Early Detection Examinations (U1 and U2)

Early detection examinations U1 and U2 are a diagnostic procedure to check both the physical and mental condition of the child. The goal of this examination is to determine whether the developmental status is age-appropriate and can be judged as adequate. The U1 and U2 pediatric screenings are usually performed in the hospital, so all children benefit from these screenings. The goal of these screenings is early detection of a possible disorder so that the risk of aggravation of the present disorder and the likelihood of further sequelae can be reduced. In the presence of a physical or mental disorder in the child, there is thus the possibility of rapid therapeutic intervention on the part of the physician.

Examination Time Services
U1 Immediately after birth
  • Apgar score (respiration, pulse, basal tone, appearance, reflexes): determination is performed one, five, ten, and 60 minutes after birth. The maximum score is 10 per examination session
  • PH determination from the umbilical cord: to determine whether the newborn has been adequately oxygenated during birth.
  • Inspection (viewing) of the baby: to determine whether malformations are present?
  • Determination of body weight, height and head circumference.
  • Vitamin K administration (U1-U2; to prevent internal bleeding) [in consultation with the mother].
24th – 48th hour of life
  • Pulse oximetry screening – for the detection of critical congenital heart defects (vitia)In home births at the latest during U2.
U2 3rd-10th day of life
  • Determination of body weight, height and head circumference (U1-U9).
  • Detailed physical examination to detect congenital diseases and malformations (eg, malformations of the heart); presence of icterus (jaundice) requiring treatment; esp. is paid attention to: Skin, sensory organs, head (mouth, nose, eyes, ears), the chest and abdominal organs, sex organs, skeletal system with muscles and nervesInspection (viewing) of the newborn (U2-U6): whole body in supine and prone position and held upright.
  • Checking passive mobility of large joints (not only hips), Moro and Galant reflex, cry automatism, clinical fracture signs (U2-U6).
  • Eye examination (U2-U3):
    • Inspection (viewing): e.g., presence of ptosis (visible drooping of one or both upper eyelids), leukocoria (whitish illumination of the pupil on backlight test), bulb size abnormalities, coloboma (cleft formation in the area of the eye), nystagmus (“eye tremor“).
    • Brückner test from a distance of 10-30 cm; room darkened: In this test, the pupils are transilluminated from short and long distances and must light up laterally. Test is used to determine strabismus (strabismus), anisometropia (inequality of vision: strongly different refractive errors in the right and left eye) or transillumination abnormalities (test in transmitted light; presence of a cataract (clouding of the lens)?/operation necessary until the 8th week!). The gaze sequence is also checked.
  • Cystic fibrosis screening (cystic fibrosis, CF; three-stage diagnosis; see below “Cystic fibrosis/laboratory diagnostics“) takes place with metabolic screening by filter card in the first four weeks of life (see below newborn screening).
  • Newborn screening (NGS): blood testing for 14 inborn errors of metabolism and hormones.
    • 12 metabolic disorders:
      • Biotinidase deficiency
      • Galactosemia (classic)
      • Amino acid metabolism disorders (phenylketonuria (PKU)/hyperphenylalaninemia (HPA), maple syrup disease (MSUD)).
      • Organoacidurias (glutaraciduria type I, isovalerianaciduria).
      • Fatty acid oxidation disorders (medium-chain acyl-CoA dehydrogenase deficiency, long-chain 3-OH-acyl-CoA dehydrogenase deficiency (LCHAD), very-long-chain acyl-CoA dehydrogenase deficiency (VLCAD)).
      • Carnitine metabolism disorders (carnitine palmitoyl transferase I deficiency (CPT_I), carnitine palmitoyl transferase II deficiency (CPT-II), carnitine acylcarnitine translocase deficiency).
      • Glutaraciduria type 1 (GA1)
      • Isovaleric acidemia (IVA)
      • Cystic fibrosis (ZF).
      • Tyrosinemia
      • Detection of multiple beta cell autoantibodies in the blood (screening for type 1 diabetes [so far only in Bavaria and Lower Saxony].
    • Two endocrinological diseases: Hypothyroidism, Adrenogenital Syndrome (AGS))
    • Severe combined immunodeficiency (SCID); screening marker: “T-cell receptor excision circles” (TREC).
    • Sickle cell disease (sickle cell anemia) [added in 2020].
  • Newborn hearing test (measurement of otoacoustic emissions (OAE); see below the topic of the same name); an abnormal measurement result does not necessarily mean that the baby is hard of hearing. Causes of a “false positive” result can include a restless child, fluid in the ear, or distracting background noise.The sensitivity of OAE screening (percentage of ill patients in whom the disease is detected by use of the test, i.e. The specificity (probability that healthy persons who do not suffer from the disease in question are also identified as healthy in the test) is given as 93.3 to 96.1 %, depending on the device.In the case of pathological OAE screening, the recording of acoustically evoked brainstem potentials (brainstem audiometry, screening BERA) should also be used as a second objective method of determining hearing thresholds. Note: 1-3 out of 1,000 newborns have a moderate or more severe hearing impairment
  • Stool color chart (U2-U4) to detect stool color, for example, to detect bile duct atresia (obstruction (atresia) of the bile ducts) in time. The stool color can be matched with the color chart itself; otherwise, the parents are to be asked about it.
  • Advice on vitamin D (rickets prophylaxis) and fluoride (caries prophylaxis).

Note: The statutory health insurance companies cover newborn screening up to four weeks after birth. Within this period, there is thus the opportunity to catch up on this if it has not occurred after birth.