours of birth
No treatment standards: refer to treatment standards, clinical
guidance and treatment pathways published by other
professional bodies.
No cardiac standards: may developed at a later date and
(dependant on UKNSC decisions re : newborn pulse oximetry
pilot)
No 6-8 week standards infant physical examination standards:
not currently measurable
5 standards

12. Eyes
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about 2 or 3
in 10,000
babies have
problems
with their
eyes that
require
treatment
NIPE
Standard 2
Timeliness of intervention (abnormality of the eye) - attending an
assessment appointment by 2 weeks of age

13. Heart
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Heart:
approx.
4-10 in 1,000
babies have
a heart
problem
No NIPE
Standard

14. Hips
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approximately
1 or 2 in
1,000 babies
have hip
problems that
require
treatment
Image courtesy of STEPs charity
NIPE
Standard 3
Timeliness of intervention (Developmental Dysplasia of Hips-DDH)
babies who have a positive screening test on newborn physical
examination and undergo assessment by specialist hip ultrasound
within two weeks of age
NIPE
Standard 4
Timeliness of intervention (Developmental Dysplasia of Hips-
DDH- risk factors) babies who have a negative screening test on
newborn physical examination but have identified risk factors and
undergo assessment by specialist hip ultrasound within six
weeks of age

15. Testes
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Approx.
1 in 100
baby boys
have
problems
with their
testes that
require
treatmentNIPE Standard 5 Timeliness of intervention (bilateral undescended
testes)
babies identified with bilateral undescended testes
detected on newborn physical examination and are
seen by a consultant paediatrician/ associate
specialist within 24 hours of the newborn examination

16. Whatmakesaneffective
NIPEprogramme?
Provides appropriate
and timely
information to parents
Offers newborn
examination to the
parents of every
newborn baby within
72 hours of birth
Has competent staff
undertaking NIPE
examination
Has on-going training
and development
programme for staff
undertaking NIPE
examination
Works to robust NIPE
screening and referral
pathways
Has a NIPE clinical
lead
Can track , manage
and report on
programme activity,
clinical referrals and
outcomes
Can collate and
manage the newborn
cohort NIPE data set
Has robust failsafe
systems
Effective
communication
between HCPs
Has NIPE SMART in
place and can
evidence effective
use ?
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17. NIPE SMART Implementation Progress 2013 – 2017
Expressions of
Interest
Actively
Implementing
LIVE with NIPE
SMART
Apr-14 45 9 17
May-14 41 18 18
Jul-14 54 22 19
Sep-14 59 20 21
Nov-14 41 41 23
Jan-15 35 48 25
Mar-15 36 35 42
May-15 27 34 55
Jul-15 29 19 71
Sep-15 18 20 77
Dec-15 12 19 84
Jan-16 9 15 90
Mar-16 6 16 97
Jul-16
4 7 108
Aug16 4 5 110
March 17 1 5 112
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18. NIPE SMART Implementation Progress – England
Where are we now ?
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7 Trusts have gone live in 2017

19. 17-18 NIPE service specification
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Published
18.4.17

20. Changes - 17-18 NIPE Service Specification
• Overall text has been updated by the NIPE programme to offer more
clarity
• Feedback from commissioners and providers has been taken into
account
• Updated weblinks throughout
• Specific updated text to support effective use of NIPE Screening,
Management and Reporting Tool (SMART) where it is in place
• e.g. local systems should be in place to maximise the input of data
into NIPE SMART to reflect accurate coverage and support robust
failsafe processes (in particular where newborn examination
is undertaken in neonatal units and in the primary care setting)
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21. Changes - 17-18 NIPE Service Specification
Use of NIPE SMART Mandated
• change of wording to : Providers must use NIPE SMART to manage the
local screening process and link into the national failsafe system . If the
provider is not using NIPE SMART then the failsafe element of the
programme is compromised
• further clarity about ensuring NIPE examination is undertaken even when
newborn babies are transferred between care providers
• The provider will retain care obligations throughout the NIPE care pathway ,
unless a formal transfer of care is made to another care provider and this is
accounted for within a failsafe system (ideally via use of NIPE SMART)
• emphasis on need to ensure completion of the screening pathway with
local processes for feedback of results from screening referrals (to ensure
that newborn babies with a positive screen are seen by a specialist within
the required referral timeframe)
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22. NIPE Programme Guidance 17-18
NIPE Programme Standards and Handbook………to be published
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23. Importance of a robust screening pathway
In line with national standards and guidance each provider
should have a process in place to assure all parts of the
NIPE newborn screening pathway
• this should be to the point of attending for diagnostic test
or specialist appointment
• this process should be in place whether or not NIPE
SMART is implemented
• it is NOT within screening Programme remit to offer
guidance on clinical management of screen positive
cases
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24. What about in ‘NIPE SMART Live’Trusts ?
Effective use of NIPE SMART enables local providers to track
outcomes for the babies screened to ensure that those who are
screen positive have been referred and attended within the
nationally recommended condition specific timescale
There should be staff designated to ensure that :
• NIPE SMART is managed and overseen
• NIPE SMART is used effectively by practitioners
• all screening and post referral outcome data is entered in a timely fashion
• monthly and quarterly NIPE data reports provided and generated are used
to assure a failsafe process and provide accurate KPI data
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25. Key Performance Indicators
NP1
The proportion of babies eligible for the
newborn physical examination who
were tested within 72 hours of birth
NP2
The proportion of babies who, as a
result of a possible abnormality of the
hips being detected at the newborn
physical examination, undergo
assessment by ultrasound within 2
weeks of birth
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26. NIPE Coverage 11/12 – 16/17
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e.g. Q2 2016 to 2017
Published Jan 2017
Babies on NIPE SMART
11/12 44,736
12/13 90,501
13/14 90,757
14/15 123,959
15/16 350,639
16/17 (to Dec) 377,956
We recommend not
using NIPE data as a
performance
measure at present
because of issues
with data quality and
completeness

