565 - Did racist differences persist after revision of guidelines for screening of infants for exposure to substance use?

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 565
Publication Number: 565.412

Carl T.. D'Angio, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States; Lynnette M. Johnson, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States

Presenting Author(s)

Lynnette M. Johnson, DO (she/her/hers)

Assistant Professor
Golisano Children's Hospital at The University of Rochester Medical Center
Rochester, New York, United States

Background: Screening newborns for exposure to maternal substance use has legal, social and privacy implications. A previous study suggested that screening was racially biased in its application in our NICU, leading to revised guidelines.

Objective: To determine whether infant drug screening was applied in a racially-biased manner. We hypothesized that infants identified as Black would be more likely to be screened than non-Black infants, and that this would not be explained by differences in infants or mothers meeting screening criteria.

Design/Methods: Maternal and infant records for NICU admissions from 1/2021 to 9/2022 were reviewed for documented evidence of meeting substance use screening criteria in our guidelines. Mandatory screening criteria were maternal cocaine, opiate, methamphetamine, alcohol or marijuana use, limited prenatal care (< 5 visits), and placental abruption without preeclampsia. Criteria prompting screen consideration (“conditional”) included infant neurologic complications, drug withdrawal symptoms, growth restriction < 10th percentile, urogenital anomalies, and necrotizing enterocolitis at < 72 hours of age. Maternal conditional criteria included premature labor, precipitous delivery, unexplained hypertensive episodes, severe mood swings, cerebrovascular accident, myocardial infarction, and repeated spontaneous abortions. We assessed whether infants had a urine drug screen for amphetamines, barbiturates, cocaine, benzodiazepines, opiates, and cannabinoids performed, whether they met mandatory or conditional criteria, and evaluated differences by race. Data were analyzed using Fisher exact test.

Results: We assessed 1939 infant-mother pairs. 24.1% of the infants were Black. Black infants were more likely than non-Black infants to have a screen performed (Table). Among 981 infants meeting any screening criterion, Black infants were not more likely to be screened than non-Black infants, nor were those meeting mandatory criteria only (N=512). Few screens (2 Black infants, 5 non-Black infants, p=1.0) were performed for conditional criteria alone. However, more Black than non-Black infants had testing performed when no criteria for testing could be identified. Among 170 infants with screens performed, there was no racial difference in positive screen proportions.

Conclusion(s): Drug screens performed using strict criteria resulted in infants being appropriately screened without a racial bias. Optional (conditional) criteria were seldom used. Screening outside of defined criteria resulted in persistent racial bias and should be avoided.