What does the NIPE heart look for?
Identifies congenital heart disease that needs intervention - either classes as critical (life threatening) or major (not critical but needs immediate referral.
Occurs in 6.3 in every 1000
Discuss heart development within utero
Day 18 - primitive heart develops from embryonic mesoderm
Day 21 - 2 tubes created from embryonic mesoderm fuse together that begin to beat
Day 35 - tube bends and twists to form heart chambers
Discuss the temporary structures within the neonates heart
Ductus venous - links umbilical vein to the superior vena cava, bypasses liver
Foramen ovale - links left and right atriums, bypasses the lungs
Ductus arteriosus - links pumonary artery (links heart to lungs) to aorta by bypass lungs.
How do the temporary structured within the neonatal heart change after birth?
Cord cut, so no blood flow to the ductus venous which is forced to close.
Increased pressure in the heart causes foramen ovale to close, as blood flow to lungs is now needed.
Blood flow to lungs causes drop in prostaglandins, closing the ductus arteriosus
Discuss risk factors of NIPE heart
Family history of cardiac problem at birth
Current first degree relative cardiac condition that affects muscles or electrical mechanism. - should have NN input in antenatal
Genetic abnormalities
T21
Parental consanguinity
Maternal conditions - T1 / T2 diabetes , epilepsy, lupus - 4x more likely
Maternal virus / infection
Teratogenic drugs in pregnancy -eg antiepilepsy drugs, alcohol, lithium and NSAIDS (BNF,2025)
What are the different types of serious CHD?
Aortic valve stenosis - aortic value is narrowed, which causes left ventricular muscle to thicken as it has to work harder to pump blood
coarction of the aortic - aorta is narrow, restricts blood flow
truncus arteriosus - pulmonary artery and aorta do not separate and are now single vessel, causing too much blood to lungs and damaging blood vessels within lungs - fatal if not treated
atrial septic defects - hole between left and right atrium, causes right side of heart to enlarge
vetricular septal defects - hole between left and right vertical, stretches left side of heart.
(British heart foundation, 2025)
Discuss observation of NIPE heart
Colour of chest and face - check lips and gums for cyanosis
Size and shape of chest - symmetry?
Respiratory rate
Any distress, chest recession, grunting
Perfusion, sweaty, good movement and tone
Discuss the palpation of NIPE heart
Capillary refill on sternum - press for 5 seconds, refill within 3
Position of cardiac apex - in between 5-6th intercostal space
Heave(working to hard) or thrill (vibration) - hand over chest recession- this is a palpable murmur
Palpate liver, hand over stomach, should feel soft
Brachial pulses - index finger on inner elbow
Femoral pulses - index finer on groin, weak pulses can be sing of coarction of aorta
Alternate pulses
What should be heard on NIPE heart
LUB - mitral and tricuspid vales
DUB - aortic and pulmonary valves
What are the different types of murmurs that can be heard?
Significant murmur - loud visible sounds of turbulent blood flow
Benin murmur - soft and short sound, to the left
Where and how do we list for NIPE heart (regions)
Aortic region - central right side between 2nd and 3rd intercostal space Heave
Pulmonic region - central left side between 2nd and 3rd intercostal space
Central region -3rd intercostal space
Tricuspid region - between 3rd -6th intercostal space on left
Mitral region- apex between 5th - 6th intercostal space
Central back (scapula)
What is a negative referral pathway for NIPE heart?
No abnormality suspected - health child programme 6-8 check with GP
Discuss with parents - no findings, observe for cyanosis, poor tone or changed in feeding / behaviour
DOCUMENT NIPE4SMART
What is a positive referral pathway for NIPE heart?
T21- NN consultant within 24h
Urgent review within 24h:
resp rate 60+ at rest
Apnoea 20+seconds with colour change
Recession
Nasal flaring
Central cyanosis
Visual / palpable heaves and thrills
Absent/weak femoral pulses
Heart Murmur
Discuss with parents findings and that NN will review
DOCUMENT NIPE4SMART
