Current Inequities in Neonatal Toxicology Testing, Why They Exist, and How We Can Move Toward an Equitable Future

Newborn toxicology testing (NTT) has been consistently shown to be ordered more frequently in newborns who are born into families that are minoritized, including poor families, Black families, and American Indian/Alaskan families. These inequitable ordering patterns lead to adverse downstream consequences for many families. NTT practices can be successfully changed by implementing protocols that limit indications for NTT to clinically necessary reasons. NTT should be ordered when it answers a clinical question that will lead to improvement in care during the newborn hospitalization. Hospital policies created by a multidisciplinary team, including people with lived experience, should guide practice and lead to regular policy assessments that evaluate effectiveness and equitable outcomes. Policies directed at support for pregnant patients with substance use disorder are highly effective at mitigating substance use during pregnancy and optimizing newborn outcomes. Criminalization of substance use during pregnancy harms families, and pediatric clinicians should work to change these punitive systems.