Tests to assess newborn babies’ health are not effective for non-white children and should be replaced, according to the NHS Race and Health Observatory.
In the UK, neonatal death rates among black and Asian newborns are much higher than for white babies.
A review of neonatal tests by Sheffield Hallam university, commissioned by the Race and Health Observatory, found that the Apgar score, used at birth to assess a newborn’s health, can give misleading scores for BAME babies, because it was developed for white European babies in 1952.
Tests involve assessing the baby’s skin tone, heart rate, reflexes, muscle tone and breathing within a few minutes of birth.
The review analysed about 200 studies and more than 80 policies about assessing newborn babies’ health. Researchers also conducted interviews with 33 healthcare professionals and 24 parents.
They found that some guidance on a healthy newborn’s skin tone still referred to terms such as “pink” “blue” “pale” or “pallor”, with no reference to alternative descriptions for black, Asian and other skin types.
The review also highlighted “reliability concerns” of two other neonatal assessments to detect cyanosis and jaundice. The fear is that health conditions in BAME babies could therefore be missed because these tests can miss signs of illness.
Jaundice – where the skin and the whites of the eyes appear yellow – is very common in babies. If identified early, it can be treated with phototherapy. But untreated, more serious jaundice can cause seizures, learning disabilities and hearing problems.
Cyanosis occurs when a newborn has insufficient oxygen in their blood, requiring urgent treatment. A common symptom of cyanosis is a change in skin colour, often described as the skin turning blue or grey.
The review found that skin colour observations for these conditions were unreliable, especially for those with darker skins. It recommends guidelines on neonatal skin colour assessment to be replaced with more accurate devices such as pulse oximeters and bilirubinometers and blood tests instead to diagnose jaundice and cyanosis, and for the suitability of Apgar scores to be urgently reviewed.
It also calls for better training on how to assess the health of newborns from black, Asian and minority ethnic backgrounds.
Otherwise, BAME newborns risk late diagnosis and poorer health outcomes, according to Dr Habib Naqvi, the chief executive of the NHS Race and Health Observatory.
He 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 minority ethnic 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.”
Dr Shabna Begum, co-chief executive of the Runnymede Trust, said models of healthcare must not universalise the white European body and called for the practical changes the report recommended to be implemented urgently.
“From the moment a child is born, the healthcare that black and minority ethnic babies are afforded is designed and delivered based on white European measures that are inadequate and inappropriate to their care.
“It has been known for decades that certain medical practices are not fit for purpose and directly discriminate against those with darker skin tones and yet, there has been no action to address this in any concerted way.”
“Until we take seriously an anti-racist approach to healthcare, black and minority ethnic people are being actively harmed.”
Health experts welcomed the findings. A spokesperson for the British Association of Perinatal Medicine said: “We fully support the recommendations which will ensure that black, Asian, and minority ethnic newborn babies with serious health conditions are identified at a much earlier stage, thereby improving experience and saving lives for these babies and their families.
“This is an important step forward to reduce inequalities in health care in babies.”
Carmel Bagness, RCN Professional Lead for Midwifery and Women’s Health, said: “This is a welcome report which highlights the need for more suitable health checks for newborn babies from black, Asian and minority ethnic babies with darker skin tones.
“It also highlights that adequate and consistent education is required nationally to ensure staff and students have the necessary skills to identify health issues in all babies, whatever their background.
“The recommendations to improve training and education in this area is a positive step towards ensuring staff are better equipped and will enable treatments to be delivered earlier if required.
“We also welcome the recommendation for an urgent review and update of written and digital materials provided to parents. Far too often they are left without the information they need to help them make informed decisions about care.”
A Department of Health and Social Care spokesperson said:“We are absolutely clear that maternity care must be of the same high standard for everyone.
“NHS England has published guidance for local maternity systems, supported by £6.8m, focusing on actions to reduce disparities for women and babies from ethnic minorities and those living in the most deprived areas.
“We also set up the maternity disparities taskforce, which brings together experts from across the health system, government departments and the voluntary sector to explore and consider evidence-based interventions to tackle maternal disparities.”
