Observational studyEuropean journal of pediatrics2020
Validation of a neonatal skin color scale.
Observational study in European journal of pediatrics, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
11 citing papers in PubMed, 21 citations in OpenAlex.
- Comparison of the analgesic effect of inhaled lavender vs vanilla essential oil for neonatal frenotomy: a randomized clinical trial (NCT04867824).European journal of pediatrics · 2022Trial
- Assessing Clinical Deterioration in Children With Dark-Coloured Skin: A Scoping Review.Journal of clinical nursing · 2026Article
- Universal Transcutaneous Bilirubin Screening in a Midwifery-Led Home Care Setting.JAMA network open · 2026Article
- Race Is an Incomplete Surrogate for Skin Pigmentation in Neonates, with Potential Relevance for Pulse Oximetry.The Journal of pediatrics · 2025Article
- Smartphone-based screening of neonatal jaundice in three populations in low and middle-income countries: a cross-sectional study.BMJ paediatrics open · 2025Article
- Transcutaneous bilirubin reliability during and after phototherapy depending on skin color.European journal of pediatrics · 2024Observational
- Neonatal jaundice in Ghanaian children: Assessing maternal knowledge, attitude, and perceptions.PloS one · 2022Article
- Reliability and agreement of instrumental skin barrier measurements in clinical pressure ulcer prevention research.International wound journal · 2021Article
- Reliability of transcutaneous bilirubin determination based on skin color determined by a neonatal skin color scale of our own.European journal of pediatrics · 2021Observational
- Objective Assessment and Quantification of Skin Color and Melanin in Neonates and Infants: A State-Of-The-Art Review.Pediatric dermatologyReview
- Validation of a Mobile Health Device for Neonatal Jaundice Screening: A Cross-Sectional Study in a Resource-Limited Setting in Mexico.Sage open pediatricsArticle
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Ethnic classification does not correlate well with skin tone. As there are no neonatal skin color scales, we aimed to create and validate one of our own. After creating the scale and briefly training our staff, we conducted a prospective, observational study to assess reproducibility and correlation of each scale color with the melanin and erythema indexes and transcutaneous bilirubin. The reliability of our color scale was measured using Kappa agreement (and its 95% confidence interval) and the concordance index by comparing inter-observer classification of neonatal skin color. We also calculated inter-rater agreement with the intraclass correlation coefficient (ICC). The Kendall tau-b correlation coefficient was used to test the correlation between our color scale and the Mexameter® MX 18. We obtained data from 258 newborns. Inter-observer agreement on color assignment was 83.2%. Median melanin index was significantly different among the 4 color groups, whereas erythema index and transcutaneous bilirubin were not.Conclusions: Our proposed neonatal skin color scale correlates well with the melanin index at 24 h of life, increasing from colors 1 to 4, and the only chromophore different among our four color groups is melanin. Scale color assignment is reproducible. Therefore, it can be used to classify neonatal skin color. Further research is warranted to assess the clinical relevance of these findings. What is known: • Classifying neonates by skin color is difficult because to date there are no skin color scales available based on real skin tone regardless of ethnicity or country of origin. • Skin color differs among individuals from a given ethnic group and depends, among others, on melanin and hemoglobin. What is new: • We created a neonatal skin color scale based on real skin color. • We conducted a study to validate it, and confirmed a good inter-observer agreement in color assignment as well as a good correlation between each color in the scale and the median melanin level.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.