that upper and lower margins of maternal age are adversely related to prenatal and perinatal outcome (PHE 2019a). Bornstein et al. (2006) explore this relationship, concluding that varied age groups have differing parenting abilities. Nevertheless, the teenage mothers may require more intensive health promotion advice for themselves, possibly their partners and their newborn infants.
A raised body mass index (BMI) can influence general health and may also indicate the family unit's dietary habits. A positive relationship exists between a raised BMI and complications of pregnancy including diabetes, hypertensive disease and thromboembolic disorders (Bhattacharya et al. 2007; NICE 2010; RCOG 2018). Pregnancy outcome can be affected, resulting in macrosomia, shoulder dystocia at delivery and hypoglycaemia of the newborn (Kalk et al. 2009; Khashan and Kenny 2009). Maternity units must have a policy in place for the prevention, detection and treatment of neonatal hypoglycaemia to identify those newborns most at risk (BAPM 2017).
Previous obstetric and medical history
The medical history can reveal conditions such as maternal hypothyroidism, cardiac disease, type 1 or gestational diabetes, renal disease, epilepsy, blood disorders e.g. idiopathic thrombocytopenia, haemophilia or von Willebrand disease, or maternal depression. The surgical history may not have such a direct impact upon risk for the newborn but does add to the completeness of the history‐taking process for the NIPE practitioner.
TABLE 1.1 Key elements of the National Antenatal and Newborn Screening Programme.
Source: Adapted from the NHS Antenatal and Newborn Screening Programmes (PHE 2016, 2018a, 2020c).
| Screening tests | Timing | Biophysical details |
|---|---|---|
| Serology investigations | ||
| Blood profile to include group, rhesus and antibodies status and haemoglobin | At booking Antibodies and haemoglobin repeated at 28 weeks | Approximately 15% of the population are rhesus‐negative (Salem and Singer 2009). Anti‐D immunoglobulin is offered to all rhesus‐negative women at 28 weeks’ gestation to prevent haemolytic disease in the newborn. Maternal antibodies can also cause haemolytic disease. |
| Sickle cell | As early as possible, preferably by 10 weeks’ gestation | Inherited genetic condition resulting in the red blood cell forming a sickle cell shape. There are variants of this disease that impact on the severity. In cases where women are healthy carriers, the baby’s father should be offered screening. The risk of an affected infant is 1:2 where both parents are carriers (PHE 2018b). |
| Thalassaemia | As early as possible, preferably by 10 weeks’ gestation | Inherited genetic condition that affects the production of red blood cells. The genes that make haemoglobin are altered, causing anaemia. This condition takes two forms: alpha and beta (Ryan et al. 2010; PHE 2018b). |
| Hepatitis B | At booking | Some populations of women are at high risk of hepatitis B infection (HBsAG positive). Transmission of the virus is through sexual contact, vertical transmission or contaminated blood, e.g. needle sharing. Transmission to the fetus can be transplacental. Vaccination of the newborn must be offered to HBsAG positive women and their partners (PHE 2016, 2019b). |
| HIV | At booking | HIV infection is a retrovirus that causes an alteration of the immune system. The virus infects the CD4 cells or the helper T cells that lower the body’s cell‐mediated immunity. Infection with HIV‐1 can progress to AIDS (Carpenter et al. 2009; PHE 2016, 2019b). |
| Syphilis | At booking | Sexually transmitted disease with a risk of transplacental transmission (PHE 2016, 2019b) |
| First trimester combined test | 11+2 − 14+1 weeks | Combined screening test with combination of age, blood profile, nuchal scan measurement and other factors (PHE 2018b). |
| Ultrasonography | ||
| Nuchal translucency | 11+2 – 14+1 weeks (part of combined test) | Nuchal translucency measurement greater than 3.5 mm in early pregnancy. This finding is significant as associated with cardiac and syndromic pathology. This finding is also part of the ‘combined’ screening test for trisomy 21 (PHE 2018b). |
| Quadruple test | 14+2 − 20+0 weeks | Biochemistry tests, which include AFP, BHcG, oestriols and inhibin A (PHE 2018b). |
| Fetal anomaly | 18+0 − 20+6 weeks | This scan can detect certain gross structural anomalies but does have its limitations. Approximately 45% of cardiac defects can be detected at this time (PHE 2018b). |
| NIPE National Standards | Within first 72 hours of birth Repeated at 6–8 weeks of age | Full physical and behavioural examination of the newborn incorporating the four‐core condition‐related screening standards: developmental dysplasia of the hip, examination of the eye, congenital heart defects and undescended testes (PHE 2018a). |
Previous obstetric histories can provide information regarding maternal well‐being and pregnancy outcome that may be of relevance. The health of existing siblings should be noted. A previous intrauterine death, neonatal death or sudden infant death syndrome (SIDS) sibling should be noted. It is good practice to offer the option of an ECG being performed on the new sibling to rule out any risk of cardiac conduction disorders, e.g. prolonged QT syndrome or Wolff–Parkinson–White syndrome. The newborn would also be on the Care of Next Infant (CONI 2020) scheme with the provision of an apnoea monitor prior to discharge.
Intrapartum history
The intrapartum history is important in terms of identifying risk factors for the newborn. If resuscitation of the newborn was required, note the level of support given and time to response. It is also important to note if the newborn required admission to the neonatal unit for ongoing observation.
Taking note of the mode of delivery is important because this may impact upon the health of the newborn. If shoulder dystocia presented during the second stage, the newborn must be thoroughly examined by a senior paediatrician for evidence of a brachial plexus injury, a clavicle fracture or sternomastoid muscle injury. An examination in the immediate post‐delivery period by a paediatrician should be part of the maternity service local shoulder dystocia management guideline.
Breech presentation carries a strong correlative risk of developmental dysplasia of the hip (DDH) and is therefore a national NHS NIPE Screening Programme risk factor (PHE 2018a, 2020c). Breech presentation at birth irrespective of mode of delivery, or clinically diagnosed in pregnancy after 36 weeks gestation, or if external cephalic version performed for breech presentation irrespective of gestational age at delivery requires referral of the newborn for ultrasound examination of the hips in line with the national NIPE standards (PHE 2018a, 2020c).
TABLE 1.2 Maternal medical records: summarised alert indicators.
| Maternal medical records: alert indicators |
|
Ultrasound
|