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NHS Race and Health Observatory releases review of neonatal assessments which focus on skin colour

12 Jul 2023

The NHS Race and Health Observatory, in collaboration with Sheffield Hallam and Nottingham University, has undertaken a comprehensive review to understand whether current guidance for assessing a baby’s condition after birth is suitable for Black, Asian, and minority ethnic newborns.

Black, Asian, and minority ethnic mothers and babies are more likely to experience adverse outcomes compared to their white counterparts. The review investigated how neonatal assessments focusing on skin colour, which were developed based on white European babies, may disadvantage babies with darker skin tones.

Through analysis of existing policies, guidance and research, alongside interviews with parents, carers and healthcare professionals, the review presents valuable insights to improve assessment and care practices such as exploring the wider use of medical devices to detect conditions, rather than relying on noticing changes in skin colour.

Professor Asma Khalil, Vice President of The Royal College of Obstetricians and Gynaecologists, said: “No mother or baby should receive suboptimal care as a result of guidance that is not appropriate for their skin tone. This review is hugely valuable, both in exploring how current care practices may be resulting in health inequalities in neonatal care, and by working with healthcare professionals and women to identify solutions.

“The College is committed to supporting the provision of equitable healthcare for all pregnant women and newborns, recognising significant inequalities persist in the UK. We welcome the recommendations within the report, including ensuring guidance and training resources are suitable for all skin tones. We will now work with partner organisations to carefully consider how we can respond to the report recommendations.”

The recommendations within the report relate to Apgar scoring (including assessment of oxygenation) and the detection of jaundice, and include:

  • Medical devices should be used to detect jaundice and cyanosis.
  • Healthcare professionals and students need better training resources which includes examples in training materials that show photos of what conditions like cyanosis, jaundice or rashes look like on Black, Asian, and minority ethnic babies.
  • Healthcare professionals and students need different types of training to help improve their skills in assessing Black, Asian and minority ethnic babies.
  • Parents should have information, which includes pictures of minority ethnic babies, to help them spot when their baby is unwell.

Further information:

  • Clinical and research
  • Pregnancy and birth