The newborn check looks impressively thorough — and is. A clinician systematically works through eyes, heart, hips, hands, palate, abdomen, genitals, reflexes, tone, weight, while parents try to remember whether the baby fed an hour ago. Most babies pass everything cleanly. The check is designed to catch the small number of conditions where finding them in the first few days makes a measurably different long-term outcome.
This article is the version of the NIPE that walks through what each part is actually for, so you know what to ask if anything comes up.
Healthbooq keeps a record of NIPE findings, vaccination dates, and the 6–8 week check in one place.
When the Checks Happen
Two formal NIPEs in the first 8 weeks:
- Within 72 hours of birth — usually before discharge from the maternity unit, or at home if the baby was born at home or transferred quickly. Done by a trained midwife, paediatric junior doctor, or NIPE-trained practitioner.
- 6 to 8 weeks — done by a GP at the postnatal check that is paired with mum's 6-week review. Same NIPE protocol, plus weight, length, head circumference, and a developmental screen.
Around these two NIPEs are two other separate screens: the heel-prick blood spot at day 5, and the newborn hearing screen before hospital discharge.
The Four Specific Conditions Being Screened For
The NIPE is a general top-to-toe check, but it has four specific screening targets — chosen because each is one where early detection genuinely changes the outcome.
1. Congenital Heart Disease
About 8 per 1,000 babies are born with a structural heart defect. Most are mild; around 1 in 4 are clinically significant.
What the clinician does:
- Listens to the heart sounds at four standard positions for murmurs, rhythm, and split S2
- Feels the femoral pulses in the groin — weak or absent femoral pulses can signal coarctation of the aorta, which can be missed otherwise because the upper-body circulation looks normal
- Pulse oximetry is now part of the NIPE in many UK trusts, screening for low oxygen saturation that can flag cyanotic heart defects (transposition, tetralogy of Fallot, hypoplastic left heart) before the baby looks blue
Many newborn murmurs are innocent and disappear in the first weeks — they reflect the transitional circulation closing down. Ones that are louder, harsh in quality, or associated with weak femoral pulses or low saturations get an echocardiogram before discharge.
What you can watch for at home: persistent rapid breathing, sweating during feeds (the baby tires from the workload of feeding), poor weight gain, and any blue tinge around the lips when calm.
2. Developmental Dysplasia of the Hip (DDH)
The hip is a ball-and-socket joint, and in some babies the socket is too shallow or the ball too loose at birth. About 1–2 babies per 1,000 have a frankly dislocatable hip; more have lesser instability. Caught in the first weeks, treatment is a Pavlik harness for 8–12 weeks and almost all hips end up normal. Caught at toddler walking, treatment becomes surgery and the long-term joint outlook is significantly worse.
The NIPE manoeuvres:
- Barlow test — gently pushing back on a flexed hip to feel whether the femoral head can be made to slip out
- Ortolani test — gently abducting a flexed hip with forward pressure, feeling for the clunk of a dislocated head returning to the socket
Risk factors that lower the threshold for hip ultrasound regardless of clinical exam:
- Breech presentation at or after 36 weeks (around 1 in 25 babies — automatic ultrasound)
- Family history of DDH in a first-degree relative
- First-born girls have higher background risk
- Conditions associated with intrauterine packing (oligohydramnios, twins)
A "clicky hip" without a true clunk is common and usually benign, but most clinicians err on the side of an ultrasound to be sure.
3. Congenital Cataracts (Red Reflex)
The clinician shines an ophthalmoscope into each pupil and looks for the red-orange reflex — the same effect that causes red-eye in flash photography. A symmetrical, equal red reflex in both eyes is normal.
What an abnormal reflex can mean:
- Congenital cataract — affects about 3 per 10,000 babies; surgery in the first weeks of life is needed to prevent dense amblyopia (permanent vision loss in the affected eye, because the visual cortex doesn't develop without input)
- Retinoblastoma — a rare eye cancer (about 1 in 18,000); white reflex (leukocoria) is the classic sign and prompts urgent ophthalmology referral
- Persistent fetal vasculature, retinal detachment, vitreous haemorrhage — all rarer but caught the same way
If you ever see a white pupil in your baby in a flash photograph at home, show your GP. The visual cortex develops in the first months, and time matters.
4. Undescended Testes (Boys)
Both testes should be palpable in the scrotum at birth. About 4–5% of term boys have one or both testes undescended at birth; most descend on their own by 3 months. By 6 months, those that haven't descended are referred for orchidopexy — usually done between 6 and 18 months.
Why the deadline matters:
- Testicular tissue at body temperature (rather than 2°C cooler in the scrotum) shows progressive damage to fertility-related cells
- Risk of testicular cancer is higher in undescended testes — bringing them down lowers but doesn't eliminate the risk, and it lets later self-examination work
- Risk of testicular torsion is higher in undescended testes
A retractile testis — one that can be coaxed down but pulls back up with cold or stimulation — is normal and doesn't need surgery. The clinician distinguishes this on exam.
