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The evidence

Understanding the Risks in the Newborn Period

An evidence-based look at the risks for newborns — from the very common to the rare — and the part a paediatrician usually plays in private newborn care.

Last reviewed

A newborn cradled in a parent's hands

The short version

Australia is one of the safest places in the world to be born. Most births go smoothly; the common findings of the first days (jaundice, low blood sugar, feeding establishment, a stay in Special Care) are frequent, expected and treatable; and the serious problems are rare and actively screened for. For a healthy term pregnancy the absolute risks are very low, and those numbers reflect routine antenatal screening, skilled birth care and structured paediatric review. Not everything can be detected at birth: some conditions only become apparent over the first weeks, which is why follow-up checks, and telling someone when something changes, matter just as much after discharge.

Worried about your baby right now? When to seek help sets out exactly what to do — and for anything life-threatening, call 000.

What happens to most babies in the first hour

Most births go smoothly. A typical term baby:

  • Cries within seconds of delivery
  • Skin-to-skin with mum, with a midwife close by
  • Apgar scores at 1 and 5 minutes, a quick check of breathing, heart rate, colour, tone and reflexes
  • First feed within the first hour
  • Vitamin K injection soon after birth and the hepatitis B birth-dose vaccine on day 1 (both with consent), identification bands, and a full paediatric examination during the stay
  • Delayed cord clamping (≥ 60 seconds): standard practice for babies not needing immediate resuscitation; reduces anaemia and improves later iron stores

The most common things in the first days

These affect a sizeable share of healthy-pregnancy babies. None of them means something has “gone wrong”, they are the everyday business of neonatal care.

Respiratory support at birth

Around 10% of newborns need some help to start breathing, usually just brief drying and gentle stimulation. This is the routine work of every birth suite, guided by the ANZCOR newborn life support algorithm.

Around 3% of babies need positive-pressure ventilation (gentle inflation breaths with a mask), about 2% are intubated, and around 0.1% need chest compressions or adrenaline during resuscitation.

Even at term, transient tachypnoea of the newborn (TTN) affects around 3.5–9 per 1,000 term infants, fast breathing that usually settles in 1–3 days with supportive care. See transient tachypnoea. A smaller number have respiratory distress from other causes (meconium aspiration, infection, congenital lung issues) that need a paediatric review and sometimes admission.

Where a paediatrician helps. The paediatrician takes medical responsibility for your baby’s breathing problem — monitoring, investigations, any intervention, and admission to the Special Care Nursery if needed. That responsibility is why Frances Perry House runs 24/7 paediatric cover.

Special Care Nursery (SCN) admission

More term babies spend time in a Special Care Nursery than parents expect, for jaundice phototherapy, hypoglycaemia, mild respiratory distress, feeding support, infection observation, or recovery from a difficult delivery. The proportion rises sharply with prematurity:

  • Late preterm (34–36 weeks): most are admitted
  • Under 34 weeks: all need admission
  • Under 31 weeks: tertiary NICU care is needed

Frances Perry SCN handles late-preterm and term babies with treatable conditions. Sicker or earlier babies are transferred next door to the Royal Women’s NICU.

Hypoglycaemia (low blood sugar)

Many newborns fall into a defined monitoring group, late preterm, small or large for gestational age, baby of a diabetic mother, hypothermic, polycythaemic, or any baby who isn’t feeding well in the first hours. Of those at-risk babies, a smaller subset drops their sugar low enough to need treatment.

Untreated, prolonged severe hypoglycaemia can cause brain injury, which is why we monitor. With pre-feed heel-prick tests, glucose gel inside the cheek, and brief IV glucose where needed, most transient hypoglycaemia resolves within 48–72 hours. Persistent or severe hypoglycaemia needs closer assessment. See hypoglycaemia management.

Jaundice (yellow skin)

About 60% of term babies (and around 80% of preterm) develop visible jaundice in the first week. Most is physiological and resolves on its own. A smaller group needs phototherapy to keep bilirubin safe.

