Objective Assessment and Quantification of Skin Color and Melanin in Neonates and Infants: A State-Of-The-Art Review

Neonatal skin color, especially melanin assessment, remains an underexplored topic in neonatology and dermatology literature. Growing concerns about racial bias in pulse oximeters in adults highlight the need for objective assessment of skin color to investigate if skin pigmentation contributes to the inaccuracy. While skin color scales and cutaneous colorimetric devices have been utilized in adult dermatology for various applications, their use and effectiveness in neonates and infants are not well understood. Objective classification and quantification of skin color in these populations are crucial for a better understanding of the inaccuracies of skin transmittance-based devices like pulse oximetry. This state-of-the-art review provides methods and findings from studies assessing neonatal skin color and pigmentation in objective and quantifiable ways, focusing on age-dependent and site-specific effects. Our goal is to provide a comprehensive overview of current knowledge regarding objective assessment of skin pigmentation, particularly melanin. We aim to guide future research efforts aimed at enhancing the accuracy of pigment measurements in medical devices, especially concerning neonates and infants.