{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:32:00Z","timestamp":1787020320089,"version":"build-2736575974"},"reference-count":47,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T00:00:00Z","timestamp":1710979200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T00:00:00Z","timestamp":1710979200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"NHS Race and Health Observatory"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ethnic inequalities in maternal and neonatal health in the UK are well documented. Concerns exist regarding the use of skin colour in neonatal assessments. Healthcare professionals should be trained to recognise symptoms of diverse skin tones, and comprehensive, and inclusive guidance is necessary for the safe assessment of all infants. Disparities in healthcare provision have been emphasised during the COVID-19 pandemic, and additional research is needed to determine whether such policies adequately address ethnic minority neonates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A desktop search included searches of guidance produced for the United Kingdom (UK). Further searches of the Cochrane and World Health Organization (WHO) were used to identify any international guidance applicable in the UK context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Several policies and one training resource used descriptors \u2018pink,\u2019 \u2018pale,\u2019 \u2018pallor,\u2019 and \u2018blue\u2019 about neonatal skin and mucous membrane colour. No policies provided specific guidance on how these colour descriptors may appear in neonates with different skin pigmentation. Only the NICE guidance and HEE e-learning resource acknowledged the challenges of assessing jaundice in infants with diverse skin tones, while another guideline noted differences in the accuracy of bilirubin measurements for the assessment of jaundice. Three policies and one training resource advised against relying on visual observation of skin colour when diagnosing neonatal conditions. The training resource included images of ethnic minority neonates, although most images included white infants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Inadequate consideration of ethnicity in UK policy and training perpetuates disparities, leading to inaccurate assessments. A review is needed for inclusivity in neonatal care, regardless of skin pigmentation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12887-024-04692-4","type":"journal-article","created":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T05:01:42Z","timestamp":1710997302000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["A review of the current policies and guidance regarding Apgar scoring and the detection of jaundice and cyanosis concerning Black, Asian and ethnic minority neonates"],"prefix":"10.1186","volume":"24","author":[{"given":"Amy","family":"Furness","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frankie","family":"Fair","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gina","family":"Higginbottom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Oddie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hora","family":"Soltani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,3,21]]},"reference":[{"key":"4692_CR1","unstructured":"Knight M, Bunch K, Patel R, Shakespeare J, Kotnis R, Kenyon S, editors. Saving Lives, Improving Mothers\u2019 Care - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2018-20. Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2022."},{"key":"4692_CR2","unstructured":"Draper ES, Gallimore ID, Smith LK, Matthews RJ, Fenton AC, Kurinczuk JJ, on behalf of the MBRRACE-UK Collaboration, et al. MBRRACE-UK Perinatal Mortality Surveillance Report, UK Perinatal deaths for births from January to December 2020. The infant mortality and morbidity studies, department of health sciences, university of leicester: leicester; 2022."