(see also Harlequin syndrome)

Benign vasomotor phenomenon occurring transiently during the first week of life in about 10% of newborns. Red discoloration of the skin suddenly appears  in a region of the body (upper or lateral hemibody) and is accompanied by pallor in other body areas. This phenomenon is attributed to immaturity of the vasomotor system.

Anesthetic implications: 

not to be confused with

1 - recessive congenital ichthyosis (see this term) with a harlequin fetal aspect already present at birth. This disease is an immediate threat to the life of the child due to  respiratory, infectious or hydroelectrolytic disorders.

2 - a right-to-left shunt through a patent ductus arteriosus in case of pulmonary artery pressure that are greater than the  systemic pressure: in this case, the colour of the child is bluish below the level of the shunt i.e. the abdomen, the limbs and often the left upper limb.

   from Pekurovsky A. (Anesthesiology)

References : 

-         Wagner DL, Sewell AD. 
Harlequin color change in an infant during anesthesia. 
Anesthesiology 1985; 62:695.

-         Adhisivam B, Chandrasekaran V. 
A half-red baby. 
N Engl J Med 2013 369; 4: 373.

-        Pekurovsky A, Monteleone MP. 
Harlequin phenomenon in a newborn after induction of general anesthesia. 
Anesthesiology 2015; 123:1187

        Updated: May 2018

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