With monitoring and timely treatment, serious bilirubin injury is rare in modern practice. Extreme hyperbilirubinaemia (severe enough to warrant exchange transfusion or carry a meaningful risk of brain injury) occurs in around 9.4 per 100,000 babies, and kernicterus in about 0.35 per 100,000 (McGillivray, APSU surveillance 2010–13). The 2-week jaundice rule (review any baby still jaundiced beyond 2 weeks — 3 weeks if born preterm) exists to catch the rare baby with biliary atresia (~1 in 14,000 live births in Australia) or another liver issue, where early surgery improves outcomes. Pale, chalky-white stools or dark urine at any age need same-day review, without waiting for the 2-week mark. See neonatal jaundice.

Feeding establishment

Feeding is the most common reason for extra paediatric attention — during the stay, or at an early review arranged before you go home: slow weight regain, latch issues, sleepy feeders, milk supply concerns, top-up plans. Healthy term newborns typically lose some birth weight in the first few days; loss exceeding 10% is the threshold for active review and prompts a feeding plan. See breastfeeding support.

Where a paediatrician helps. Feeding sits between the medical and the parental, and telling a sleepy baby who’s thriving from one heading into trouble is exactly what inpatient rounds are for.

The structural things we look for in every baby

These conditions are usually invisible at birth and would otherwise be missed without screening. The screening tests below are universal practice and form the backbone of the paediatric examination. Screening greatly improves detection, but it cannot make detection complete: some of these conditions are not detectable at the first examination at all, and only appear over the following weeks.

Congenital heart disease (CHD), including VSD

Around 1 in 100 babies (8–10 per 1,000) are born with some form of congenital heart disease, making CHD the most common congenital disorder in newborns. Most are mild and never cause problems. A subset have critical CHD that needs intervention in the first year of life, sometimes in the first weeks.

The most common type is a ventricular septal defect (VSD): a hole in the wall between the two pumping chambers. Many small VSDs close on their own in the first year and never need treatment. Larger VSDs need cardiology follow-up and sometimes surgery.

A VSD murmur is often not audible in the first days of life: the pressure in a newborn’s lungs starts high and falls over the first days and weeks, and only as it falls does flow across the hole become loud enough to hear. Many VSDs are first picked up at a later check rather than at the newborn examination — a normal early examination does not exclude one.

Critical CHD is detected by:

  • Antenatal ultrasound: important but incomplete — up to half of congenital heart disease is not picked up antenatally, which is why the newborn checks below matter
  • Pulse oximetry screening: every baby has oxygen saturations checked before discharge. This identifies several critical heart conditions that can otherwise look completely well at first, though no single screen detects every heart problem.
  • The first paediatric examination: listening for murmurs, feeling pulses (especially femoral pulses for coarctation of the aorta)

Where a paediatrician helps. A new murmur, a discrepancy in pulses, or a saturation difference between hand and foot prompts immediate paediatric assessment. This identifies much of the critical CHD missed antenatally before discharge — but not all of it can be found this early. Some heart problems only become detectable in the weeks after you go home, which is why the heart is examined again at the 6-week review.

Developmental dysplasia of the hip (DDH)

DDH is a spectrum, from a shallow socket that settles on its own (common) to a fully dislocated hip (rare).

Universal clinical hip examinations at birth, 6–8 weeks and 4 months, plus a 6-week ultrasound for risk groups, mean most cases are identified early; in published Australian figures, around 85% respond to a Pavlik harness and around 95% of DDH overall is treated successfully. The checks are repeated because a normal newborn hip examination does not exclude DDH: some hips examine normally at birth and develop dysplasia over the following weeks to months. Late detection, especially after 6 months, needs more involved treatment. See hip dysplasia screening.

Newborn bloodspot screen (heel-prick)

Done on day 2 or 3, this screens for more than 30 rare but serious conditions (35 on the current Victorian panel, sickle cell disease being the newest addition), congenital hypothyroidism, phenylketonuria, cystic fibrosis, congenital adrenal hyperplasia, MCAD deficiency, sickle cell disease and others. Many are treatable with diet or medication if caught before symptoms develop, and devastating if missed. The screen is one of the most useful preventive checks in routine newborn care. See newborn screening.

Hearing screen

About 1–2 per 1,000 newborns have significant congenital hearing loss. The Victorian Infant Hearing Screening Program uses an automated auditory brainstem response (AABR) test, gentle, takes a few minutes, no wake-up needed. Early identification (before 3 months) and intervention (before 6 months) is associated with substantially better language outcomes. See hearing screen.

