Concerns have been raised regarding the emphasis placed on skin color during newborn checks.

A review conducted by the NHS Race and Health Observatory has expressed significant concerns regarding the emphasis on skin color during routine health checks for newborns.

The Apgar score, determined by a series of quick assessments immediately after birth, traditionally includes checking whether the baby is “pink all over”.

The report is being criticized for its relevance and accuracy when it comes to babies from ethnic minorities.

An immediate update of maternity guidelines is being called for.

The text states that the wide-ranging review examines the diagnosis of newborn jaundice.

• Stillbirth rates are disproportionately high for black and Asian babies in the United Kingdom.

• Black women are still more likely to die in childbirth.

Prof Jacqueline Dunkley-Bent, previously England’s chief midwife and presently co-chair of the NHS Race and Health Observatory group, has drawn attention to the biased assessment practices in the maternal and neonatal health sector. She highlighted that terms such as ‘pink’ are commonly employed to describe a baby with good blood supply, overlooking the diverse range of skin tones within our population.

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

A team of researchers from Sheffield Hallam University conducted a comprehensive review of scientific literature and policies. They also conducted interviews with 33 healthcare professionals and 24 parents.

The Apgar score, which was devised in the 1950s, is first considered.

Healthcare professionals perform a thorough assessment of the baby’s muscle tone, pulse, reflex response, breathing rate, and appearance. Each component is assigned a maximum score of two.

The assessment of a baby’s appearance is an important aspect to consider in many cases.

• signs of blue (no points)
• completely pink (two points)

The text indicates that when the overall score is lower, there is a higher likelihood that the baby will require immediate assistance.

The review found:

• Most people interviewed said the language was inappropriate and needed to change
• Many – though 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

Experts are suggesting that alternative methods for assessing wellbeing should be analyzed and assessed.

There are concerns regarding the “subjective nature” of guidelines for assessing jaundice, which is characterized by the yellowing of the skin, whites of the eyes, and gums due to a buildup of bilirubin.

Babies are routinely checked for jaundice within the first few days of life. Midwives typically perform a visual examination while also assessing the baby’s level of alertness and feeding habits.

Jaundice is a common condition that can resolve on its own, but it can lead to serious complications if left untreated. It is important to seek treatment at the right time. A blood test can determine the levels of jaundice.

Lauren Clarke, a research practitioner in the East Midlands, had her son Jaxson in 2019.

The woman mentioned that her child was diagnosed with jaundice when he was just 6 days old. According to her, the levels of jaundice were very high and required immediate treatment. However, she believes that the condition should have been detected and treated at an earlier stage.

Lauren mentioned that she observed a yellowish color in Jackson’s eyes and skin during his initial days. However, when she reported this to the staff, they simply advised her to be vigilant, without providing any additional guidance.

A midwife and two maternity support workers visually checked the baby after she returned home, however, Lauren felt that her concerns were not heard.

Jaxson’s blood test was only done when she was admitted for treatment of another infection, according to the staff on the ward.

Lauren mentioned that when they received the results, a junior doctor promptly took the baby out of her arms and provided him with rapid light treatment.

Lauren told the BBC: “It was so hard when he was being treated with light therapy. I couldn’t feed him and he was crying so much.”

She added: “I think if he had not been mixed-race the jaundice would have been picked up sooner.”

The hospital conducted a review and acknowledged that concerns regarding jaundice should have been escalated.

The review says the baby’s skin tone “may have made it more difficult to determine if the jaundice was getting worse.”

The text suggests recommendations for improving staff training and increasing the utilization of handheld meters for measuring jaundice levels.