'Pink' newborn check irrelevant to black and Asian babies | Fieldfisher
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'Pink' newborn check irrelevant to black and Asian babies

Jane Weakley
The longstanding clinical assessment of babies immediately after birth is under review after the NHS Race and Health Observatory raised concerns that the focus on skin colour is misleading.

The Apgar score of a newborn, calculated by maternity staff, rates the baby's health according to quick tests including whether the baby is 'pink all over' to indicate good blood supply. The Apgar score test was introduced in the 1950s and is often used as part of the evidence in assessing a birth injury claim.

The latest report by the NHS body tasked with identifying and tackling ethnic inequalities in healthcare describes the tests as 'biased' and questions their accuracy for some babies belonging to ethnic minorities. It has called for an immediate update to maternity guidelines.

The report is based on research conducted by Sheffield Hallam University, which reviewed scientific literature and policies and includes interviews with healthcare professionals and parents.

Traditionally, medics performing the Apgar score check a baby's muscle tone, pulse, reflex response, breathing rate and appearance, giving each component a maximum score of two. This generally includes assessing the baby's appearance as signs of blue (no points), completely pink (two points). The lower the overall score, the more likely the baby is to need urgent care.

The report acknowledged that most healthcare professionals in practice instinctively adapted the check, for example looking for colour changes around the lips, but there was no consistent, evidence-based approach and particularly in training, checks needed clarifying. Words such as 'pink', 'blue and 'pale' were highlighted as unhelpful.

The report also raised concerns about the 'subjective nature' of guidelines for assessing jaundice, indicated by yellowing of the skin, whites of the eyes and gums caused by a build-up of bilirubin.

Healthcare professionals admitted it was harder to identify jaundice in babies belonging to ethnic minorities. Despite clinical awareness that using skin colour to assess jaundice was problematic, this did not always translate into policy changes and training. Untreated jaundice can cause Kernicterus, a serious condition that occurs when high levels of bilirubin in the blood lead to brain damage in newborns.

This latest report echoes the ongoing campaign by FiveXMore among others that the stillbirth rate of black babies is almost twice that of white babies. One of the report's recommendations is to establish a national image database.

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