Other rare-but-screened-for findings

  • Major congenital anomalies affect about 3 in 100 babies overall, but most are minor and don’t require intervention
  • Significant congenital anomalies needing surgery or active management are closer to 1 in 100
  • Neural tube defects, abdominal wall defects, gastrointestinal atresias: most are picked up antenatally; the paediatric exam confirms and plans next steps
  • Cleft lip / palate: around 1 in 530–800 births (Stock et al; Safer Care Victoria); usually identified at the first exam
  • Genital ambiguity, undescended testes, hypospadias: checked routinely at the first paediatric exam

Some things only appear over time

A normal newborn examination and normal screening results substantially lower the chance of a significant problem. They cannot lower it to zero, because several important conditions are not detectable at birth:

  • VSDs and other murmurs: often silent in the first days, emerging over the first weeks as the pressure in the lungs falls
  • Coarctation of the aorta: can present only after discharge, when the fetal duct closes — sometimes days after a normal examination and normal saturations
  • Hip dysplasia: some hips examine normally at birth and develop dysplasia later, which is why hip checks are repeated at 6–8 weeks and 4 months
  • Biliary atresia and other liver conditions: look like ordinary jaundice at first; the 2-week jaundice review exists to separate them
  • Feeding and growth problems: only measurable once feeding is established and weights are tracked over days to weeks
  • Developmental, hearing and vision concerns: emerge across the first year and beyond, on the Maternal & Child Health schedule

This is why newborn care is built as a sequence of checks rather than a single examination: reviews during the hospital stay, an MCH weight check in the first week, the 6-week paediatric review, and the MCH schedule beyond. It is also why what parents notice matters so much: you watch your baby for hours every day; clinicians see minutes. If feeding, breathing, colour or behaviour changes between scheduled checks, seek review rather than waiting for the next appointment.

Less common but more serious

These are the uncommon issues, each one is why a paediatrician is on call. The numbers and the routine step that protects against each:

Condition How common What protects babies
Early-onset GBS sepsis GBS carried silently by 12–15% of Australian pregnant women (15–25% internationally); without labour antibiotics, can cause meningitis, septic shock and death Screening at 35–37 weeks or risk-based assessment (protocols vary by hospital), plus antibiotics in labour — this greatly reduces, but does not eliminate, early-onset GBS
Other early-onset sepsis 1–2 in 1,000 term babies in the first week Risk-factor awareness (prolonged ruptured membranes, maternal fever, prematurity); symptoms detected on rounds; antibiotics work well when started early
HIE / birth asphyxia (moderate–severe) 1–2 per 1,000 live births Therapeutic hypothermia: cooling to 33.5°C for 72 hours, started within 6 hours; reduces death or major disability
Vitamin K deficiency bleeding ≈1 in 11,000 without prophylaxis (30–60% with brain bleeding); 0.6 per 100,000 in Australia with it Routine vitamin K injection at birth
Critical congenital anomalies ≈1 in 100 need surgery or active management (diaphragmatic hernia, oesophageal atresia, major heart defects, gastroschisis) Antenatal morphology scans; planned delivery, immediate care and surgical-centre transfer

Late-onset GBS (1 week to 3 months) isn’t prevented by labour antibiotics, which is why any fever in a baby under 3 months is always urgent.

Cooling for HIE is time-critical: recognition and transfer to a NICU with cooling capacity within 6 hours is a clear example of the first hour shaping long-term outcome.

Neonatal mortality in context

Australia is one of the safest places in the world to be born. From the AIHW 2023 stillbirth and neonatal-death data:

  • Stillbirths (death in utero from 20 weeks): around 8.7 per 1,000 births in 2023
  • Neonatal mortality (death in the first 28 days): around 2.4 per 1,000 live births, with a steep socioeconomic gradient
  • Perinatal mortality (stillbirths + neonatal deaths combined): around 11 per 1,000 births

These figures hide significant variation: most neonatal deaths are concentrated in extreme prematurity and major congenital anomalies. For a healthy term singleton pregnancy, the absolute risk is very low.

These outcomes rest on routine antenatal screening, intrapartum care, resuscitation and structured paediatric review. Together they reduce risk; they do not remove it entirely.

