Newborn checks for Black, Asian and ethnic minority babies ‘not fit for purpose’

Newborn health checks for Black, Asian and ethnic minority babies need immediate revision, according to the NHS Race and Health Observatory.

It is calling for changes on how healthcare professionals reliably and robustly assess the skin colour of non-white babies to ensure that they benefit from timely and appropriate healthcare. The assessments are used as standard by healthcare professionals regardless of a baby’s skin tone and can give misleading scores.

It comes as the independent health body announces the results of a commissioned review undertaken by Sheffield Hallam University which highlights a number of ‘reliability concerns’ around three current neonatal assessments and perinatal practices – the Apgar score and the detection of cyanosis and jaundice.

Using a mixed methods approach, consisting of data research and in-depth interviews, researchers from Sheffield Hallam University spoke to a total of 33 healthcare professionals including midwives, health visitors, paediatricians, neonatologists, obstetricians, nurses, along with 24 parents.

Systematic reviews were carried out screening around 200 and including over 80 documents on neonatal assessment and practice including but not limited to – the appearance component of Apgar scores, detection of cyanosis and the identification of jaundice. Targeted locations such as around/inside the mouth for Apgar or yellow in the whites of eyes for jaundice may be better indicators than skin colour particularly in Black, Asian, and minority ethnic newborns.

Skin colour and newborn examinations

Inconsistencies were also shown with a lack of policy consideration in the formulation of guidelines, understanding and training regarding skin colour in neonatal examinations. Several maternal health policies referred to terms such as “pink” “blue” “pale” or “pallor” in reference to neonatal skin, with no reference to alternative descriptions for Black, Asian and ethnic minority babies. Interviews showed many healthcare professionals were uncertain how to apply the Apgar score in Black, Asian and ethnic minority newborns. This led to many adapting the score in their own way, which did not always align with best practice.

Chief Executive of the NHS Race and Health Observatory, Dr Habib Naqvi, said: “We need to address the limitations in visual examinations of newborns, such as Apgar scores, where the assessment of skin colour can potentially disadvantage Black, Asian and ethnic minority babies with darker skin. The results from this initial review highlight the bias that can be inherent in healthcare interventions and assessments and lead to inaccurate assessments, late diagnosis and poorer outcomes for diverse communities. The Observatory is committed to providing practical solutions to patient safety challenges.”

Several recommendations have been made for healthcare policy, providers and researchers, including:

• Immediate update of guidelines that refer to neonatal assessment by skin colour
• Medical devices should be used to detect jaundice and cyanosis
• Better education for parents and families to be able to spot the signs of jaundice
• A data bank of open access images of Black, Asian and ethnic minority neonates to be included in health care education and training
• Urgent need for education and training for healthcare professionals on clinical assessment on neonates from Black, Asia and minority ethnic backgrounds.
• Further studies into reliability of using Apgar score and how healthcare professionals use this when assessing babies from Black, Asian or minority ethnic backgrounds

In the UK, Black women are four times more likely to die during pregnancy or childbirth compared to White women with women from Asian backgrounds facing twice the risk of maternal mortality. Similarly, there is also a higher rate of stillbirth and neonatal death for babies from Black and Asian ethnic minority groups.

Details of a forthcoming new research commission by the NHS Race and Health Observatory will seek to establish the existing evidence on screening for jaundice in Black, Asian and ethnic minority babies and determine clear implications and recommendations for clinical practice, healthcare users and their families.