Giving a newborn a drug test might seem like it’s a strange process to perform, but there is a reason for it. Identification of newborns exposed to illicit substances can alert the practitioner to problems one might encounter in the delivery room and nursery, such as intoxication, withdrawal syndromes, and long-term needs for exposed neonates. It can also serve as an opportunity to identify families with substance abuse disorders, which can put the newborn at risk after being discharged from the hospital.
According to a report from the U.S. National Institutes of Health, self-reports of illicit drug use are often inaccurate and universal drug testing is neither practical for the clinician nor recommended by the American Academy of Pediatrics](https://www.aap.org/en-us/Pages/Default.aspx). It is recommended, however, that every facility that provides newborn care establish their own testing protocols, including establishing unbiased guidelines to identify those who should be tested.
Two modes of testing are available: umbilical cord tissue and meconium. Meconium is the earliest stool of an infant composed of materials ingested while the infant is still in the uterus. Meconium the traditional specimen to detect and document drug use during pregnancy, while umbilical cord tissue is relatively new for testing.
Effects of Maternal Drug Use
Exposure to maternal drug use during pregnancy may lead to adverse effects such as poor neonatal development and acute adverse effects such as infant mortality and neonatal abstinence syndrome (NAS). NAS is a group of conditions caused when a baby is exposed to certain drugs in the womb, most often opioids, and is withdrawn from those drugs after birth. NAS can lead to long-term health and developmental problems such as hearing and vision problems and issues with learning and behavior. Most babies with NAS get treatment in the hospital after birth and typically get better within a few days or weeks.
Universal vs. Risk-Based Testing
There are advantages and disadvantages to both universal and risk-based testing. Universal testing will generate more positive results that require follow-up by the laboratories and patient care teams, as well as may increase referrals to social services and play an increased burden on governmental agencies for relatively low-risk mothers.
Risk-based testing uses hospital-defined criteria such as maternal history or signs of drug use, social risk factors, limited or absent prenatal care, and symptoms of withdrawal. This testing approach, however, may be perceived as unfairly profiling mothers, exposing the institution to legal issues. Risk-based testing may also miss infants exposed to drugs if the policies do not adequately identify and test for probable exposures.
Drug Testing for Newborn Exposure by State
States handle drug use during pregnancy differently. Tennessee is the only state with a statute that specifically makes it a crime to use drugs while pregnant. Alabama and South Carolina have interpreted existing child endangerment and chemical endangerment statues to all prosecution of drug-using pregnant women.
Eighteen states have laws that say drug use during pregnancy is child abuse. Additionally, in three states, Minnesota, South Dakota, and Wisconsin, women who use drugs during pregnancy can be involuntarily committed to a treatment program. In fifteen states, health care workers are required to report to authorities if they suspect a woman is abusing drugs during pregnancy. In most states, there is no law that requires hospitals to test infants and new moms for illicit substances. In Minnesota and North Dakota, a test is required if drug-related complications occur at birth. The following four states require testing if drug use during pregnancy is suspected (risk-based testing): Iowa, Kentucky, Minnesota, and North Dakota.