Establishing Neonatal Toxicology Testing Protocols to Prioritize Clinical Utility Reduces Racial and Socioeconomic...

Area of Science:

• Neonatal care
• Clinical toxicology
• Health equity research

Background:

• Newborn toxicology testing is often clinically irrelevant and actionable.
• Lack of a protocol at Yale New Haven Children's Hospital led to suspected overuse and discrimination.
• Disproportionate testing rates were observed based on race and insurance status.

Purpose of the Study:

• To evaluate the impact of a new protocol on newborn toxicology testing rates and disparities.
• To determine if reducing testing affects newborn outcomes and safety.
• To assess the role of quality improvement in promoting health equity.

Main Methods:

• Implementation of a hospital-wide protocol for newborn toxicology testing.
• Analysis of testing volumes, racial, and socioeconomic distributions before and after protocol implementation.
• Tracking of newborn outcomes, including hospital readmissions for withdrawal symptoms.

Main Results:

• Testing rates decreased significantly from 3.2% to 0.3% after protocol implementation.
• Disparities in testing rates by race and insurance status were eliminated.
• No increase in hospital readmissions for withdrawal or adverse events was observed.

Conclusions:

• Reducing newborn toxicology testing is feasible and safe when coupled with social support.
• A quality improvement initiative can effectively decrease testing overuse and address health disparities.
• This approach highlights the importance of evaluating clinical utility and promoting health equity in neonatal care.