},{"issue":"4","key":"4692_CR3","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1136\/adc.2010.206755","volume":"96","author":"M Atkinson","year":"2011","unstructured":"Atkinson M, Budge H. Review of the NICE guidance on neonatal jaundice. Disease in Childhood-Education and Practice. 2011;96(4):136\u201340.","journal-title":"Archives Disease Childhood-Education Pract"},{"issue":"6p2","key":"4692_CR4","doi-asserted-by":"publisher","first-page":"1905","DOI":"10.1111\/j.1475-6773.2003.00208.x","volume":"38","author":"M Exworthy","year":"2003","unstructured":"Exworthy M, Blane D, Marmot M. Tackling health inequalities in the United Kingdom: the progress and pitfalls of policy. Health Services Research. 2003;38(6p2):1905\u201322.","journal-title":"Health Serv Res"},{"issue":"10234","key":"4692_CR5","doi-asserted-by":"publisher","first-page":"1413","DOI":"10.1016\/S0140-6736(20)30940-5","volume":"395","author":"M Marmot","year":"2020","unstructured":"Marmot M. Society and the slow burn of inequality. Lancet. 2020;395(10234):1413\u20134.","journal-title":"Lancet"},{"issue":"4","key":"4692_CR6","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1016\/j.jnn.2010.03.002","volume":"16","author":"D Blake","year":"2010","unstructured":"Blake D. Do we assess \u2018colour appropriately using the Apgar score? Journal of Neonatal Nursing. 2010;16(4):184\u20137.","journal-title":"J Neonatal Nurs"},{"key":"4692_CR7","doi-asserted-by":"crossref","unstructured":"Lee AC, Folger LV, Rahman M, et al. A novel icterometer for hyperbilirubinemia screening in low-resource settings. Pediatrics. 2019;143(5):e20182039.","DOI":"10.1542\/peds.2018-2039"},{"issue":"5","key":"4692_CR8","doi-asserted-by":"publisher","first-page":"F317","DOI":"10.1136\/adc.2008.150714","volume":"94","author":"R Keren","year":"2009","unstructured":"Keren R, Tremont K, Luan X, Cnaan A. Visual assessment of jaundice in term and late preterm infants. Archives Disease Childhood-Fetal Neonatal Ed. 2009;94(5):F317\u201332.","journal-title":"Archives Disease Childhood-Fetal Neonatal Ed"},{"issue":"2","key":"4692_CR9","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1016\/S0022-3476(73)80181-7","volume":"82","author":"HI Goldman","year":"1973","unstructured":"Goldman HI, Maralit A, Sun S, Lanzkowsky P. Neonatal cyanosis and arterial oxygen saturation. Journal of Pediatrics. 1973;82(2):319\u201324.","journal-title":"J Pediatr"},{"key":"4692_CR10","doi-asserted-by":"publisher","unstructured":"Rimmer A. Presenting clinical features on darker skin: five minutes with Malone Mukwende. BMJ. 2020;369. https:\/\/doi.org\/10.1136\/bmj.m2578.","DOI":"10.1136\/bmj.m2578"},{"issue":"5","key":"4692_CR11","doi-asserted-by":"publisher","first-page":"271","DOI":"10.12968\/bjom.2000.8.5.8129","volume":"8","author":"J Schott","year":"2000","unstructured":"Schott J, Henley A. Health-Care equity: how to recognize clinical signs in skin. British Journal of Midwifery. 2000;8(5):271\u20133.","journal-title":"Br J Midwifery"},{"issue":"11","key":"4692_CR12","doi-asserted-by":"publisher","first-page":"2038","DOI":"10.1111\/ced.15328","volume":"47","author":"S Shah","year":"2022","unstructured":"Shah S, Arbuiso S, Gorgy M, Cline A, Moy J. Assessment of diversity in skin colour in dermatology medical education resources. Clinical and Experimental Dermatology. 2022;47(11):2038\u201340. https:\/\/doi.org\/10.1111\/ced.15328.","journal-title":"Clin Exp Dermatol"},{"issue":"5","key":"4692_CR13","doi-asserted-by":"publisher","first-page":"S97","DOI":"10.1016\/j.jid.2021.02.584","volume":"141","author":"BN Wilson","year":"2021","unstructured":"Wilson BN, Sun M, Olayinka J, Murrell DF, Murase J. Assessment of skin of color and diversity and inclusion content published in the Journal of Investigative Dermatology: an analysis and call to action. Journal of Investigative Dermatology. 2021;141(5):S97.","journal-title":"J Invest Dermatology"},{"key":"4692_CR14","unstructured":"NHS Race and Health Observatory. Pulse oximetry and racial bias: Recommendations for national healthcare, regulatory and research bodies. 