Neonatal Toxicology Testing: Ethical Considerations for Pediatricians

Pediatricians caring for newborns during the birth hospitalization are tasked with identifying and managing newborns with prenatal substance exposure and neonatal opioid withdrawal syndrome (NOWS) and coordinating care plans for affected families. Neonatal toxicology testing (NTT) is a frequently used tool to identify and clinically manage NOWS. At times, however, the harms of testing may outweigh the benefits. Current variability in NTT practices continue to result in negative consequences and harm to affected newborns and their families, adding to perpetuation of bias, inequity in who is tested, and separation of newborns from families. This article highlights well-described ethical principles and frameworks that have the potential to inform clinical practice and policies related to exposed newborns and NTT, which can help to align medical care and legislative requirements, reduce variability and inequity found in current testing approaches, and optimize the health and well-being of affected newborns and families. Pediatricians are well positioned to provide education, influence policy, and challenge the current use of NTT results in legislative definitions of NOWS. Along with hospital leaders, pediatricians should critically examine current toxicology testing practices and hospital policies with the goal of developing supportive, rather than punitive, approaches to care. This article focuses on in utero opioid exposure and may be more generally applied to exposure to other substances.