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Evidence Library · What is normal

Present in 96 of 100 Black newborns, written down in none of 124 charts

A 1981 study of 437 babies found a mark almost every Black newborn had, and then found it recorded nowhere.

Some findings deserve their own moment. This is one, and it is as much a fact about medical records as about babies.

In 1981, a study at Jackson Memorial Hospital in Miami examined 437 consecutively born full-term newborns for the flat blue-grey patch known then as a Mongolian spot and now as dermal melanocytosis. It usually sits over the lower back and buttocks, sometimes the shoulders, and it looks, to anyone who has not seen one before, exactly like a bruise.

Group, 437 newborns, Miami, 1981Had the finding
Black infants96%
Hispanic infants46%
White infants9.5%

Now the part that matters. The same researcher reviewed 124 newborn records from the same hospital over the same period. The finding, quoted exactly: dermal melanocytosis was not described by house officers in any, although the probability of its occurrence would have been approximately 90 cases, based on the results of the study.

Something present in roughly nine of ten Black newborns appeared in zero of 124 charts. Parents are not told about it because the people examining the baby were not writing it down.

Two modern checks, in mixed populations. The San Diego study of 594 US newborns found dermal melanocytosis in 20%. A Brazilian study of 2,530 newborns found it in 24.61%. Both fit the pattern; neither breaks the numbers down by race.

The honest limits of the 1981 figures. That study is more than forty years old, from one hospital, with 437 babies. No modern US study reporting this finding by race could be found for this guide. So the 96% is published here as what one Miami hospital found in 1981, dated on purpose, not as a current national figure. The gradient across groups is consistent with the two modern studies; the exact numbers should be read as their era's.

Why this belongs in a consent guideA mark this common, this harmless and this easily mistaken for an injury should be named to every parent before discharge, and it often is not. Families have been questioned about bruising that was a birthmark. If the finding is on your baby, you are entitled to have it written in the record, in words, before you go home.
Say this out loud"Does my baby have any birthmarks, and can you show me where they are?"
"Please write the blue-grey patches into the notes and tell me what they are called."
"Will these fade, and roughly over what time?"
Where this comes from:
685. Cordova A. The Mongolian spot: a study of ethnic differences and a literature review. Clin Pediatr (Phila). 1981;20(11):714-9.
682. Kanada KN, Merin MR, Munden A, Friedlander SF. A prospective study of cutaneous findings in newborns in the United States: correlation with race, ethnicity, and gestational status using updated classification and nomenclature. J Pediatr. 2012;161(2):240-5.
683. Reginatto FP, DeVilla D, Muller FM, Peruzzo J, Peres LP, Steglich RB, et al. Prevalence and characterization of neonatal skin disorders in the first 72h of life. J Pediatr (Rio J). 2017;93(3):238-45.

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