U2 – Newborn Preventive Health Check-Up

What is the U2?

The U2 is the second routine preventive health examination in the German statutory child health screening programme, known as the U-Untersuchungen (U1 through U9). It takes place between the 3rd and 10th day of life, often still during the hospital stay after birth or shortly afterwards at a paediatrician. The examination is fully covered by statutory health insurance in Germany.

Goals of the U2

The primary goal of the U2 is the early detection of congenital diseases, developmental abnormalities, or physical conditions that may be present shortly after birth. Early identification allows for timely treatment, significantly improving long-term health outcomes for the child.

Contents of the U2 Examination

Physical Examination

The paediatrician performs a thorough physical assessment of the newborn, including:

• Skin: Colour, jaundice (neonatal icterus), signs of malformation
• Head and face: Skull shape, fontanelles, eyes, ears, mouth and palate
• Heart and lungs: Heart murmurs, breathing rate and quality
• Abdomen: Abdominal organs, umbilical cord, umbilical hernia
• Genitalia and hips: Hip dysplasia screening, testicular position in boys
• Limbs: Mobility, reflexes, muscle tone
• Nervous system: Newborn reflexes such as sucking, grasping, and stepping reflexes

Newborn Metabolic Screening

As part of the U2, the extended newborn metabolic screening is typically performed if it has not already been carried out within the first 36 hours of life. A small blood sample is taken from the infant's heel to test for more than 20 congenital metabolic and hormonal disorders, including:

• Hypothyroidism (underactive thyroid)
• Phenylketonuria (PKU)
• Cystic fibrosis
• Galactosaemia

Newborn Hearing Screening

If the newborn hearing screening was not completed in the maternity clinic, it is performed at the latest during the U2. This test uses otoacoustic emissions (OAE) or automated auditory brainstem response (AABR) to check whether the infant can hear adequately.

Parental Guidance and Counselling

An important element of the U2 is a counselling session with the parents. Topics typically discussed include:

• Breastfeeding and newborn nutrition
• Vitamin K and Vitamin D prophylaxis
• Safe sleeping position to reduce the risk of sudden infant death syndrome (supine position recommended)
• Umbilical cord care
• Recognising warning signs and when to seek medical attention

Documentation in the Child Health Record

All findings from the U2 are recorded in the Gelbes Heft (Yellow Booklet), the official child health record in Germany. This booklet accompanies the child through all subsequent preventive check-ups and serves as a comprehensive health record.

Why is the U2 So Important?

The U2 is one of the most significant early detection examinations in a child's life. Many congenital conditions show no or very few symptoms in the first days of life. Through systematic screening, treatable conditions can be identified early, preventing serious long-term complications. Participation in the U2 is strongly recommended by all major medical professional associations.

References

1. Gemeinsamer Bundesausschuss (G-BA): Kinder-Richtlinie - Directive on Early Detection Examinations for Children. www.g-ba.de (2023).
2. Deutsche Gesellschaft fuer Kinder- und Jugendmedizin (DGKJ): Recommendations on Preventive Check-Ups in Childhood. www.dgkj.de (2022).
3. Robert Koch Institut (RKI): Health Reporting for Germany - Child Health in Germany. Berlin (2022).