Toxicology Testing in a Newborn ICU: Does Social Profiling Play a Role?

A rising incidence in maternal drug use during pregnancy has led to a concomitant rise in neonatal opioid withdrawal syndrome. Despite evidence that drug use during pregnancy affects all demographic groups equally, authors of recent studies have suggested that minority women are tested for drug use more than their counterparts. In this study, we aimed to assess whether toxicology testing of neonates was associated with maternal characteristics.

Retrospective cohort study reviewing charts of neonates born at an urban academic center between January 1, 2018, and December 31, 2018, who underwent toxicology testing. Demographics from tested neonates were taken from mothers' self-reported data and compared with sociodemographics of all mothers with deliveries in 2018, including age, race, marital status, and zip code. Indication for toxicology testing as recorded by ordering clinician was also collected. There were no standardized guidelines for toxicology testing during this study period.

Of 6438 births in 2018, toxicology testing was sent on 86 neonates (1.3%). Mothers of neonates with testing were younger (P < .0001), less likely to be white (P < .0001), self-reported "single" (P < .0001), and lived in lowest income zip codes (P < .0001). Indications for testing were varied, with the most common indications including maternal substance use disorder (37%) and marijuana use (26%).

Maternal age, race, marital, and socioeconomic status were associated with toxicology testing on neonates, although data suggest that drug use affects all demographic groups. Current practice at our institution may overtest some groups. Evidence-based, standardized guidelines are urgently needed to reduce bias and repercussions of toxicology testing of neonates.