The consultation process has opened on proposed changes to the newborn and infant physical examination (NIPE) hip screening pathway.
Several changes to the pathway have been suggested by an expert hip screening working group, including a proposal that babies with ‘clicky hips’ and no hip risk factors should not undergo hip ultrasound scan. It is also being proposed that there should be no differentiation in timeline for ultrasound scan completion for babies with screen positive findings or risk factors. There is currently no national guidance on the upper or lower limit for timing of hip ultrasound. It is now being proposed that the ultrasound not be undertaken earlier than 3 weeks of age.
Similarly, there is no specific current guidance regarding post-ultrasound management. The proposed new guidance would state that babies who have an abnormal newborn clinical examination, but normal ultrasound should be discharged without the need to see an orthopaedic surgeon or specialist practitioner. The same would apply to babies with risk factors but normal ultrasound. In addition, it is being proposed that breech presentation at birth should only be considered a risk factor at or after 28 weeks gestation.
At present, all babies are eligible for newborn examination unless they are too unwell to be screened. There is no current national guidance for NIPE screening based on gestational age. The expert group is now recommending that where a baby is born before 36 completed weeks, clinical examination of the hips should be delayed until they reach 36 completed weeks gestation or are discharged, whichever is earlier. The ultrasound scan target date would be based on date of the examination.
Stakeholders are invited to submit comments on the proposed changes. Comments can be emailed to ANNB.Support@phe.gov.uk. The closing date is 12 pm Wednesday 27 June 2018.
