An observational cohort study on the etiology and outcomes of neonates with thumb in flexion sign

Sruthy Gnanasekaran, Natarajan P.


Background: One constant observation by Pediatricians during postnatal rounds is that many of the early neonates exhibit a sign with thumb adducted and flexed over the palm and the rest of the fingers flexed over the thumb. In an otherwise normal neonate with no obvious etiological factors, we do come across TIF sign in more than half of the early neonate. This study attempts to know weather this sign is physiological or pathological and what would be the neurological outcome of the neonates exhibiting this sign in the early neonatal period.

Methods: The study was conducted in the department of Pediatrics (post-natal ward in) of Sri Venkateshwara Medical College Hospital & Research centre, Ariyur, Puducherry, a tertiary care hospital loacted in a rural area.

Results: Among 227 study participants 152(67%) had TIF sign. The infants born after history of fetal distress had higher incidence of TIF sign (76.1%) with a p value 0.05. One significant finding was that all the 7 infants who had language delay had history TIF sign within 7 days of life. The p value was 0.01.

Conclusions: The pathological view of the TIF sign is, perhaps, a sign of minimal insult to the developing brain from which it recovers over a period of few months. From our study we conclude that the incidence of TIF sign was about 67 %. Thumb in Flexion sign has clinical significance with etiological factors like fetal distress in apparently healthy full-term infants. The secondary outcome of TIF sign was isolated language delay which was present in babies who had TIF sign within first week of life without neurological deficits up to 1 year of life with statistical significance. Hence it is recommended that the neonates with this sign need periodic neurological evaluation.


Fetal distress, Hammersmith neonatal neurological examination, Language delay, Term neonates, Thumb in flexion sign

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