A multi-analytical approach to fetal/neonatal birth trauma and possible metabolic stress in a Neolithic alpine mobility context (3932–3653 cal BCE)

Fetal or neonatal skeletal trauma is uncommon even in modern clinical settings and is hardly identifiable in the archaeological record, where preservation constraints and the absence of soft tissues limit diagnostic confidence. We report a fetal/neonatal individual (RAB ID1; c. 40 lunar weeks) recovered from the Ripari Alti rock shelter (north-eastern Italian Alps; c. 1100 m a.s.l.). AMS radiocarbon dating of a tibial fragment places the remains within 3932–3653 cal BCE (2σ), dating to the Late Neolithic. The assemblage comprises six elements dispersed within a restricted excavated volume and attributable to a single individual based on osteological coherence, contralateral pairing of tibiae, and the absence of duplicated elements. Macroscopic examination, digital microscopy and SEM document: (i) bilateral tibial diaphyseal porosity with metaphyseal lace-like cortical reduction; (ii) mandibular porosity with lamellar bone deposition; (iii) and a mid-diaphyseal right humeral fracture with smooth, curved surfaces and an oblique-to-spiral trajectory, showing homogeneous cortical colour across the fracture plane. The porous and lamellar changes is most consistent with systemic metabolic stress, interpreted as possible micronutrient deficiency, while acknowledging diagnostic overlap with other conditions and incomplete skeletal representation. Fracture morphology and microstructural features support a perimortem origin and, by comparison with clinical literature, are most plausibly compatible with birth-related forces during a difficult delivery and attempted extraction manoeuvres. This case provides unique osteological insight into fetal/neonatal risk, maternal–fetal health, and obstetric decision-making within Neolithic alpine mobility systems.