Neonatal skin colour

The colour of the newborn’s skin gives clues about the health of the baby and there will also be obvious differences in natural skin colour, due to pigment levels in the skin.

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The African-American baby girl on the right, clearly has darker skin than the Caucasian baby on the left. This difference in skin colour is due to melanin (the pigment in human skin). Dark-skinned babies have more melanin in their skin than light-skinned babies. Melanin is produced by cells called melanocytes and apart from skin, also gives our hair and eyes their colour.

What about conditions that can cause the skin colour to change?

There are a number of conditions that can alter the colour of the skin of a newborn that you need to be aware of. Imagine a paint chart that you might find in a hardware shop…

Cyanosis

One of the most important symptoms of low blood oxygen concentrations in the newborn (hypoxia) is a change in skin colour, known as cyanosis. This is where the skin has a bluish hue. In dark skinned babies, this can be more difficult to see. For this reason, always inspect the mucous membranes (inside the mouth and the tongue) to determine if cyanosis is present. If you discover the mucous membranes are blue, this is known as central cyanosis.

It’s important to note that in the term newborn, the hands and feet will be cyanosed immediately at birth and for several hours afterwards – this is known as acrocyanosis and occurs because the newborn is transitioning from intra-uterine to extra-uterine life. Acrocyanosis is completely normal!

Pallor

Pallor simply means pale. The main reason for a newborn to exhibit pallor is due to blood loss. This is very serious and requires immediate intervention.

Jaundice

Jaundice refers to the yellow discolouration of the skin, caused by a build-up of bilirubin in the body. This condition is known as hyperbilirubinaemia. Bilirubin is a breakdown of red blood cells, formed in the liver. It is a pigment that is yellowy-orange in colour. Jaundice is a common condition in term babies and occurs in almost all premature babies. This is due to an immature liver and a higher circulating red blood cell volume at birth, which breaks down in the first few days of life. In babies with severe hyperbilirubinaemia, the whites of the eyes (sclera) may also be stained yellow.

Polycythaemia

Some babies are born with a higher than normal level of red blood cells (haematocrit). These neonates are considered to have polycythaemia. They can be asymptomatic (showing no symptoms) or demonstrate a range of non-specific symptoms. Most neonates with polycythaemia will have a ruddy-red, sanguine appearance. This is quite different from a ‘pink’ baby – and rest assured, the colour difference will be immediately obvious to you.

Your task

Jaundice is a fairly common presentation for newborns. Using the comments link below, post any questions and comments you may have about skin colour and share your experiences with jaundice.

References

Kain, V. & Mannix, T. (2018). Neonatal Nursing in Australia and New Zealand, 1st Edition. Australia: Elsevier