2021. Available from: https:\/\/www.nhsrho.org\/wp-content\/uploads\/2021\/03\/Pulse-oximetry-racial-bias-report.pdf. Accessed 12 Jan 2023."},{"issue":"1","key":"4692_CR15","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1038\/s41372-021-01230-3","volume":"42","author":"Z Vesoulis","year":"2022","unstructured":"Vesoulis Z, Tims A, Lodhi H, Lalos N, Whitehead H. Racial discrepancy in pulse oximeter accuracy in preterm infants. Journal of Perinatology. 2022;42(1):79\u201385.","journal-title":"J Perinatol"},{"key":"4692_CR16","doi-asserted-by":"crossref","unstructured":"Razai MS, Kankam HK, Majeed A, Esmail A, Williams DR. Mitigating ethnic disparities in COVID-19 and beyond. BMJ. 2021;372:m4921.","DOI":"10.1136\/bmj.m4921"},{"key":"4692_CR17","unstructured":"Brouwers MC, Kho ME, Browman GP, et al.; for the AGREE Next Steps Consortium. AGREE II: Advancing guideline development, reporting and evaluation in healthcare. 2017 update. Available from: https:\/\/www.agreetrust.org. Accessed 12 2023."},{"key":"4692_CR18","unstructured":"British Association of Perinatal Medicine (BAPM). Newborn Early Warning Trigger & Track (NEWTT) \u2013 a Framework for Practice (2015). London: British Association of Perinatal Medicine; 2015. Available from: https:\/\/www.bapm.org\/resources\/38-newborn-early-warning-trigger-track-newtt-a-framework-for-practice-2015. Accessed 12 Jan 2023."},{"key":"4692_CR19","unstructured":"British Association of Perinatal Medicine (BAPM). DRAFT framework: Deterioration of the Newborn (NEWTT 2). London: British Association of Perinatal Medicine; 2022a. Available from: https:\/\/www.bapm.org\/resources\/deterioration-of-the-newborn-newtt-2-a-draft-framework-for-practice. Accessed 12 Jan 2023."},{"key":"4692_CR20","unstructured":"British Association of Perinatal Medicine (BAPM). DRAFT Framework: Early Postnatal Care of the Moderate-Late Preterm Infant. London: British Association of Perinatal Medicine; 2022b. Available from https:\/\/www.bapm.org\/resources\/framework-early-postnatal-care-of-the-moderate-late-preterm-infant.. Accessed 12 Jan 2023."},{"key":"4692_CR21","volume-title":"Specialist neonatal respiratory care for babies born preterm (NICE Guideline No. NG124)","author":"National Institute for Health and Care Excellence (NICE)","year":"2019","unstructured":"National Institute for Health and Care Excellence (NICE). Specialist neonatal respiratory care for babies born preterm [NG124]. 2019. Accessed 12 Jan 2023."},{"key":"4692_CR22","volume-title":"&amp; Royal College of Obstetricians &amp; Gynaecologists (RCOG). Postnatal care (NICE Guideline No. NG194)","author":"National Institute for Health and Care Excellence (NICE)","year":"2021","unstructured":"National Institute for Health and Care Excellence (NICE). & Royal College of Obstetricians & Gynaecologists (RCOG). Postnatal care [NG194]. 2021. Accessed 12 Jan 2023."},{"key":"4692_CR23","unstructured":"Neonatal Nurses Association. \/ University of Hertfordshire. Assessment of the neonate. (no date a). Available from: https:\/\/www.herts.ac.uk\/study\/schools-of-study\/health-and-social-work\/course-subject-areas\/nursing\/childrens-nursing\/neonatal-nursing. Accessed 12th Jan 2023."},{"key":"4692_CR24","unstructured":"Office for Health Improvement & Disparities (OHID). Newborn and infant physical examination (NIPE) screening programme handbook. London: Office for Health Improvement & Disparities; 2021. Available from: https:\/\/www.gov.uk\/government\/publications\/newborn-and-infant-physical-examination-programme-handbook\/newborn-and-infant-physical-examination-screening-programme-handbook. Accessed 12 Jan 2023."},{"key":"4692_CR25","volume-title":"Immediate Care of the Newborn. Evidence based guidelines for midwifery-led care in labour","author":"Royal College of Midwives (RCM)","year":"2012","unstructured":"Royal College of Midwives (RCM). Immediate Care of the Newborn. Evidence based guidelines for midwifery-led care in labour. London: RCM; 2012."