27. KPI NP 1 Reports – Monthly NIPE SMART Reports
March 2017
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NP1
Recorded coverage ranges from
40% to 100%
NP2
Very poor data
few outcomes recorded
Screening activity, referrals and
outcomes not being accurately
recorded
Planned production of better
summary reports
Key: Green = 95%; Orange 80% - 94%; Red < 80%

28. Hip Screening Work – various queries
Undertaking the examination
• in the preterm (? age adjustment – applicable to all NIPE screening )
• ? additional risk factors
NIPE SMART
Recording screening outcomes- out with NIPE standards e.g. clicky hips
• Hip outcome fields (being amended along with all outcome fields )
Ultrasound
• some confusion re timescales (working to local guidance)
• Validity of methods for preterm babies
• validated technique (alpha and beta angles , graf method )
Responsibilities along the screening pathway
Screening incidents
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29. Hip Screening Working Group
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30. Hip Screening Working Group
Task and finish group – 1st Meeting took place 10th July 2017
Purpose
To review the NIPE hip screening pathway including:
• current NIPE screening hip risk factors
• current guidance for NIPE examination of hips in preterm infants
• timescale for referral for ultrasound at 2 weeks (screen positive after clinical newborn exam)
• timescale for referral for ultrasound at 6 weeks (pre disposing risk factors exam)
• Et al ………………
Membership includes :
NIPE team including NIPE clinical advisor
Consultant Paediatrician/ Neonatologist , Superintendent Radiographer Ultrasound, Neonatal
Screening Specialist / NIPE Specialist Midwife , Consultant Radiologist , Consultant Orthopaedic
Surgeons (one with Subspecialty Interest in Paediatric Hip Disease), Consultant Neonatologist,
Research and Information Officer STEPs charity
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31. Newborn Pulse Oximetry Screening Pilot Update
Pilot led by :
• Claire Evans Pilot Project lead
• Jill Walker NIPE Programme Manager
• Professor Andy Ewer - clinical advisor.
Aims:
• understand the impact of implementing newborn pulse oximetry
screening on NHS services
• establish feasibility for future national roll out as an addition to the existing
suite of screening tests undertaken as part of the newborn NIPE
examination (<72 hrs)
• 15 participating Trusts across England
• pilot active screening and prospective data collection phase July –
December 2015
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32. Participating Trusts
Newborn Pulse Oximetry Screening Pilot Trust Listing Group A
(already screening for PO)
1. Norfolk & Norwich University Hospitals NHS Foundation Trust
2. Surrey and Sussex Health Care NHS Trust
3. Warrington and Halton Hospitals NHS Foundation Trust
4. Cambridge University Hospitals NHS Foundation Trust
5. Northern Lincolnshire and Goole Hospitals NHS Foundation Trust
6. Bradford Teaching Hospitals NHS Foundation Trust
7. Countess of Chester Hospital NHS Foundation Trust
8. The Royal Wolverhampton Hospitals NHS Trust
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33. Participating Trusts
Newborn Pulse Oximetry Screening Pilot Trust Listing Group B
(PO as new screen )
1. Hull & East Yorkshire Hospitals NHS Trust
2. United Lincolnshire Hospitals NHS Trust
3. Brighton & Sussex University Hospitals NHS Trust
4. East Cheshire NHS Trust
5. Liverpool Women's Hospital NHS Foundation Trust
6. York Teaching Hospital NHS Foundation Trust
7. University Hospitals of Leicester
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34. Headline Pilot Data
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• Over the six month pilot period 38,828 babies were born
in the 15 participating pilot Trusts
• Of these, 2,513 (6.2%) were ineligible for screening
• A total of 32,836 babies (90.4%) who were eligible were
recorded as having PO screening

