Description

We describe the case of a newborn female baby, born at term after an uncomplicated pregnancy and a caesarean section. She had a cephalic presentation and weighed 3820 g at birth. She cried immediately after birth. After 8 min of life, intense pallor appeared from the knee to the toes of the right foot (figure 1). The episode lasted about 11 min and resolved spontaneously in a cephalocaudal direction (figure 2). This Harlequin phenomenon, which is transient, is related to a benign skin disorder and can occur in approximately 10% of healthy newborns.1–3 The phenomenon presents as a well demarcated colour change, with one half of the body manifesting erythema and the other half manifesting pallor. It usually occurs between the second and fifth days of life, but there are cases in the literature mentioning occurrence up to 3 weeks of age.1 ,3 It has an average duration between 30 s and 30 min and occurrence can vary from 1 to 12 episodes over a period of 24 h.1 ,3 Although the exact cause of this phenomenon is unknown, it appears to be related to vasomotor instability caused by hypothalamic immaturity, frequent at this age. The gravity effect seems to trigger most cases. When newborns are placed in the lateral decubitus position, the plethoric half seems to be side-dependent and the pale half arises from the contralateral side. With crying, this change may disappear.3

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Figure 1

Pallor in the inferior 1/3 of the right lower limb after birth—Harlequin phenomenon.

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Figure 2

Spontaneous resolution of Harlequin phenomenon in a cephalocaudal direction.