Detection of intrauterine illicit drug exposure by newborn drug testing

Identification of intrauterine drug-exposed newborns with toxicological screening may have benefits including close follow-up of the infant by both medical and social services. Applying specific written guidelines to select newborns for drug testing decreases bias and protects the physicians and hospitals involved. All drugs reported as positive should be confirmed by an appropriate second test. Urine and meconium testing are the best current options for identifying drug-exposed neonates. Urine testing sensitivity is low because of problems encountered in urine collections and the high thresholds used in current urine assays. The disadvantage to meconium testing is the increased labor and time required to work with this material. Testing of newborn hair is unlikely to be widely used until technically less demanding assays become available. Testing of amniotic fluid or gastric lavage is still in the developmental stages. Adopting lower urine assay thresholds for newborn samples would increase sensitivity and would be an appropriate modification of current methodologies.