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Updated: Feb 21, 2026

Visualizing Visual Adaptation
Published on: April 24, 2017
Harlequin Colour Change
Suneeta Khemani1, Shirin Bahadur Ali1, Sarfaraz Karim1
1Department of Paediatrics, Aga Khan Hospital for Women and Children, Kharadar, Karachi.
Abstract:
Harlequin colour change (HCC) is a rare, benign and transient colour change presenting in normal healthy neonates in initial days of life and resolves spontaneously. It is thought to be due to hypothalamic immaturity, leading to capillary bed dysregulation. Gravity might also play a role, as this is apparent on the dependent side. It is important for physicians to recognize this phenomenon so that they do not order any irrelevant investigations. Here, we present a case of a healthy neonate who had HCC, which was unilateral, well demarcated erythema, with patchy pallor. Baby was vitally stable at that time. This colour change was observed twice and each time resolved within 20 minutes of its appearance and was not observed again to date (after 20 days). Baby was discharged in a stable condition after 48 hours of life.
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