},{"key":"4692_CR26","unstructured":"Royal College of Nursing (RCN). Standards for Assessing, Measuring and Monitoring Vital Signs in Infants, Children and Young People. London: Royal College of Nursing; 2017. Available from: https:\/\/www.rcn.org.uk\/professional-development\/publications\/pub-005942. Accessed 12 Jan 2023."},{"key":"4692_CR27","unstructured":"Resuscitation Council. Newborn resuscitation and support of transition of infants at birth guidelines. London: Resuscitation Council United Kingdom (RCUK); 2021. Available from: https:\/\/www.resus.org.uk\/library\/2021-resuscitation-guidelines\/newborn-resuscitation-and-support-transition-infants-birth. Accessed 12 Jan 2023."},{"key":"4692_CR28","unstructured":"World Health Organization (WHO). Early essential newborn care: clinical practice pocket guide, 2nd edition. Geneva: World Health Organization; 2022b. Available from: https:\/\/www.who.int\/publications\/i\/item\/9789290619659. Accessed 12 Jan 2023."},{"key":"4692_CR29","unstructured":"Health Education England (HEE). E-learning for healthcare. 2022. Available from: https:\/\/www.e-lfh.org.uk. Accessed 12 Jan 2023."},{"key":"4692_CR30","volume-title":"Intrapartum care. Care of healthy women and their babies during childbirth. Version 2 (NICE clinical Guideline No. CG190)","author":"National Institute for Health and Care Excellence (NICE)","year":"2017","unstructured":"National Institute for Health and Care Excellence (NICE). Intrapartum care. Care of healthy women and their babies during childbirth\u00a0[CG190]. 2017."},{"key":"4692_CR31","unstructured":"Knight M. Resuscitation of the healthy baby at birth: the importance of drying, airway management and establishment of breathing. In: Myles\u2019 textbook for midwives. 17th edition. Edinburgh: Elsevier; 2020."},{"key":"4692_CR32","unstructured":"National Collaborating Centre for Women\u2019s and Children\u2019s Health (NCC-WCH) and Royal College of Obstetricians & Gynaecologists (RCOG). Neonatal jaundice. London: Royal College of Obstetricians & Gynaecologists; 2010."},{"key":"4692_CR33","unstructured":"World Health Organization (WHO). WHO recommendations on maternal and newborn care for a positive postnatal experience. World Health Organization: Geneva; 2022a."},{"key":"4692_CR34","unstructured":"Institute of Health Visiting (iHV). Babies who have neonatal jaundice: Good practice points for health visitors. London: Institute of Health Visiting; 2022. Available from: https:\/\/ihv.org.uk\/news-and-views\/news\/updated-gpp-babies-who-have-neonatal-jaundice. Accessed 12 Jan 2023."},{"key":"4692_CR35","volume-title":"Jaundice in newborn babies under 28 days (NICE clinical Guideline No. CG98)","author":"National Institute for Health and Care Excellence (NICE)","year":"2016","unstructured":"National Institute for Health and Care Excellence (NICE). Jaundice in newborn babies under 28 days [CG98].\u00a0 2016."},{"key":"4692_CR36","unstructured":"Neonatal Nurses Association \/ University of Hertfordshire. Monitoring vital signs in the neonate. (no date b). Available from: https:\/\/www.herts.ac.uk\/study\/schools-of-study\/health-and-social-work\/course-subject-areas\/nursing\/childrens-nursing\/neonatal-nursing."},{"key":"4692_CR37","unstructured":"Resuscitation Council. Air\/oxygen blenders and pulse oximetry in resuscitation at birth. London: Resuscitation Council United Kingdom (RCUK); 2011. Available from: https:\/\/childliverdisease.org\/wp-content\/uploads\/2020\/10\/Jaundice-in-Newborn-Baby-DL.pdf. Accessed 12 Jan 2023."},{"key":"4692_CR38","volume-title":"Jaundice in newborn babies under 28 days. (Quality standard no. QS57)","author":"National Institute for Health and Care Excellence","year":"2014","unstructured":"National Institute for Health and Care Excellence. Jaundice in newborn babies under 28 days [QS57]. 2014."},{"key":"4692_CR39","unstructured":"Children\u2019s Liver Disease Foundation. Jaundice in the newborn baby. 2019. Available from: https:\/\/childliverdisease.org\/wp-content\/uploads\/2020\/10\/Jaundice-in-Newborn-Baby-DL.pdf."