NEWBORN BLACK babies are being put at risk due to old-fashioned tests based on white skin, health experts say.

Tests stating a healthy baby should be “pink all over” are still being used today.

Several maternal health policies use terms such as “pink” “blue” “pale” or “pallor” to describe neonatal skin, but fail to include alternative descriptions for Black and mixed heritage babies.

The NHS Race and Health Observatory described the tests as not fit-for-purpose.

Neonatal assessments, including the Apgar score, a quick observation test used to assess babies minutes after birth was developed in 1952, and is now considered out of date by many health care professionals.

Based on a score of 1 to 10, with a high Apgar score indicating good health for babies, minutes following birth, the assessments are used as standard by healthcare professionals regardless of a baby’s skin tone and can give misleading scores.

Medical staff use the Apgar to decide whether clinical actions are needed.

Inadequate tests for non-white babies could put them at greater risk.

Historically the assessment was developed based on white European babies and implemented regardless of diverse populations and babies with Black and varying skin tones.

Some guidance still reference a baby’s skin should be ‘’pink all over’’.

It comes as the independent health body announces the results of a commissioned review called ‘Review of neonatal assessment and practice in Black, Asian and minority ethnic newborns: Exploring the Apgar score, the detection of cyanosis, and jaundice’.

The research, by Sheffield Hallam University, highlights a number of ‘reliability concerns’ around three current neonatal assessments and perinatal practices – the Apgar score and the detection of cyanosis and jaundice.

It is calling for an immediate update of maternity guidelines that refer to assessments by skin colour and the increased use of screening tool devices, including oximeters and bilirubinometers. 

Urgent research is also needed which focuses on enhancing the reliability of these tools especially for darker skinned babies.

The report was officially launched at the House of Commons yesterday at an event hosted by Bell Ribeiro-Addy MP.

Co-chair of the Observatory maternal health working group, Professor Jacqueline Dunkley-Bent will also join parents and lead researchers.

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.

Inconsistencies were also shown with a lack of policy consideration in the formulation of guidelines, understanding and training regarding skin colour in neonatal examinations.

Findings from the reviewinclude 56 studies with only six studies related to Apgar scores, three considered the detection of lack of oxygen (cyanosis) and the remainder the detection of jaundice.

Midwife, Hora Soltani, Professor of Maternal and Infant Health, Sheffield Hallam University, said: “We are very grateful to the Observatory for supporting this project and for the efforts of our collaborative team who for the first time, have systematically examined the relevance of the most commonly practised neonatal assessments which have been developed decades ago mainly based on White European babies.

“The importance of listening to the parents’ concerns and appropriateness of policies and education of healthcare professionals including access to educational materials which reflect the impact of various skin colour tones on such important areas of neonatal assessment are among the key findings of this work.”

She added: “This was extremely intensive work and although it doesn’t provide all the answers, it certainly highlights research, policy, practice and educational gaps as a first step towards ensuring commonly used neonatal assessments are sensitive to the needs of our super-diverse communities.”

Racism and bias was also an issue with some women feeling silenced within the healthcare system, whilst some felt dismissed, ignored, or belittled, others feared raising concerns due to worries over being labelled as “difficult” or “too much trouble”.

The review also reports on an infant developing cerebral palsy due to failures in listening to the mother’s concerns over jaundice.

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.”