In the first weeks at home

Once you go home, the risk picture shifts. The most common at-home concerns:

Where a paediatrician helps at home too. The early-weeks rhythm is an MCH weight check in the first week, then a paediatric review at 6 weeks, brought earlier when jaundice, weight, feeding or a hospital finding needs it. Structured review is how the small issues a parent may not know to flag, and the conditions that only become detectable after discharge — an emerging murmur, an evolving hip, jaundice that hasn’t cleared — get looked for.

Long-term outcomes by gestation

The strongest single predictor of newborn outcome is gestation at birth. For healthy term pregnancies the risks below are very low; for preterm babies they increase stepwise, and structured follow-up matters more.

Cerebral palsy and neurodevelopmental disability

  • The birth prevalence of cerebral palsy in Australia has fallen from ~2.1 per 1,000 live births in 1995–96 to ~1.5 per 1,000 in 2015–16 (Australian Cerebral Palsy Register), one of the lowest rates in the world
  • Some children, preterm or term, develop a significant neurodevelopmental difficulty by school age (learning, communication, motor or behavioural disorder, intellectual disability, autism), picked up through the Maternal & Child Health schedule and the Australian Early Development Census
  • Late preterm (34–36 weeks): risk close to but slightly above the term baseline. See the late preterm journey for the day-by-day picture
  • Very preterm (28–31 weeks): meaningfully elevated risk; structured paediatric and developmental follow-up matters. For 31-week babies in private practice, see the 31-33 week preterm journey
  • Extremely preterm (< 28 weeks): high-risk window where modern NICU care, antenatal steroids and tertiary-centre birth all substantially shift outcomes

The chart below shows the shape of how risk changes with gestation. For the precise individualised numbers, the nic-predict.com.au calculator takes gestation, sex, antenatal steroid exposure and birth setting and returns scenario-specific probabilities, drawn from the same VICS dataset.

Modern early-detection (GMA + HINE + neonatal MRI where indicated) identifies CP from as early as 3 months corrected age: far earlier than the historical “wait and see until 2 years” approach. Earlier diagnosis means earlier intervention, which is associated with better long-term function. See neurodevelopmental milestones & early CP detection.

How risk changes with gestation

How risk changes with gestation at birth

A simple picture. Risk is highest below 28 weeks, falls steadily from 28–32 weeks, then drops quickly through the late-preterm window so that by full term it is back to baseline.For an individual estimate, use the nic-predict.com.au calculator — this graphic shows the shape, not the number.

Risk relative to term, by gestation at birth A smooth curve showing relative risk falling rapidly as gestation increases. Below 28 weeks the curve sits very high in the high-risk zone. Between 28 and 32 weeks the curve descends steeply. At 32 weeks the curve is around twice the term-baseline level — annotated on the chart. Between 32 and 37 weeks the curve drops further toward baseline. From 37 weeks onward the curve is flat at the term-baseline reference line. Background bands colour the chart by zone: red for extremely preterm, amber for very preterm, peach for late and moderate preterm, and green for term.extremely pretermvery pretermlate & moderate pretermtermterm-baseline risk32 weeksabout twice baseline34–36 weeksclose to term baseline22w24w26w28w30w32w34w36w37w40wGestation at birthhigher riskbaseline

The takeaway for late-preterm families. By 34–36 weeks the high-risk window is behind you. Risk continues to fall and reaches term baseline by full term. A late-preterm baby still benefits from extra monitoring (feeding, weight, jaundice, hypoglycaemia) — but the trajectory is reassuring, not alarming.

Visual shape based on Australian VICS publications (Boland, Cheong, Doyle). The 32-week ~2× rule of thumb and the late-preterm curve are illustrative only. For an individualised estimate based on gestation, sex, antenatal steroids and birth setting, use nic-predict.com.au.

The pattern in plain English:

  • Below 28 weeks is the high-risk window. Modern NICU care, antenatal corticosteroids and tertiary-centre birth substantially improve outcomes, but risk remains elevated.
  • 28–32 weeks is where risk falls steeply. Most very-preterm babies do well; structured developmental follow-up still matters.
  • 32 weeks is roughly twice the term-baseline risk as a rule of thumb, and the curve keeps falling.
  • 34–36 weeks (late preterm) is close to term baseline. The high-risk window is behind you. Late-preterm babies still need extra attention to feeding, weight, jaundice and blood sugar in the first weeks, but the long-term trajectory is reassuring.
  • 37 weeks and beyond is the term baseline (~1 in 25 lifetime ND difficulty rate, in the population).

