The following clinical guidance outlines the appropriate screening tests depending on age for babies found to have missed NIPE screening. If the missed screen is due to a screening pathway failure, then actions should be taken in line with national screening incident guidance.
7.1 Classification of missed NIPE newborn screening examination If the NIPE newborn screening examination is not completed by 72 hours of age, it should be done as soon as possible. The reasons for the delay beyond 72 hours of age should be recorded on S4N and used locally to collate mitigations against NP1 coverage performance target. Babies remain eligible for NIPE newborn screening examination until 6 weeks of age. Reasons for delayed screening should be locally audited and investigated if appropriate. All babies should have all elements of the NIPE newborn screening examination before being fully discharged from the care of any maternity, neonatal or paediatric inpatient services. A NIPE newborn screening examination is classified as ‘missed’ if it is not completed:
before full discharge from maternity, neonatal or paediatric inpatient services (without provision for completion within the community setting)
by 6 weeks of age for unscreened babies who remain in maternity or neonatal inpatient care
by 6 weeks of age for unscreened babies who have moved into an area
At 6 weeks of age, babies become eligible for the NIPE infant screening examination.
7.2 Infants who have missed NIPE screening Up to and including 3 months of age NIPE newborn screening examinations not undertaken by 72 hours of age should be completed as soon as possible after this time by the current care provider (see the NIPE newborn screening examination section above for reasons screening can be delayed). Babies remain eligible for NIPE newborn screening examination until 6 weeks of age, but the examination should be completed as close to the 72-hour target as possible. This includes unscreened babies who ‘move in’ to an area or between care providers. Eligible babies who move into the area who have not been screened should be offered screening by the responsible service provider. This may be by the maternity, neonatal or paediatric services or in primary care depending on the age and condition of the baby. For these babies, screening results will, in practice, only be recorded on S4N if the NIPE newborn screening examination is undertaken by the maternity or neonatal service. If NIPE newborn screening is performed at or after 6 weeks of age, it is not necessary to do the NIPE infant screening examination. Older than 3 months of age If the NIPE infant screening examination is overdue (after 6 to 8 weeks of age), it should be done as soon as possible. The screening examination for unstable hips using the Barlow and Ortolani manoeuvres is no longer accurate at this age. Any asymmetry of leg length or restricted hip abduction should be assessed, and the child’s gait observed, if walking. In line with advice in the PCHR, the parent(s) should be advised to contact their GP or health visitor if they have any concerns regarding their child’s wellbeing.
7.3 Completing a missed NIPE examination The relevant examination or observation must be undertaken by a NIPE qualified practitioner.