The Rest of the Top-to-Toe
Beyond the four screening targets, the NIPE works methodically through:
- Head shape and fontanelles — sutures, moulding, caput, cephalhaematoma. Anterior fontanelle should be soft and level; bulging or sunken in a calm baby is a flag.
- Eyes — symmetrical opening, tracking briefly to a face, no obvious squint, no discharge.
- Mouth and palate — finger sweep along the hard and soft palate to feel for cleft palate that may not be visible (about 1 in 1,500 babies has an isolated cleft palate without lip involvement). Tongue-tie is noted but only treated if causing significant feeding problems.
- Clavicles — feeling for the small step or crepitus of a clavicle fracture, which can happen during difficult vaginal delivery and heals on its own.
- Tone and posture — flexed limbs, symmetrical movement, response to handling.
- Skin — colour, jaundice, birthmarks (port-wine stains, café-au-lait spots, congenital melanocytic naevi), neonatal rashes (erythema toxicum, milia — both normal).
- Chest movement and breathing pattern — symmetry, rate, work of breathing.
- Abdomen — palpating for the liver edge (normally felt 1–2 cm below the costal margin in newborns), spleen, bladder, and any masses. Cord stump.
- Spine — running a finger along to check for sacral dimples (deep, hairy, or off-midline ones get imaged), spina bifida occulta, scoliosis.
- Genitalia — boys: testes, hypospadias check, hydrocoele. Girls: visible labia, vaginal opening, no fusion.
- Anus — patent and in the right position (rare conditions like imperforate anus are picked up here).
- Reflexes — Moro (startle), rooting, sucking, palmar and plantar grasp, stepping. Symmetry matters more than the individual presence.
- Hips — already covered above.
- Femoral pulses — already covered.
- Weight — usually a midwife task; charted on the WHO 0–4 year growth chart.
The Heel-Prick Blood Spot (Day 5)
A separate screen, run by a midwife at home or in clinic. A small lance to the side of the heel, then 4–5 spots of blood onto a card.
The card screens for nine conditions:
- Phenylketonuria (PKU) — without treatment, severe learning disability; with a special diet from infancy, normal development
- Congenital hypothyroidism — without treatment, severe developmental delay; with thyroxine, normal development
- Cystic fibrosis — early diagnosis improves nutritional and respiratory outcomes
- Sickle cell disease — early diagnosis allows preventative penicillin and parental education
- MCADD (medium-chain acyl-CoA dehydrogenase deficiency) — without recognition, sudden hypoglycaemic collapse during illness; with awareness, easy to manage
- MSUD (maple syrup urine disease), IVA (isovaleric acidaemia), GA1 (glutaric aciduria type 1), HCU (homocystinuria) — all rare metabolic conditions where dietary management changes outcome dramatically
Results take 6–8 weeks. Normal results are not posted out (the "no news is good news" rule). Abnormal screens prompt a phone call within days.
The Newborn Hearing Screen
Run before hospital discharge or, for home births, by a community team within a couple of weeks.
- AOAE (automated otoacoustic emissions) is the standard test — a soft probe in the ear emits a click and listens for the cochlea's echo. Takes a few minutes.
- AABR (automated auditory brainstem response) is used for NICU babies and as a follow-up — measures the brain's response to sound through scalp electrodes.
A "refer" result is not a diagnosis of hearing loss. Common reasons for a refer: fluid in the middle ear (very common in the first days), background noise, baby moving. About 1 in 30 babies need a re-screen, and about 1 in 1,000 turn out to have permanent hearing loss.
What the 6–8 Week Check Adds
The second NIPE repeats everything, with a few additions:
- Growth — weight, length, head circumference plotted on the WHO chart
- Development — fixing on faces, following past midline, lifting head briefly during tummy time, social smile (most babies are smiling by 6 weeks)
- Feeding review — how it's going, weight gain, any concerns
- Mum's review — Edinburgh Postnatal Depression Scale, contraception, perineal recovery, any concerns
- First vaccinations — usually scheduled separately at 8 weeks rather than at the check itself
How to Get the Most from the Check
A short list:
- Bring the red book (personal child health record) — every check goes in it
- Have the baby fed and changed if possible — a calm baby cooperates better
- If you have specific worries, write them down before — easy to forget once you're there
- Ask about anything noted: "what does that murmur sound like?" "what does a clicky hip mean?" — clinicians prefer engaged questions to silence
- Ask what to watch for at home if anything is being followed up
The NIPE is one of the most consistently delivered, most evidence-based screening programmes in UK health care. The conditions it targets are uncommon, but for the babies who have them, catching it in week one rather than year one is the difference between a fixable problem and a permanent one.
Key Takeaways
Every UK baby gets the same Newborn and Infant Physical Examination (NIPE) within 72 hours of birth and again at 6–8 weeks. It is a top-to-toe check, but the four things being specifically screened for are: congenital heart disease, hip dysplasia, congenital cataract, and undescended testes (in boys). Each is on the list because catching it early changes the outcome dramatically. Around the same time, the heel-prick blood spot screens for 9 inherited conditions, and the hearing screen runs once before discharge. Knowing what is being checked makes you a more useful observer of your baby in between checks.
