The first days after birth involve more clinical contact than many new parents expect. A newborn's first physical examination – part of the NHS Newborn and Infant Physical Examination (NIPE) programme – is a structured screening process rather than simply a check that the baby "looks healthy." Knowing what it covers and why each component is included helps parents engage with the process and ask informed questions.
Healthbooq covers newborn health and development in the early weeks.
What the NIPE Is and Who Performs It
The Newborn and Infant Physical Examination (NIPE) is a structured examination offered to all newborns in England within 72 hours of birth. It is carried out by a doctor (neonatologist, paediatrician, or GP with relevant training) or an advanced neonatal nurse practitioner. The examination follows a standardised protocol.
A second NIPE examination is offered at 6-8 weeks, typically in primary care, and this second examination provides an opportunity to identify conditions that may not have been apparent immediately after birth.
The Four Core Screening Components
The NIPE prioritises four conditions where early detection significantly changes outcomes:
Eyes. The examiner uses an ophthalmoscope to check for red reflex in each eye. The presence of a normal red reflex indicates that light is passing through the eye normally without obstruction. Absence or asymmetry of the red reflex may indicate congenital cataract, retinoblastoma, or other serious eye conditions. Congenital cataracts affect approximately 2-3 per 10,000 babies; early detection allows surgery within weeks of birth, preventing permanent visual impairment.
Heart. A stethoscope examination of the heart assesses for murmurs that may indicate congenital heart disease. Heart murmurs in newborns are common (around 1% of newborns have a murmur) and most are innocent, but structural congenital heart disease affects around 8 per 1,000 births. Pulse oximetry (measurement of oxygen saturation) is also performed in many maternity units as an additional screen for critical congenital heart disease.
Hips. The Ortolani and Barlow manoeuvres are used to assess hip stability and detect developmental dysplasia of the hip (DDH). DDH affects approximately 1-2 per 1,000 live births in its clinically significant form. Early detection allows treatment with a Pavlik harness (a soft brace) rather than surgery.
Testes (boys only). Both testes are palpated to confirm they are descended into the scrotum. Undescended testes (cryptorchidism) affect around 2-5% of term male births, with higher rates in preterm babies. Undescended testes that do not descend spontaneously (most do so in the first 6 months) are managed with orchidopexy before 18 months.
The General Examination
Beyond the four core screening components, the NIPE includes a general assessment: overall appearance and tone; skin condition; head shape; face, palate (checking for cleft palate), and mouth; abdomen; femoral pulses (felt at the groin to check for coarctation of the aorta); the spine; and neurological assessment.
Other Newborn Screening Tests
The NIPE is distinct from but complementary to other newborn screening programmes:
The newborn blood spot test (heel prick test) is performed at 5-8 days and screens for nine conditions including phenylketonuria, congenital hypothyroidism, cystic fibrosis, and sickle cell disease.
Newborn hearing screening is offered within the first few weeks, either before leaving the maternity unit (AABR or AOAE screening) or at a community clinic shortly after discharge.
These three screening programmes together form the foundation of UK newborn health surveillance.
What Parents Should Know
The NIPE examination is a screening tool, not a guarantee. Some conditions will not be detected at the newborn examination – they may be too subtle at this stage, or they may develop later. The 6-8 week check provides an important second opportunity.
Parents are encouraged to ask about anything that is found during the examination. Referral for a finding at NIPE (for example, a hip that feels mildly unstable on Barlow testing) does not necessarily mean a serious problem is present – many referrals result in a reassuring specialist assessment.
Key Takeaways
All newborns in the UK receive a physical examination within the first 72 hours of life, known as the Newborn and Infant Physical Examination (NIPE). This examination is carried out by a doctor or advanced neonatal nurse practitioner and covers six core areas: eyes, heart, hips, and testes (in boys) – the four most clinically significant screening components – along with a general assessment. A second NIPE examination is offered at 6-8 weeks. The NIPE programme is distinct from the heel prick (blood spot) test and the newborn hearing screening, which are offered separately.
