NMHS43380 Examination of Newborn

Academic Year 2023/2024

The aim of this module is to develop and advance the clinical skills of registered midwives to become competent practitioners in the advanced clinical examination and screening of the neonate. This type of neonatal examination & screening is performed prior to the baby being deemed fit for discharge from the maternity service/unit to the community.
The advanced examination and screening of the neonate is an assessment of the newly born baby additional to the midwife’s check of the neonate shortly after birth, and the midwife's daily postnatal assessments.
This programme is designed to meet the requirements of a rapidly changing maternity and neonatal service by providing the registered midwife with the theoretical knowledge and psychomotor skills necessary for evidenced-based practice in the advanced physical examination and screening of the neonate. Attainment of the requisite knowledge and skills is assured via a combination of written assessments and supervised, competency-based clinical assessments .

The module will examine in-depth the gestational development of the embryo and foetus, including the development of the major organ systems. The content and relevance of the HSE (2018) Newborn Clinical Examination Handbook, NIPE standards (Public Health England, 2021) for screening, and the NICE Postnatal Guideline (2021) on examination and assessment of the neonate shall be evaluated.
Students will be encouraged to follow a systematic approach to the assessment of neonatal well-being including: a detailed examination of the antenatal history and other significant risk factors, the potential impact of events during labour & birth on neonatal well-being, and the five steps of the neonatal examination: preparation, observation, examination, explanation and documentation (Baston and Durward, 2017).
The common congenital and chromosomal abnormalities, minor neonatal disorders, feeding issues, other screening programmes, and referral pathways for any deviations from the norm are explored in-depth. The related sociological, behavioural and professional aspects of the examination and screening process will be appraised via simulation-based learning then later under the guidance of the student's clinical mentor/assessor.

All students are required to be a registered midwife with NMBI (or equivalent) and have a minimum of two years experience in intranatal/postnatal/neonatal care.

Content in Trimester 1 (autumn) from Week 1 to Week 12 is delivered primarily via online lectures, tutorials, and workshops. An in-person simulation and clinical examination skills workshop is offered at the end of the trimester. Total contact time of 36 hours.
The student must pass two assessments in the autumn trimester- an MCQ and written assignment at the end of the autumn trimester before they can progress to the clinical component of the programme.

The clinical component requires the student to complete 40 examinations of the neonate under the specified level of supervision during the spring trimester.
All neonatal examinations and assessments must be documented, then signed off by the named Lead Mentor/Assessor within the Examination of the Newborn Competency Assessment Tool (EoNCAT) document.
The EoNCAT document must be submitted to the Module Coordinator by the end of the spring trimester.
The student must also complete the Reflective Learning Portfolio and Record of Clinical Supervision also contained within the EoNCAT document.

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Curricular information is subject to change

Learning Outcomes:

On completion of this module, students should be able to:
• Demonstrate detailed knowledge of the gestational development of the embryo and foetus, including the anatomy and physiology of the major organ systems of the neonate's body, the risk factors that may disrupt the optimal development of the embryo and foetus then apply this knowledge to each individualised examination of the neonate.
• Critically analyse the research literature relating to examination and screening of the neonate and related evidence-based care e.g. HSE (2018 Newborn Clinical Examination Handbook; NICE (2021) Postnatal Care Clinical Guideline, PHE (2021) Newborn and Infant Physical Examination-NIPE standards.
• Competently perform a systematic and complete physical examination & screening of the neonate which demonstrates in-depth knowledge of normal neonatal physiology, and the commonly occurring conditions and abnormalities that are screened for.
• Document clearly and refer all identified deviations from the norm in the neonate to the appropriate personnel/service for follow-up as per the recommended timelines and local/national PPPGs.
• Evaluate and reflect upon the legal, ethical and professional issues relating to examination & screening of the neonate and advocating for holistic midwifery care and management in addition to identifying particular family issues and providing the appropriate professional, psychological and social support.
• Both critically evaluate and promote the enhanced/expanding role of the midwife in the examination & screening of the neonate.

