Fair Frankie J, Furness Amy, Higginbottom Gina, Oddie Sam J, Soltani Hora
College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK.
School of Health Sciences, University of Nottingham, Nottingham, UK.
Pediatr Res. 2025 Feb;97(3):939-952. doi: 10.1038/s41390-024-03543-3. Epub 2024 Sep 14.
Apgar score and cyanosis assessment may disadvantage darker-skinned babies. This review explored cyanosis and Apgar score assessments in Black, Asian, or minority ethnic neonates compared to White neonates.
Four databases were searched. Studies of any methodology were included. A narrative synthesis was undertaken.
Ten studies were included. Three studies involving over 39 million neonates showed Apgar score ≤3 was predictive of neonatal mortality across all ethnicities. Black babies with Apgar score ≤3 had lower mortality rates before 28 days, however, variations in scoring practices were also observed. Three further studies (n = 39,290,014) associated low Apgar scores with poorer mental development up to 22 months, especially in mixed ethnicity and Black infants. One study reported inadequate training in assessing ethnic minority neonates. Cyanosis was the focus of three included studies (n = 455) revealing poor visual assessment of cyanosis across ethnicities. With pulse oximetry occult hypoxemia occurred slightly more frequently in Black neonates. Tongue color indicated oxygen requirement at birth, regardless of ethnicity.
Apgar scores correlate well with neonatal mortality in all ethnicities, however scoring variations exist. Cyanosis assessment is challenging, with tongue and lips the best places to observe in the absence of pulse oximetry.
Assessment of the color component of the Apgar score and of cyanosis visually are not accurate in babies with darker skin. Small racial differences may exist for pulse oximetry in neonates, but it is more reliable than visual assessment.
阿氏评分和发绀评估可能对肤色较深的婴儿不利。本综述探讨了与白人新生儿相比，黑、亚或少数族裔新生儿的发绀和阿氏评分评估情况。
检索了四个数据库。纳入了任何方法的研究。进行了叙述性综合分析。
纳入了十项研究。三项涉及超过3900万新生儿的研究表明，阿氏评分≤3可预测所有种族的新生儿死亡率。阿氏评分≤3的黑人婴儿在28天前的死亡率较低，然而，评分实践也存在差异。另外三项研究（n = 39290014）将低阿氏评分与22个月前较差的智力发育相关联，尤其是在混合种族和黑人婴儿中。一项研究报告称，在评估少数族裔新生儿方面培训不足。发绀是三项纳入研究（n = 455）的重点，揭示了各种族对发绀的视觉评估不佳。使用脉搏血氧饱和度仪时，黑人新生儿隐匿性低氧血症的发生率略高。无论种族如何，出生时舌色可提示氧气需求。
阿氏评分与所有种族的新生儿死亡率密切相关，然而评分存在差异。发绀评估具有挑战性，在没有脉搏血氧饱和度仪的情况下，舌头和嘴唇是观察的最佳部位。
对于肤色较深的婴儿，视觉评估阿氏评分的颜色成分和发绀并不准确。新生儿脉搏血氧饱和度仪可能存在微小的种族差异，但它比视觉评估更可靠。