},{"key":"4692_CR40","doi-asserted-by":"crossref","unstructured":"Madlon-Kay DJ. Recognition of the presence and severity of newborn jaundice by parents, nurses, physicians, and icterometer. Pediatrics. 1997;100(3).","DOI":"10.1542\/peds.100.3.e3"},{"key":"4692_CR41","volume-title":"Clinical guidelines and evidence review for Post Natal Care: routine Post Natal Care of recently delivered women and their babies","author":"K Demott","year":"2006","unstructured":"Demott K, Bick D, Norman R, Ritchie G, Turnbull N, Adams C, et al. Clinical guidelines and evidence review for Post Natal Care: routine Post Natal Care of recently delivered women and their babies. London: National Collaborating Centre For Primary Care And Royal College Of General Practitioners; 2006."},{"issue":"6","key":"4692_CR42","doi-asserted-by":"publisher","first-page":"782","DOI":"10.1016\/j.jpeds.2007.11.003","volume":"152","author":"A Riskin","year":"2008","unstructured":"Riskin A, Tamir A, Kugelman A, Hemo M, Bader D. Is Visual Assessment of Jaundice Reliable as a Screening Tool to detect significant neonatal hyperbilirubinemia? Journal of Pediatrics. 2008;152(6):782\u20137.","journal-title":"J Pediatr"},{"issue":"1","key":"4692_CR43","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12887-021-02859-x","volume":"21","author":"I Dionis","year":"2021","unstructured":"Dionis I, Chillo O, Bwire GM, Ulomi C, Kilonzi M, Balandya E. Reliability of visual assessment of neonatal jaundice among neonates of black descent: a cross-sectional study from Tanzania. BMC Pediatrics . 2021;21(1):1\u2013383. https:\/\/doi.org\/10.1186\/s12887-021-02859-x.","journal-title":"BMC Pediatr"},{"key":"4692_CR44","unstructured":"Birthrights. Systemic racism, not broken bodies: An inquiry into racial injustice and human rights in UK maternity care. 2022. Available from: https:\/\/www.birthrights.org.uk\/campaigns-research\/racial-injustice."},{"key":"4692_CR45","unstructured":"World Health Organization (WHO). Guidelines on basic newborn resuscitation. Geneva: World Health Organization; 2012. Available from: https:\/\/www.who.int\/publications\/i\/item\/9789241503693. Accessed 12 Jan 2023."},{"key":"4692_CR46","doi-asserted-by":"crossref","unstructured":"Rennie JM, Beer J, Upton M. Learning from claims: hyperbilirubinaemia and kernicterus. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2018.","DOI":"10.1136\/archdischild-2017-314622"},{"key":"4692_CR47","doi-asserted-by":"crossref","unstructured":"Baskaran D, Gale C, Jawad S, Oughham K, Pang K, Basu AP. Kernicterus in neonates from ethnic minorities in the UK. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2022.","DOI":"10.1136\/archdischild-2022-324642"}],"container-title":["BMC Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12887-024-04692-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12887-024-04692-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12887-024-04692-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T05:05:03Z","timestamp":1710997503000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpediatr.biomedcentral.com\/articles\/10.1186\/s12887-024-04692-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,21]]},"references-count":47,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["4692"],"URL":"https:\/\/doi.org\/10.1186\/s12887-024-04692-4","relation":{},"ISSN":["1471-2431"],"issn-type":[{"value":"1471-2431","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,21]]},"assertion":[{"value":"18 October 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 March 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 March 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising from this submission.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Given the nature of the research design and the data collection methods employed, ethical approval was not required.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests regarding the publication of this research paper.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"198"}}