NIPE Summary Flashcards
what is involved with preparation of NIPE?
Review family, maternal and full perinatal history in notes.
Gather and check equipment
Introduce yourself to parents, name and role.
Offer congratulations.
Briefly the procedure including limitations.
Confirm with mum any significant history or clarify anything identified from notes.
Confirm baby name and date of birth
Seek and gain consent to complete NIPE
what equipment is needed for NIPE?
- Ophthalmoscope – eyes
- Tongue depressor – mouth
- Stethoscope
- Temperature – if baby hasn’t had one already
- Pen torch
- Pulse oximetry
- Tape – measure head circumference
how do you explaining NIPE?
This examination is a screening test checking for any abnormalities, through checking things like … heart, eyes, and hips. My job is to not diagnose therefore, I refer to more experienced and specialised people if I would like someone to review anything within the check. However, this check does not prevent any abnormalities developing. Meaning that things can change from now until … next check which is completed by the GP between 6-8 weeks. Have you got any questions?
what does the observation and discussion of NIPE involve?
Ascertain any carers anxieties and observe interaction with the baby
Observe baby’s general condition while settled and undisturbed:
colour, breathing, behaviour, activity, tone and cry
Confirm urine and stool output
Establish feeding method and any concerns
Perform hand hygiene and don PPE if appropriate
what is the expected urine and stool output?
How many nappies has baby had in the last 24 hours? – meconium (may not be one within 6 hours but aiming for two within 24) day 1-2- 1-2 wet, 1 dirty (black), day 3-4, 3-4 wet, 2 dirty changing
what are the steps of hand hygiene?
- Wet hands with warm water
- Single application of soap
- Rub hand palm to palm
- Palm over the back of hand interlace fingers
- Palm to palm fingers interlaced
- Back of ginfers to opposing palms fingers interlocked
- Rotational rubbing of thumbs
- Fingertips cleaning palms
- Rinse with warm water
- Dry hands
observing a baby’s general condition involves what?
Colour – should be pink in colour
Breathing – should be regular, not irregular and should not look like it requires a lot of effort.
Behaviour – is baby alert, sleeping and settled
Activity – movement
Tone – baby should not feel floppy when held
Cry – does the cry sound normal, not high pitched etc
what does the NIPE involve?
Undress baby as required, keep warm
Skin:
Assess throughout - Colour, integrity, birthmarks, trauma
Head & face:
general overview and facial symmetry
Head & scalp - shape, size, sutures, head circumference, fontanelles, injury.
Eyes - shape, position, discharge and red reflexes
Nose – patency, philtrum
Mouth – visualising and digital inspection of the hard and soft palate to uvula, tongue and gums, presence of suck reflex, jaw
Ears – size, shape, position, level, abnormalities, hearing test
Palpate the neck and clavicles
Upper limbs:
movement, proportion, symmetry, Brachial pulses, hand creases, digits
Chest:
Visual inspection, respiratory rate & effort, chest sounds
Heart:
Cap refill, heart auscultation x5 – heart rate, heart rhythm, heart sound, heaves, thrills. pulse oximetry
Abdomen:
General inspection, palpate through four corners shallow then deeper, kidneys, umbilical cord
Genitalia and anus:
appearance, positioning, completeness and patency? – both sexes
Lower limbs:
Femoral pulses, Symmetry, movement, tone, length, plantar creases, digits
Hips:
Leg height position, leg/buttock creases
Barlow’s test
Ortolani’s test
Spine:
Skin appearance, bony structure, sacrum, buttock cleft.
Reflexes:
Moro, rooting, suck/swallow, grasp
Dress and wrap baby
Doff PPE if appropriate and perform hand hygiene
brief assessment of the skin…
Colour, integrity, birthmarks, trauma
brief assessment of the head…
shape, size, sutures, head circumference, fontanelles, injury.
OFC – 32-36cm
Fontanelle should not be sunken or raised.
Sunken – dehydration
Raise – bleeding trauma.
If baby have an FSE in labour check it is not infected
brief assessment of the eyes?
shape, position, discharge and red reflexs, sclera
brief assessment of the nose…
patency, philtrum
brief assessment of the mouth?
visualising and digital inspection of the hard and soft palate to uvula, tongue and gums, presence of suck reflex, jaw
brief assessment of the ears?
size, shape, position, level, abnormalities, hearing test
brief assessment of the neck and clavicles?
Neck – tumours, skin tags, skin folds (there should be creases but no extra folds). Remember to check the back of the neck.
Clavicles - to detect trauma - if it doesn’t feel smooth this may indicate fracture
brief assessment of the upper limbs?
movement, proportion, symmetry, Brachial pulses - equal, hand creases - 2, digits
check no webbing
palmer grasp reflex
check arm pit elbows, may be a good time to do a temperature.
brief assessment of the chest…
Visual inspection, respiratory rate & effort, chest sounds, nipples
Synchronous – rising and falling equally on both sides.
Check side rib cage, under armpit (sides)
Resps – 40-60 per min
Check nipples.
Sound – no cracking, smooth noises
Extra work breathing?
brief assessment of the heart…
Cap refill, heart auscultation x5 – heart rate, heart rhythm, heart sound, heaves, thrills. pulse oximetry
Capillary refill – on chest press for 2 seconds and should refill less than 3 seconds
Heaves & thrills - (thrill vibration like a phone, heaves hand over sternum should feel heart beat as such) is this normal?
heart rate - 120-160bpm
heart rhythm - LUB DUB noise (No ectopic beats - missed beats, any extra or difference is murmur)
heart sound - LUB DUB
MTPAMS
brief assessment of the abdomen?
General inspection, palpate through four corners shallow then deeper, kidneys, umbilical cord
Roll hands from lower corner up to see if anything is enlarged. You may feel tip of the liver or baby’s right side but nothing more than a finger length. You shouldn’t feel the baby’s spleen.
Press just above baby’s pubic, bone you should not feel the bladder.
brief assessment of both genitalia?
appearance, positioning, completeness and patency? – both sexes
Male – Penis size, penis shape, testes x 2 in scrotum. If not felt may be still undescended.
Female – clitoris, labia, vaginal opening. May be discharge, bleeding (pseudo menstruation)
brief assessment of lower limbs…
Femoral pulses, Symmetry, movement, tone, length, plantar creases, digits
webbing, no deep creases, reflexes - toes curl
brief assessment of the hips…
Leg height position, leg/buttock creases
Barlow’s test
Ortolani’s test
Fingers in line with leg (trigger fingers) straight down leg and apply pressure and go out
Stabilised baby’s pelvis with hand at gentilia, thumb at the front and fingers at the back.
If there is no issue you shouldn’t feel anything - smooth motion
Clicking means it is just a clicky hip
Clunk noise and feeling is not normal as it has went back into place
brief assessment of the spine…
Skin appearance, bony structure, sacrum, buttock cleft.
brief assessment of the reflexes?
With the next you hands should flare out then come back into the body.
Sit baby up then lie in back into hand aka catch baby,
Warn and be sensitive to parents.
Moro reflex: when rapidly tipped backwards the arms and legs will extend
Suckling reflex: placing a finger in the mouth will prompt them to suck
Rooting reflex: tickling the cheek will cause them to turn towards the stimulus
Grasp reflex: placing a finger in the palm will cause them to grasp