35. What was detected by PO screening ?
True screen positive cases (8)
• Coarctation of the Aorta (CoA)
• Critical pulmonary stenosis (PS), ventricular septal defect (VSD) and patent
ductus arteriosus (PDA)
• Critical PS x 2
• Transposition of the great arteries (TGA) with VSD
• TGA
• Supracardiac total anomalous pulmonary venous drainage (TAPVD)
• Hypoplastic aorta/CoA (hypoplastic left heart syndrome) and mixed TAPVD
False screen negative cases (2)
• CoA
• Hypoplastic left heart syndrome
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36. Newborn pulse oximetry screening pilot - latest
information
• End report produced May 2016 (not published )
• UKNSC meeting June 2016
• Economic evaluation now progress
• PO screening pathway available (please e mail PHE Screening helpdesk)
• Summary report sent out to Pilot Trusts March April and
all Trust NIPE Leads May 2017
• Final decision by UKNSC expected in late 2017/ early
2018
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37. Screening Data – wider considerations
• CHIS Service specification
• NIPE SMART read only access possible (with reporting
capabilities)
• Process - request from Trust to NIPE helpdesk
• New CHIS Hubs
• Mismapping problems (working with Northgate and NHS
Digital )
• Considering code mapping hierarchy
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38. Child Health Digital Strategy
https://www.england.nhs.uk/digitaltechnology/child-health/
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39. NIPE E learning Resource
• Full review 2016/17
• Successful RGCP reaccreditation January
2017
• Removal of
sensitive content
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40. New Illustrations
and Pixilation
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41. Accessible via e Learning for Healthcare
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http://www.e-lfh.org.uk/programmes/nhs-screening-programmes/

42. Maintaining Competency
17/18 Handbook amended
Newborn examination – a doctor (paediatrician or GP) who is competent to undertake all
elements of the newborn examination or a midwife, nurse or health visitor who has
successfully undertaken a university accredited ‘examination of the newborn’
programme of study and has also undergone locally agreed competency assessment
by a practising NIPE examiner. Trusts which have a locally delivered training course for
practitioners to undertake examination of the newborn are responsible for managing any
risk associated with this approach.
Programme has considered :
• if use of numbers of examinations can be used as a measurement to help benchmark
competency in practise
• the programme position regarding the current practice of local Trust’s provision of in
house training to undertake NIPE Newborn examination (rather than practitioners
attending accredited University Examination of the Newborn course)
Currently considering :
• additional guidance/ tools to support annual competency assessment
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43. 43 NIPE Update Regional Events 2017

44. What else are we doing ?
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• Ongoing NIPE SMART system development review
• Northgate (review of service)
• Failsafe (checks and audits )
• Updating NIPE pathway
• Mapping of HEIs provision of examination of the newborn courses data
now being analysed (including as part of pre-registration midwifery
training)
• NIPE SMART user group
• NIPE SMART trust support visits
Trust based or joint ‘neighbourhood ‘ meetings – let us know
PHE.ANNB-Admin@nhs.net

45. NIPE Blogs
August 2016 Re: NIPE SMART version 5.6 release
‘NIPE SMART: New release imminent’ https://phescreening.blog.gov.uk/2016/08/01/nipe-smart-new-release-imminent/
September 2016 – Re: NIPE e learning review work
‘Help us review the newborn and infant physical examination e-learning module’ https://phescreening.blog.gov.uk/2016/09/07/help-us-
review-the-newborn-and-infant-physical-examination-e-learning-module/
September 2016 – Re: Forthcoming IT work
‘We're working on making NIPE SMART even smarter’ https://phescreening.blog.gov.uk/2016/09/23/were-working-on-making-nipe-
smart-even-smarter/
October 2016 NIPE SMART update
‘National support offered to trusts implementing NIPE SMART’ https://phescreening.blog.gov.uk/2016/10/11/national-support-offered-
to-trusts-implementing-nipe-smart/
October 2016 NIPE Educators day
‘NIPE education day well received’ https://phescreening.blog.gov.uk/2016/10/12/nipe-education-day-well-received/
January 2017 Pulse Oximetry Update
https://phescreening.blog.gov.uk/2017/01/10/newborn-pulse-oximetry-screening-pilot-update/
June 2017 Trust Support Visits ‘We’re happy to help: how we’re supporting local services to use NIPE SMART’
https://phescreening.blog.gov.uk/2017/06/27/were-happy-to-help-how-were-supporting-local-services-to-use-nipe-smart/
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46. Conclusion : What should we all be interested in ensuring ?
That :
there is a safe and effective screening pathway for ALL
newborn babies
there are local processes in place that work
the screening cohort is monitored and gaps addressed
all screen positive cases are followed up
competent staff undertake NIPE screening
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47. We will continue to ……………….
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48. Thank you
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• for your continued support to the
NIPE programme
• for helping to maintain a high
quality screening programme
• for feeding back to us any
issues or concerns
• for continuing to support the
successful implementation of
NIPE SMART

49. Any queries please contact :
Jill Walker
Programme Manager
NHS Newborn and Infant Physical
Examination Screening Programme
jillwalker1@nhs.net
or via screening helpdesk
phe.screeninghelpdesk@nhs.net
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