Indicative Module Content:

Professional and ethical issues for midwives including autonomy, multidisciplinary working, and maintaining competence in an expanded scope of midwifery practice;
Assessing the perinatal history- confirming neonatal wellbeing and screeing for risk factors or red flags for deterioration or congential disorders;
Assessment of neonatal behaviour including responses to stimuli, crying sound & pattern, and feeding;
Knowledge of healthy term neonatal anatomy and physiology required to conduct the complete (detailed) head-to-toe physical examination & screening of the neonate that includes:
Physiology & assessment of the Head, Eyes (including screening for congenital cataracts), Ears, Nose, Mouth & Palate, and Neck;
Physiology & assessment of the neonatal cardiovascular system (including screening for congential cardiac defects);
Physiology & assessment of the neonatal respiratory system;
Physiology & assessment of the skin and musculoskeletal systems (including screening of the hips for DDH);
Physiology & assessment of the genitourinary system (including screening for undescended testes);
Physiology & assessment of the gastrointestinal system;
Physiology & assessment of the genitourinary system;
Physiology & assessment of the neurologic system (including assessment of newborn primitive reflexes);
Physiology & assessment of normal transiton to extrauterine life including monitoring for physiological jaundice;
Growth monitoring, plotting, and interpretation of anthropometric measurements (measurement and recording of weight, head circumference, and length);
Provision of neonatal health and care advice (including provision of advice on recognising signs & symptoms of illness/deterioration), assessment of infant mental health, and discharge planning from the maternity unit/service (including confirming arrangements for newborn bloodspot and hearing screening).

Student Effort Hours: 
Student Effort Type Hours
Laboratories

6

Specified Learning Activities

74

Autonomous Student Learning

140

Online Learning

30

Total

250

Approaches to Teaching and Learning:
Lectures; tutorials; critical writing; reflective learning; virtual and in-person skills workshops and simulation; enquiry & problem-based learning; case-based learning; active/task-based clinical learning with a named mentor; peer and group work. 
Requirements, Exclusions and Recommendations

Not applicable to this module.


Module Requisites and Incompatibles
Not applicable to this module.
 
Assessment Strategy  
Description Timing Open Book Exam Component Scale Must Pass Component % of Final Grade In Module Component Repeat Offered
Assignment: A short written assignment focusing on a specific aspect of neonatal screening. Coursework (End of Trimester) n/a Alternative non-linear conversion grade scale 50% No

20

Yes
Multiple Choice Questionnaire: A 2-hour multiple-choice question examination. 30 questions.
Must be passed in order to progress to clinical component in Trimester 2
1 hour End of Trimester Exam n/a Other Yes

30

Yes
Practical Examination: EoNCAT Portfolio includes record of all 40 newborn examinations to be completed and passed successfully. The final three examinations (38, 39, 40) are OSCE-type assessments with named mentor/assessor Throughout the Trimester n/a Pass/Fail Grade Scale Yes

50

Yes

Carry forward of passed components
Yes
 
Remediation Type Remediation Timing
In-Module Resit Prior to relevant Programme Exam Board
Please see Student Jargon Buster for more information about remediation types and timing. 
Feedback Strategy/Strategies

• Feedback individually to students, on an activity or draft prior to summative assessment
• Feedback individually to students, post-assessment
• Group/class feedback, post-assessment
• Peer review activities
• Self-assessment activities

How will my Feedback be Delivered?

Not yet recorded.

