A Review of 499 Newborn and Infant Physical Examination (NIPE) Referrals at Queen Alexandra Hospital, Portsmouth

Background: A large number of urgent and non-urgent referrals are generated at the Newborn and Infant Physical Examination (NIPE) screening programme. We undertook a review with an aim to evaluate whether national standards were being met, appointments were being made in a timely manner and resources were being wasted with inappropriate referrals.

Objectives: We were interested in whether referral solely for a finding of one or more clicky hips was supported by rates of diagnosis of developmental dysplasia of the hip (DDH). Referrals for clicky hip(s) constitute a significant proportion of the total referrals made but are not considered a Key Performance Indicator (KPI) and ultrasonographic evaluation is not mandated in UK national guidance.

Methods: We reviewed all referrals over a 6-month period amounting to 499 referrals and collected data on reason for referral, time to appointment and outcome.

Results: 499 referrals were made to 12 different specialities. The majority of referrals were for evaluation for hip dysplasia compromising 401 referrals, 119 of which were for clicky hip(s) without additional risk factors. 13 urgent (within 2 weeks) referrals were made for a finding of dislocatable hip(s) of which 3 were diagnosed with DDH (23%). Of the 119 referrals for clicky hip(s) alone there was one case of DDH (0.8%).

Conclusions: Although the numbers of DDH were small, the findings do support a discontinuation of the current practice of ultrasonographic evaluation of newborn infants with a finding of clicky hip(s) in the absence of other risk factors and with an otherwise normal examination. This is in line with UK national guidance and will create increased capacity to reduce waiting times. The high incidence of DDH in infants with dislocatable hips highlights the importance of timely referral and evaluation in this group.