In the first three days of your baby's life, a clinician will do a careful, structured examination of them — the NIPE. It looks like a relaxed top-to-toe check, but it's a deliberate screening tool aimed at four conditions where early detection actually changes outcomes. Knowing what's being looked for, why, and what the numbers behind each component are makes the whole thing feel less mysterious — and helps you ask the right questions if anything turns up.
Healthbooq covers newborn screening, the early weeks at home, and what is and isn't normal.
What the NIPE Is
The Newborn and Infant Physical Examination (NIPE) is offered to every newborn in England, Scotland, Wales, and Northern Ireland within 72 hours of birth. A doctor or specially trained nurse practitioner runs through a national protocol — what they're checking for, in what order, and how to record it, is standardised across the NHS.
A second NIPE follows at the 6 to 8 week check, usually with your GP, because some conditions either weren't apparent at birth or develop afterward. Both visits matter. Don't skip the 6-week one.
Eyes: The Red Reflex
The clinician will dim the lights and shine an ophthalmoscope at each eye from a short distance. They are looking for the red reflex — the same effect that gives you red-eye in a flash photograph. A normal red reflex means light is travelling cleanly through the eye. An absent or asymmetric one can indicate:
- Congenital cataract (around 2 to 3 in 10,000 babies)
- Retinoblastoma — rare but a malignancy where speed of detection is everything
- Other lens or retinal abnormalities
Cataract surgery within the first weeks of life prevents lifelong visual impairment. This is the highest-stakes test in the NIPE.
Heart: Listening and Oxygen
A stethoscope check listens for murmurs across the four standard auscultation points. Murmurs are common — about 1 in 100 newborns has one — and most turn out to be innocent (the so-called Still's murmur, transient). What the clinician is screening for is structural congenital heart disease, which affects roughly 8 in 1,000 births.
Most NHS units now also do pulse oximetry — a clip on the foot or hand reading the oxygen saturation. A reading below 95% triggers a closer look. This catches a subset of critical heart conditions that don't produce an obvious murmur in the first day of life.
If a murmur is heard but the baby is feeding well, has good colour, normal pulses, and normal saturations, the clinician will often arrange a follow-up rather than admit straight to cardiology. Most innocent murmurs resolve.
Hips: Ortolani and Barlow
This is the bit where it looks like the clinician is gently bicycling your baby's legs. The two named tests:
- Ortolani — the hip is gently abducted to feel for a clunk that suggests the head of the femur is being relocated into the socket
- Barlow — the hip is gently adducted with light pressure to feel for the head slipping out
They are screening for developmental dysplasia of the hip (DDH) — clinically significant in about 1 to 2 per 1,000 births. Higher risk: breech position in the last trimester, family history of hip problems, or a sibling with DDH.
Early detection matters because treatment depends on age. A baby diagnosed in the first weeks of life is usually managed with a Pavlik harness — a soft brace worn for 6 to 12 weeks. The same condition picked up after walking starts often requires surgery. The wide gap in treatment burden is exactly why hips are a NIPE priority.
If the clinician asks for an ultrasound after the NIPE, that's a routine next step, not a sign that something dramatic is wrong.
Testes (Boys)
Both testes are gently palpated to confirm they are in the scrotum. Undescended testes (cryptorchidism) affect 2 to 5% of full-term boys and significantly more preterm babies. The reassuring news is that most descend on their own in the first six months. Those that haven't by then are usually managed with orchidopexy before 18 months — a short surgical procedure to bring the testis down. Earlier surgery is associated with better long-term fertility and lower testicular cancer risk.
Boys who are screened as "high" rather than fully descended at the first NIPE will usually be re-checked at the 6-week appointment.
Everything Else: The General Examination
Beyond the four big-ticket items, the clinician is also doing a calm head-to-toe:
- Tone and movement — does the baby move all four limbs symmetrically; is tone normal, not too floppy, not too stiff
- Skin — colour, jaundice, birthmarks
- Head and fontanelles — shape, soft spots, any bruising or moulding from delivery
- Face, palate, and mouth — a finger sweep across the roof of the mouth checks for cleft palate, which is sometimes hidden under an intact lip
- Abdomen — feeling for the liver, spleen, and any masses; checking the cord stump
- Femoral pulses — a hand on each groin to check for coarctation of the aorta
- Spine — looking for any pit, dimple, tuft of hair, or curve
- Neurological — Moro reflex, suck, root, grasp; symmetry on both sides
What the NIPE Is Not
The NIPE is separate from two other newborn screens that you'll also be offered:
- Heel-prick blood spot test, usually on day 5 (sometimes 5 to 8). Screens for 9 conditions including PKU, congenital hypothyroidism, cystic fibrosis, sickle cell disease, and several inherited metabolic conditions. A few drops of blood from the heel onto a card.
- Newborn hearing screen — usually before discharge from the maternity unit, or at a community clinic in the first few weeks. Uses either AOAE (otoacoustic emissions) or AABR (automated brainstem response). A "refer" result on first test is common and not the same as a diagnosis — most refers are clear at the second test.
If anything is missed at NIPE — say, your baby was born quickly at home and the visit slipped — ask your community midwife or GP to arrange it. It's not a paperwork formality.
What to Do If the Clinician Finds Something
A "we'd like to follow this up" finding at NIPE is far more often a precaution than a diagnosis. Many onward referrals — for a soft murmur, a hip click, a "high" testis, an asymmetric Moro — turn out to be nothing on specialist review. Ask:
- "What specifically did you find?"
- "What's the most likely explanation?"
- "What's the next step, and on what timescale?"
Get the appointment booked before you leave the room if you can. Don't lose the referral letter — bring it to the specialist visit.
What to Bring Up Yourself
The NIPE is a chance to ask. Worth raising if it applies:
- Family history of heart problems in young relatives, hip problems, or congenital deafness
- A first-degree relative with cystic fibrosis, sickle cell, or thalassaemia
- Any concern from pregnancy scans that was deferred to "after delivery"
- How feeding is going — feeding is one of the most useful clinical pieces of information about a newborn
- Anything that looks different from what you expected — a lump, a skin change, a movement that worries you
Clinicians are used to these questions. None of them are silly.
A Note on the 6 to 8 Week Check
This second NIPE is genuinely important. Hips that felt fine at birth occasionally show up as abnormal at 6 weeks. Murmurs that weren't there on day one sometimes appear. Eyes are easier to examine in a baby who is more alert. It's also when you'll typically discuss feeding, weight, the first vaccinations, and your own postnatal recovery with the GP. Take 5 minutes before you go in and write down anything you've noticed. The check is short; preparation makes it useful.
Key Takeaways
Every UK newborn is offered a head-to-toe examination within 72 hours of birth, called the NIPE — Newborn and Infant Physical Examination. It's a screen for four specific things where catching them early genuinely changes the outcome: eyes (red reflex, looking for cataract or retinoblastoma), heart (murmurs and pulse oximetry, looking for congenital heart disease), hips (Ortolani and Barlow tests for developmental dysplasia), and — in boys — testes. A second NIPE happens at 6 to 8 weeks because some conditions don't show up immediately. The NIPE is separate from the heel-prick blood test (days 5 to 8) and the newborn hearing screen.
