Concerns raised over focus on skin colour in routine newborn health checks

by Emily Gilbert |
Posted on

As soon as they are born, your new baby will immediately have a newborn check-up to ensure everything is as it should be with their health and wellbeing. The very first test is the Apgar score, which stands for Appearance, Pulse, Grimace, Activity and Respiration and evaluates your baby’s physical condition to check if any further care is required.

However, one of these assessments includes checking whether baby is "pink all over" and a review led by the NHS Race and Health Observatory has questioned the relevance and accuracy for some babies belonging to ethnic minorities, calling for an immediate update of maternity guidelines.

Professor Jacqueline Dunkley-Bent, who co-chairs the NHS Race and Health Observatory group working on maternal and neonatal health, said: "This biased assessment is exemplified by terms like 'pink' being used to describe a well-perfused baby [with good blood supply], disregarding the diversity of skin colours within our population.

"Consequently, it raises concerns about the clinical accuracy of such assessments when applied to ethnically diverse populations."

The report, led by researchers from Sheffield Hallam University, reviews scientific literature and policies and involves interviews with 33 healthcare professionals and 24 parents.

On the subject of the Apgar score:

• Most of the people interviewed said the language was inappropriate and needed to change

• Many - but not all - policies used words such as "pink", "blue" or "pale" but most did not consider how this may be assessed on different skin tones

• Most healthcare professionals had, in practice, instinctively adapted the check, to look for colour changes around the lips, for example - but there was no consistent, evidence-based approach

• Experienced medics said they did not overly rely on a single part of the score in their assessment but it needed to be reviewed, particularly in training

As well as the Apgar score, the report also has concerns about the "subjective nature" of guidelines for assessing jaundice, typically defined as the yellowing of the skin. During the first few days of their life, all babies are checked for jaundice via a physical check.

The review says more consistent training for healthcare staff and parents on how to spot jaundice in babies belonging to ethnic minorities is needed and recommends establishing a national image database.

"There is a pressing need for more objective outcome measures to mitigate the impact of racial bias when employing these assessments," says Professor Dunkley-Bent and Dr Daghni Rajasingam, who co-chair the NHS Race and Health Observatory group working on maternal and neonatal health.

"By rectifying these anomalies that are present in our current practices, we can strive towards a more equitable healthcare system that upholds the health and wellbeing of all newborns, irrespective of their ethnic background."

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