For an individualised estimate based on gestation, sex, antenatal steroids and birth setting, see Dr Jubal’s calculator at nic-predict.com.au. It uses VICS data (Boland, Cheong, Doyle) and is intended as a discussion aid, not a diagnostic tool.

Long-term: adolescent and adult outcomes (VICS)

The Victorian Infant Collaborative Study has followed several preterm cohorts into young adulthood. Headline findings (Doyle, Cheong and colleagues):

  • Cardiometabolic: slightly higher rates of hypertension and insulin resistance after extreme preterm birth, in the twenties
  • Mental health: anxiety and depression somewhat more common
  • Education and employment: population-level employment rates similar; tertiary education attainment somewhat lower
  • Lung function: measurably lower in extremely preterm-born adults; most are clinically asymptomatic, but smoking is particularly risky

For late preterm and moderate preterm births, adult outcomes are closer to term, but still measurably elevated for some learning, attention, and respiratory measures. Late preterm is not the same as term, even when babies look completely well at discharge.

How early care improves outcomes

Structured neonatal care changes outcomes through:

The interventions that protect newborns

  • Antenatal screening + GBS prophylaxis: greatly reducing early-onset sepsis
  • Antenatal corticosteroids before anticipated preterm birth: substantially reducing respiratory distress, brain bleeds and death from 24–34 weeks
  • Skilled birth attendance + ANZCOR resuscitation: first 60 seconds matter
  • Therapeutic hypothermia for HIE: preventing brain injury
  • Routine vitamin K injection: preventing VKDB
  • Universal newborn bloodspot screening: catching 30+ rare but serious conditions early
  • Universal newborn hearing screen: early intervention is linked to better language outcomes
  • Universal pulse oximetry screen: catching critical congenital heart disease
  • Routine jaundice surveillance: preventing kernicterus
  • Routine hip examination + risk-group ultrasound: preventing late DDH surgery
  • Hypoglycaemia surveillance for at-risk babies: preventing brain injury from low sugars
  • Regular paediatric rounds in hospital (daily in special care): clinical early-warning radar
  • Structured discharge planning, MCH and paediatric follow-up: catching feeding, growth, and developmental concerns early
  • Preterm follow-up programs (CRE-aligned) with GMA, HINE and developmental review, early CP detection and intervention
  • The national immunisation schedule, plus RSV protection — maternal RSV vaccination in pregnancy, and state-funded nirsevimab for eligible infants — reducing infectious morbidity and mortality
  • Maternal mental health screening and PANDA-aligned support

Each is routine, and each has a measurable effect on preventable harm.

How a paediatrician supports your family

For a healthy pregnancy and term baby, midwives, GPs and obstetricians cover most of the routine work above. A paediatrician adds:

  1. Regular inpatient rounds (daily in special care): a clinician trained specifically to read newborns
  2. Quick decisions when something changes: distinguishing a sleepy baby who is fine from one heading into trouble
  3. Antenatal consultation: your specific pregnancy, anticipated risks, screening plan, before the birth
  4. Continuity of care: same clinician across the inpatient stay, any early review, and the 6-week check
  5. A point of contact after discharge: the rooms for non-urgent questions between visits — urgent concerns still go to your GP, the MCH Line or an emergency department
  6. Coordination with subspecialists, cardiology, surgery, ophthalmology, allergy, when needed

Most healthy babies need no more than midwife and GP care. A paediatrician mainly helps with the smaller proportion of issues that arise unexpectedly, and with antenatal-through-6-week continuity.

A note on uncertainty

Numbers on this page are drawn from Australian evidence (AIHW, Safer Care Victoria, RCH, RANZCOG, VICS). Where the science is settled, the numbers are tight. Where it isn’t, particularly at very early gestations, or for less common conditions, the ranges are deliberately wide.

Where to go from here on this site

More information

Evidence and guideline sources

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Going through the relevant risks for your pregnancy, the screening plan, and what good early care looks like for your family.

References