An Interpretable Deep Learning System for Fine-Grained Classification and Longitudinal Tracking of Neonatal Auricular Deformities

Early non-invasive correction of neonatal auricular deformities is highly dependent on timely and precise diagnosis. However, clinical practice is often compromised by the subjectivity of visual assessments and the lack of objective tracking metrics, which frequently leads to missed optimal treatment windows. To address these challenges, we developed an interpretable deep learning-based diagnostic system for the automated screening and fine-grained classification of these deformities. Methodologically, a large-scale, multi-source dataset (n = 4644) was curated to support model training. The system pairs an automated object detector (YOLOv11) for background-reduced region-of-interest isolation with a cascaded classification pipeline optimized via ConvNeXt-Tiny. Crucially, we introduced a supervised contrastive learning module to project high-dimensional morphological features into a continuous severity score, enabling quantitative longitudinal tracking of therapeutic efficacy. To evaluate generalization and robustness, the framework underwent rigorous evaluation across three independent real-world cohorts and one controlled synthetic stress test. The system achieved 88.2% accuracy (Area Under the Curve (AUC): 0.949) in binary screening and 87.4% accuracy (macro-AUC: 0.976) in multi-class subtyping on the internal baseline. To enhance interpretability and build clinical trust, Gradient-weighted Class Activation Mapping (Grad-CAM) was utilized to explore the spatial distribution of the model’s attention, which frequently aligned with key anatomical landmarks. Furthermore, the learned severity scores robustly quantified post-intervention improvements (p = 0.0004), effectively capturing subtle anatomical normalization. While validation for rare subtypes remains underpowered, and the severity score currently functions mainly as a learned morphological similarity index requiring future clinical calibration, this study ultimately provides an objective and standardized web-based tool to facilitate the early intervention and precision management of neonatal auricular anomalies.