Core References/Resources

Baston H. and Durward H. (2017) Examination of the Newborn- A Practical Guide, 3rd edition. Routledge Publications.
Campbell D. & Dolby L. (2018) Physical Examination of the Newborn at a Glance, Wiley Blackwell.
Tappero E. P. and Honeyfield M. E. (2018) Physical Assessment of the Newborn. A Comprehensive Approach to the Art of Physical Examination, 6th edition. Springer Publishing
Lomax A. (2015) Examination of the Newborn: An Evidence-Based Guide, 2nd edition. Wiley Blackwell.
HSE-Health Service Executive (2018) The Newborn Clinical Examination Handbook. Available at: https://www.hse.ie/eng/about/who/healthwellbeing/our-priorityprogrammes/child-health-and-wellbeing/newborn%20exam.pdf
HSELanD (2018) National Healthy Childhood Training Programme. Available at: https://www.hseland.ie/dash/Account/Login
NHS/Public Health England (2021) Newborn and Infant Screening Programme Handbook. Available at: https://www.gov.uk/government/publications/newborn-andinfant-physical-examination-programme-handbook
NHS/Public Health England (2021) Newborn & Infant Physical Examination Screening Programme Standards. Available at:
https://www.gov.uk/government/publications/newborn-and-infant-physical-examination-screening-standard s
DoH (2009) Using the new UK-World Health Organisation 0-4 Growth Charts: Information for healthcare professionals about the use and interpretation of growth charts. Available at: https://www.rcpch.ac.uk/resources/uk-who-growth-charts-guidance-health-professionals
NICE (2021) Postnatal care NICE guideline [NG194] . Available at: https://www.nice.org.uk/guidance/ng194
NMBI (2021) Code of Professional Conduct & Ethics for Registered Nurses & Registered Midwives. Available at: https://www.nmbi.ie/Standards-Guidance/Code
NMBI (2022) Practice Standards for Midwives. Available at: https://www.nmbi.ie/Standards-Guidance/Midwives-Standards
NMBI (2015) Scope of Nursing & Midwifery Practice Framework. Available at: https://www.nmbi.ie/Standards-Guidance/Scope-of-Practice
NMBI (2015) Post-registration nursing & midwifery programmes: standards & requirements. Available at: https://www.nmbi.ie/Education/Standards-andRequirements/Post-Registration-Nursing-Midwifery
RCPCH (2015) Palate Examination: Identification of cleft palate in the newborn. Available at: https://www.rcpch.ac.uk/sites/default/files/2018-04/2015_palate_examination_-_best_practice_guide.pdf
RCPCH (2017) Free Online Course in Examination of the Newborn Palate (click on the ‘non-rcpch member’ tab. Instructions: https://www.networks.nhs.uk/nhsnetworks/yorkshire-humber-neonatal-odn/education/education-resources/rcpch-e-learning-module-cleft-palate Online Course Available at: https://rcpch.learningpool.com/login/index.php

Additional Reading/Resources:

Bartholomew M. (2018) Newborn and infant physical examination: motivating midwives after training, The Practising Midwife, 21(5) pg. 20-24
Carr N, Foster P (2014) Examination of the newborn; the key skills. Part 1 the Eye, Practising Midwife 17(1) 26-9
Carr N, Foster P (2014) Examination of the newborn; the key skills. Part 2 the Cardiovascular system and congenital heart disease, Practising Midwife 17(2) 30-3
Carr N, Foster P (2014) Examination of the newborn; the key skills. Part 3 the Hips, Practising Midwife 17(3) 32-5
Carr N, Foster P (2014) Examination of the newborn; the key skills. Part 4 the Testes, Practising Midwife 17(4) 27-30
Greene E., et al. (2023) Instruments measuring practitioner performance of the complete examination and screening of neonates: a systematic review. Journal of Paediatrics and Child Health, *(*), pp. ****.
Hempstock (2011) Routine examination of the newborn – development of a fully midwifery led service. Infant, 7(2) 49-51
Jones T., Furber C. (2017) The Newborn Infant Physical Examination- Incorporating the theory into midwifery education, British Journal of Midwifery 25(9) pg. 593-597
Lanlehin R. (2017) A clinical assessment tool for midwives undertaking the Newborn Infant Physical Examination, British Journal of Midwifery, 25(5) pg. 293-295.
Lewis (2014) A Comprehensive Newborn Examination: Part I. General, Head and Neck, Cardiopulmonary. American Family Physician 90(5), 289-296
Lewis (2014) A Comprehensive Newborn Examination: Part II. Skin, Trunk, Extremities, Neurologic. American Family Physician 90(5), 297-302
Murphy J. (2013) Examining the Newborn. World of Irish Nursing 21(8). Available at: https://www.inmo.ie/tempDocs/MidwiferyMatters_PAGE37oct13.pdf
McKinnon (2017) How do junior doctors learn the newborn & infant physical examination. Archives of Disease in Childhood 102(1)
NMBI (2020) National Quality Clinical Learning Environment Professional Guidance Document (2020). Available at::https://www.nmbi.ie/StandardsGuidance/More-Standards-Guidance/National-Quality-Clinical-Learning-Environment.
RCM (2012) Evidence Based Guidelines- Immediate Care of The Newborn
Watkins A. (2018) Examination of the Newborn: The First 72 hours of Life. Available at: https://www.ausmed.com/articles/examination-of-the-newborn/
Name Role
Ms Mary Curtin Lecturer / Co-Lecturer