Routine examination of the newborn: the EMREN study. Evaluation of an extension of the midwife role including a randomised controlled trial of appropriately trained midwives and paediatric senior house officers

Townsend J, Wolke D, Hayes J, Dave S, Rogers C, Bloomfield L, Quist-Therson E, Tomlin M, Messer D
Record ID 32004000182
Authors' objectives:

To assess the implications and cost-effectiveness of extending the role of midwives to include the routine (24-hour) examination of the healthy newborn. The main comparison is examination by a midwife specifically trained for the examination (ENB N96), with standard practice, which is routine examination by a paediatric senior house officer (SHO).

To assess the value of a repeat examination by a community midwife at home at 10 days.

Authors' results and conclusions: There was no statistical difference between SHO and midwife examinations in appropriate referral rates to hospital or community or in inappropriate referral rates to hospital. Midwives made more informal community referrals to general practitioners or community midwives. For problems occurring in the first year of life, there were no significant differences between the groups in problems either identified or not identified at 24 hours. In the audio-visual quality assessment, for each item where significant quality differences between examinations were identified, the item was rated as carried out more appropriately by the midwives than by the SHOs. Major differences were found for examination of the heart and lungs, for overall quality of the examination and in communication skills. Overall quality of the physical examination by midwives was rated as good or very good by the midwife raters for 73% of the examinations and by paediatric consultant raters for 23%. Corresponding figures for SHO examinations were 12 and 0%. Overall maternal satisfaction was high, with 81% of mothers reporting that they were satisfied or very satisfied with the newborn examination. However, mothers were more satisfied when a midwife rather than an SHO examined their babies. The discussion of healthcare issues by the examiner and continuity of care were both significantly related to higher satisfaction. Midwives were significantly more likely to discuss healthcare issues such as feeding, sleeping and skin care than were SHOs (61 versus 33%), and could provide continuity of care. After controlling for both of these factors and for history of miscarriage, maternal satisfaction was no longer significantly related to randomised group. Few new health problems were identified at the extra 10-day examination. From the National Survey, it was estimated that about 2% of babies in England are examined by a midwife, although 44% of midwifery units had midwives (median of two) with a postregistration qualification in the examination of the newborn. Of these units, 51% reported that all and 18% reported that some of these trained midwives conducted the examination. About one-third of those so trained were not examining at all. Reported referral rates were very similar at 6.8% for SHOs and 6.6% for midwives. In 60% of units, all babies were examined before discharge. In the remaining 40%, a median of 3% were transferred home without the examination and were examined mostly by a GP. About 1% of babies born in hospital were examined at home. None of the consultants or midwifery managers had major objections to midwives examining; with training and resources, midwife examination was acceptable. Twelve universities in England were identified as approved to train professionals for the N96 programme with 286 completions over 4 years. Nearly all those trained were midwives, although the courses were open to other professionals, notably doctors and health visitors. In the interviews with health professionals and mothers, there was general agreement that either SHOs or midwives were appropriate to carry out the examinations if trained; most mothers had no preference provided that the person was qualified and trained. SHOs reported that they had received little training for the examination.
Authors' recommendations: All component aspects of the study were consistent in showing benefits or at least no significant barriers to suitably qualified, trained midwives carrying out the examinations. It was surprising, given the findings, that midwives currently examine only 2% of babies and that some N96 trained midwives are not carrying out examinations.
Authors' methods: Randomised controlled trial, survey
Project Status: Completed
URL for project:
Year Published: 2004
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England, United Kingdom
MeSH Terms
  • Costs and Cost Analysis
  • Infant, Newborn
  • Midwifery
  • Neonatal Screening
  • Pediatrics
  • Physical Examination
Organisation Name: NIHR Health Technology Assessment programme
Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
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