A leading medical Academy may scrap its guidance on treating jaundice in newborns because it contains the phrase ‘black race’ — despite warnings it is harder to spot the condition in babies of African descent.
The American Academy of Pediatrics currently lists being black as a risk factor for the condition, which triggers a yellowing of the skin and eyes.
But as part of its mission to purge the catalogue of ‘race-based’ language, the academy told DailyMail.com it was reviewing the 20-page guidance and aimed to retire it ‘as expeditiously as possible’, and within this year.
The Center for Disease Control and Prevention (CDC) warns jaundice may be harder to recognize in black infants because of their darker skin color.
It tells doctors to check gums or inner lips for the condition, and test black infants for the condition if they are concerned.
It was not clear whether the paper would be replaced, but last year guidelines on treating urinary tract infections that were retired for containing the phrase ‘non-black race’ were not re-instated.
The American Academy of Pediatrics is on a mission to purge its catalogue of ‘race-based language’. It is currently reviewing guidance for treating jaundice in newborns, which contains the phrase ‘black race’. This is despite the CDC warning these babies are more at risk
Jaundice is one of the most common conditions that can affect newborns with about six in ten developing it every year, estimates suggest.
Most youngsters are checked for the condition within 72 hours of being born, although it is normally harmless to them.
It is triggered by the build-up of bilirubin — a yellow substance made when red blood cells are broken down — in the bloodstream.
What is jaundice?
Jaundice is a yellow discoloration in the skin and eyes.
In babies, it occurs because their blood contains an excess of bilirubin, a yellow-colored pigment of red blood cells.
It is common in babies, particularly those born before 38 weeks gestation (preterm babies) and some breast-fed babies.
Infant jaundice usually occurs because a baby’s liver isn’t mature enough to get rid of bilirubin in the bloodstream. In some cases, an underlying disease may cause jaundice.
Treatment of infant jaundice often isn’t necessary, and most cases that need treatment respond well to noninvasive therapy.
Although complications are rare, a high bilirubin level associated with severe infant jaundice or inadequately treated jaundice may cause brain damage.
Source: Mayo Clinic
This is more likely to affect infants because they have more red blood cells and their livers are not yet fully developed, so are less able to remove bilirubin from the blood.
Doctors say treatment for the condition is not normally needed because the symptoms pass within 10 to 14 days.
But in cases where bilirubin levels are ‘very high’ a transfusion may be offered, because these can lead to brain damage.
Dr Tiffani Johnson, an emergency medicine physician and who is involved in the drive to ‘eliminate race-based medicine’ at the AAP, told DailyMail.com they were aiming to evaluate ‘all of our guidelines with a racial equality lens’.
She said: ‘The goal is to dig deeper, so that when we see racial differences, we recognize that race is usually a proxy for racism or other social determinants of health.’
She added: ‘Doing this work is going to be hard — it will be a heavy lift and examining the biases built into our own structures will make some uncomfortable.
‘However, this work is critically important if we are to ensure that all children have an equal chance to achieve their highest level of health and well-being.’
In the current guidelines, ‘black race’ is mentioned in the table showing ‘risk factors for the development of severe hyperbilirubinemia (jaundice)’.
It is referenced to a study carried out in 2001 and published by the AAP, which looked into factors predicting jaundice in newborns and near-term babies.
When asked what the phrase may be replaced with, a spokeswoman for the AAP pointed DailyMail.com to the AAP’s ‘inclusive, anti-biased’ language guide.
This says that documents should not use the word ‘race’ because it can be ‘misleading or inaccurate’ in some instances.
It says that terms such as ‘black’ may be used to describe a specific group.
The CDC says online: ‘Jaundice may be missed or not recognized in a baby with darker skin color. Checking the gums and inner lips may detect jaundice.’
Britain’s National Health Service says: ‘Yellowing of the skin can be more difficult to see in brown or black skin. It might be easier to see on the palms of the hands or the soles of the feet.’
In a new policy announced Monday, the AAP said it is putting all its guidance under the microscope to eliminate ‘race-based’ medicine and resulting health disparities.
A re-examination of AAP treatment recommendations that began before George Floyd´s 2020 death and intensified after it has doctors concerned that Black youngsters have been undertreated and overlooked, said Dr. Joseph Wright, lead author of the new policy and chief health equity officer at the University of Maryland’s medical system.
The influential academy has begun purging outdated advice.
It is committing to scrutinizing its ‘entire catalog’, including guidelines, educational materials, textbooks and newsletter articles, Wright said.
‘We are really being much more rigorous about the ways in which we assess risk for disease and health outcomes,’ Wright said. ‘We do have to hold ourselves accountable in that way. It´s going to require a heavy lift.’
Dr. Brittani James, a family medicine doctor and medical director for a Chicago health center, said the academy is making a pivotal move.
‘What makes this so monumental is the fact that this is a medical institution and it´s not just words. They´re acting,’ James said.