Neonatal outcomes of congenital clubfoot according to laterality

Congenital clubfoot is a common congenital musculoskeletal deformity that may occur as an isolated anomaly or in association with multiple congenital abnormalities. However, neonatal clinical outcomes according to laterality remain insufficiently studied. This study aimed to compare the prevalence of associated congenital anomalies and neonatal clinical outcomes according to laterality. We conducted a retrospective cohort study of neonates with congenital clubfoot admitted between September 2018 and February 2026. According to laterality, infants were classified into bilateral and unilateral groups. We compared the baseline characteristics, associated anomalies, and respiratory and feeding outcomes of the neonatal period. Altogether, 96 infants with congenital clubfoot were included, of whom 62 had bilateral and 34 had unilateral involvement. In the overall cohort, associated major anomalies were in 20% of infants, and genetic abnormalities were in 14%. Bilateral clubfoot was associated with markedly greater deformity severity of foot, a higher prevalence of major associated anomalies, and more frequent abnormal genetic test results. Respiratory outcomes, including resuscitation at delivery were not significantly different. Feeding intolerance occurred substantially more often in the bilateral group with gastroesophageal reflux accounting for most cases. Admission duration was considerably longer in bilateral clubfoot. Compared with unilateral clubfoot, bilateral clubfoot was linked to a higher prevalence of major anomalies, more frequent abnormal genetic findings, a higher incidence of feeding intolerance, and longer hospitalization. Thus, bilateral clubfoot, rather than unilateral clubfoot, may represent a phenotype with clinical complexity and severity in the neonatal period. Careful screening for associated anomalies, individualized feeding support, and consideration of genetic assessment may be necessary when bilateral clubfoot is identified.