The newborn examination is thorough enough to look intimidating – a clinician methodically working through a baby's whole body, checking things that parents may not even know can go wrong. The reality is that the vast majority of babies pass all aspects of the examination, and the screens are designed to pick up the specific conditions that benefit most from early detection.
Understanding what is being checked, and why those four specific conditions are the focus, changes the experience from passive to engaged. A parent who understands what the hip check is for, and what finding a clunk means, is better placed to follow up appropriately if a concern is identified.
Healthbooq (healthbooq.com/apps/healthbooq-kids) covers newborn health and the first weeks.
When the Examinations Happen
The NIPE (Newborn and Infant Physical Examination) occurs twice: in the first 72 hours of life (usually before hospital discharge) and again at 6-8 weeks, typically performed by a GP or trained nurse at the 6-week postnatal check. The screening aims to identify conditions early enough that treatment produces significantly better outcomes than late detection.
The Four Specific Screening Targets
Congenital heart defects. The clinician listens carefully with a stethoscope to the baby's heart sounds and checks femoral pulses (in the groin, which reflect blood flow from the aorta to the lower body). A heart murmur or absent/weak femoral pulses may indicate a significant congenital heart defect. Many murmurs in newborns are innocent and resolve – the clinical challenge is identifying those that are not. Pulse oximetry (measuring blood oxygen with a sensor) has been added to some NIPE protocols to detect hypoxaemia from cyanotic heart defects.
Developmental dysplasia of the hip (DDH). The hip examination uses two specific manoeuvres: the Ortolani test (attempts to relocate a dislocated hip, feeling for a clunk as the femoral head returns to the acetabulum) and the Barlow test (attempts to gently dislocate an unstable hip). Risk factors for DDH include breech presentation, family history, and being a first-born girl. Babies with a positive or equivocal hip examination are referred for hip ultrasound. DDH detected and treated early (with a Pavlik harness) has excellent outcomes; undetected, it can lead to significant joint problems in adulthood.
Congenital cataracts. The red reflex examination shines a light through the pupil and should show a symmetric red-orange glow in both eyes. An absent, asymmetric, or white reflex (leukocoria) may indicate a cataract, retinoblastoma, or other significant eye condition. Congenital cataracts require urgent treatment (surgery, then contact lenses or glasses to allow normal visual development) to prevent permanent visual impairment from amblyopia.
Undescended testes. In boys, both testes should be palpable in the scrotum at birth. If one or both are not descended, the baby is referred for surgical review. Undescended testes are associated with reduced fertility and increased risk of testicular cancer if not corrected before age 2; orchidopexy (surgical correction) is typically done at 6-18 months.
The Rest of the Examination
Beyond the four screening targets, the NIPE covers a thorough general assessment. The examiner checks the head shape and fontanelles; the palate (for cleft palate, which may not be visible externally but is identified by finger examination); the clavicles (for fractures from difficult delivery); tone and movements; skin colour and condition; the spine (for sacral dimples or abnormalities that may indicate spina bifida occulta); the abdomen (for organomegaly); and genitalia. Weight is recorded.
Neurological assessment includes observing tone, assessing key primitive reflexes (Moro, grasp, sucking), and checking that movements are symmetrical.
The Newborn Bloodspot (Heel-Prick) Test
At around day 5, a midwife takes a small sample of blood from the baby's heel using a lancet, absorbed onto a special card. This screens for nine conditions: congenital hypothyroidism, phenylketonuria (PKU), cystic fibrosis, sickle cell disease, medium-chain acyl-CoA dehydrogenase deficiency (MCADD), maple syrup urine disease (MSUD), isovaleric acidaemia (IVA), glutaric aciduria type 1 (GA1), and homocystinuria (HCU). These conditions benefit dramatically from early detection and treatment.
The Newborn Hearing Screen
The NHS Newborn Hearing Screening Programme offers hearing screening to all newborns before discharge from hospital (or shortly after). The test uses otoacoustic emissions (OAE) – tiny sounds produced by the inner ear in response to clicks. NICU babies use automated auditory brainstem response (AABR) testing instead, because OAE does not detect auditory neuropathy. A "refer" result means the test needs to be repeated and is not a diagnosis of hearing loss.
Key Takeaways
All newborns in the UK undergo the Newborn and Infant Physical Examination (NIPE) within 72 hours of birth and again at 6-8 weeks. The examination screens specifically for four conditions: congenital heart defects, developmental dysplasia of the hip (DDH), congenital cataracts, and undescended testes (in boys). It also assesses tone, reflexes, feeding, skin, and general health. Separate screening programmes include the newborn bloodspot (heel-prick) test at day 5, and the newborn hearing screen. Parents are encouraged to ask questions during these examinations; knowing what is being checked and why helps parents notice changes in between.
