BACKGROUND:
Ethnic inequalities in neonatal healthcare are increasingly recognised; with concerns around practices primarily developed on White babies and normalised to diverse populations regardless of applicability.

OBJECTIVES:
To review neonatal assessments which include assessing skin colour, particularly Apgar score, cyanosis, and jaundice in Black, Asian, and minority ethnic newborns.

METHODS:
A mixed methods approach comprised of policy review, systematic reviews and stakeholder interviews with 24 parents and 33 healthcare providers.

RESULTS:
Within the literature neonatal mortality increased with low Apgar scores in all ethnicities. Neonatal mortality was lower in Black infants with an Apgar score ≤3 than White infants. However, more Black infants received lower scores. Healthcare provider interviews suggested inconsistent Apgar scoring, including inadequate assessment of individual components. Relevance of the terms ‘pink’ and ‘blue’ for darker pigmented infants was disputed. However, ‘pink’, ‘blue’ and ‘pale’, were widely used within policies without adequate differentiation for different skin tones. Literature revealed poor visual detection of cyanosis in all infants, with pulse oximetry preferred. Occult hypoxaemia was however higher in Black (9.2%) compared to White infants (7.7%). Interviews confirmed inadequate visual cyanosis detection and concerns over more severe hypoxia in darker pigmented infants. The literature suggested transcutaneous bilirubinometers (TCB) detected jaundice more accurately than visual assessment, with no consistent pattern regarding TCB accuracy in dark vs. light pigmented neonates. Interviews noted healthcare providers employed a lower threshold for testing minority ethnic neonates to prevent missing jaundice. Several parents reported professionals dismissed their concerns about jaundice. Many healthcare providers described lacking confidence to assess darker pigmented infants.

CONCLUSIONS:
Assessments such as Apgar score, cyanosis and jaundice are particularly difficult in darker pigmented neonates. Skin colour should not be relied upon in isolation.

KEY MESSAGE:
To reduce inequalities healthcare provider education, guidelines and policies should highlight limitations of visual assessment and terms ‘pink’, ‘blue’ or ‘pale’ for global majority neonates. Poster session 1 (Group A)