Less than 7% of newborn infants displayed clinically significant abnormal issues during postnatal physical examinations

Abstract

All Finnish newborn infants are systematically and comprehensively examined by a specialist or trainee paediatrician before discharge, to identify any diseases, deformities and birth injuries. This usually happens at 24–48 h of age. The mother's health and medication during pregnancy, delivery details and the infant's weight and feeding are also evaluated to ensure their safe discharge.¹

Early discharge in Finland is defined as <36 h of age. If the child is examined before 24 h of age, it is repeated within a couple of days, because issues such as some congenital heart defects are not detectable immediately after birth.¹

This retrospective register study focused on 3729 children born at Tampere University Hospital, one of Finland's largest maternity hospitals, in 2022. They were discharged from the postnatal ward, which only admits infants born at 35 weeks of more and weighing more than 2000 g. Infants admitted to the neonatal intensive care unit were excluded. We assessed the frequency and type of abnormal findings identified during these examinations, which inform discharge decisions and may help to plan neonatal discharge criteria and follow-ups.

The information on the infants, their medical examination and any International Classification of Diseases, Tenth Revision (ICD-10) diagnoses were collected from their records. Abnormal findings were grouped according to body parts and organs. As some newborn infants were examined numerous times after they were discharged, we focused on their last examination in the postnatal ward.

There were 1297 abnormal findings in 20.9% of the newborn infants (Table 1) and 20.0% of these were clinically significant. The most common abnormalities related to skin or colour (13%), head or fontanels (4.0%), hip joints (3.6%) and genitals (2.4%). An ICD-10 diagnosis code other than normal birth was recorded in 37.5% of the children, with 5.5% related to growth, 4.1% to jaundice, 1.1% to respiratory abnormalities and 1.0% to the cardiovascular system. They also included 0.9% with birth injuries and 0.4% with dysmorphism (Table 1).

The median age at discharge was 59 (range: 7–347) h and 5.4% were discharged before 36 h. Most (72.4%) of the examinations were performed on the postnatal ward, with the remainder in outpatient clinics.

The main results were that there were no abnormal findings in two thirds of the newborn infants, most of the abnormalities were related to their skin or colour and the median age at discharge was 59 h.

Skin abnormalities in newborn infants are common and other studies have reported that 57%–99.3% had at least one.² They were found in 13% of our infants and half of these related to skin colour. Infants are often routinely screened for jaundice before they are discharged, by measuring bilirubin transcutaneously or from serum. The lower frequency in our study may have been due to different classifications, as some findings were grouped by noses and mouths, genitals and heads and fontanels. Also, some studies focused on the first 4 weeks, rather than up to the 48 h in our study, and may have detected later skin manifestations.

The incidence of congenital heart defects was 0.1%–0.3% in a Swedish study that evaluated congenital heart defect screening.³ It highlighted the importance of neonatal physical examinations, as some subjects with negative prenatal screening and postnatal pulse oximetry screening were diagnosed after these. The authors reported that 11% of the heart defects were diagnosed based on early symptoms and 14% by physical examinations after negative pulse oximetry screening. Our study found that 2.6% of our cohort had abnormal cardiovascular system findings and just under 1.0% received an ICD-10 diagnosis related to their cardiovascular system. Our study had a higher diagnosis rate, as it included all cardiovascular system diagnoses.

One study reported that postnatal hospital stays had shortened since the 1970s, especially in developed countries, and that 7.9% of Finnish newborn infants were discharged during the first 2 days in 2008–2015.⁴ Our study found that hospital stays had shortened even more, as 27.4% of our cohort were discharged during the first 2 days and 5.4% before 36 h. However, we included premature and caesarean section births, so that increase could be even more significant.

The neonatal examinations performed during our study showed that 29.1% of the newborn infants had abnormal findings and 20.0% of these were clinically significant. However, most of them (89.8%) did not have a significant impact on discharge decisions (Table 1). We could not establish if the abnormalities were discovered during the clinical examinations or simply verified and documented at that point. Further studies are needed to assess the role of physical examinations during the discharge process for newborn infants.

Johanna Soikkeli: Investigation; writing – original draft; writing – review and editing; formal analysis. Katja Ovaskainen: Conceptualization; writing – review and editing; supervision. Päivi Korhonen: Conceptualization; writing – review and editing; supervision. Sauli Palmu: Conceptualization; investigation; writing – review and editing; methodology; project administration; supervision; resources.

No conflicts of interest.