Advances, Nuances, and Future Directions in Neonatal Toxicology Testing

Toxicology testing is a commonly used tool applied to the identification and management of infants with prenatal substance exposure. Although such testing has the potential to aid in the clinical management of newborns, clinicians who order such testing are frequently unaware of the limitations and harms of testing and the impact of the test results on the pregnant person-newborn dyad. In this review, we summarize the types and limitations of neonatal toxicology tests and identify areas for improvement, including policy change and advocacy, to drive equitable care for newborns and families with perinatal substance exposure. Clinicians ordering toxicology testing for neonates must understand their facility's testing capabilities, the screening vs confirmatory nature of that available testing, how to proceed with confirmatory testing of a screening test, and how to accurately interpret the result of that test.