Prevalence and Early Postnatal Course of Measurement-Defined Pectus Excavatum in Neonates: A Prospective Cohort Study

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Background: Pectus excavatum (PE) is the most common congenital anterior chest wall deformity, yet most prevalence data derive from older children and adolescents. Systematic measurement-based neonatal data are scarce, and the early course of PE detected during this period remains largely unknown. This study evaluated the prevalence and early course of measurement-defined PE in a prospectively screened neonatal cohort. Methods: In this prospective single-center cohort, consecutive late-preterm and term neonates underwent ruler-based measurement of sternal depression. Neonates with an initial depth of ≥0.3 cm underwent independent confirmatory measurements by two trained study clinicians. Measurement-defined PE required a confirmatory patient-level depth of ≥0.3 cm and was classified as mild, moderate, or severe. Infants meeting this criterion were reassessed at 5–7 months using the same standardized protocol. Results: Among 2579 neonates, 143 met the screening threshold and underwent confirmatory assessment; 122 met the study-defined criterion for PE (measurement-defined neonatal prevalence, 4.73%). Follow-up was completed in 118 infants (96.7%). At 5–7 months, study-defined resolution occurred in 39 infants (33.1%), severity decreased in 22 (18.6%), remained stable in 44 (37.3%), and increased in 13 (11.0%). Median sternal depression depth decreased from 0.50 cm (IQR 0.40–0.70) to 0.40 cm (IQR 0.20–0.65; p < 0.001). Study-defined resolution was less frequent with a positive family history (15.8% vs. 49.2%; p < 0.001); positive family history and greater baseline severity were independently associated with lower odds of study-defined resolution at 5–7 months in exploratory analysis. Conclusions: Measurement-defined neonatal sternal depression showed heterogeneous early changes. Greater baseline severity and positive family history were associated with lower odds of study-defined resolution at 5–7 months. These findings may inform counseling about the early course but do not establish a benefit from universal neonatal screening or predict later clinically significant PE.