Drug screening the potentially substance-exposed infant

Consider a newborn drug screen if any of the following risk factors are present:


Known drug use

History of drug use

Erratic behavior

Inconsistent or no prenatal care

Sexually-transmitted disease

No stable home

Multiple partners

Excessive/teenage smoking



Placental abruption

Preterm labor/asphyxia

Maternal hypertension





Abnormal behavior (unexplained jitteriness, agitation, or seizures, etc.)

Dysmorphology compatible with fetal alcohol syndrome

Abnormal physical findings (IUGR, cerebral infarction, etc.)

The risk factors in bold should almost always prompt a drug screen.

A specimen for drug screening should be obtained as soon as suspicion arises. The physician should inform the mother that a drug screen has been sent. The physician should also make the social workers aware of the concerns, and a social worker will assist in obtaining a screening history from the mother.

The drug screening specimen of choice depends on the infantís age.

If the baby is < 48 hours old, send a urine drug screen and save all the meconium.

If the urine drug screen is negative but suspicion remains, send a meconium drug screen.  If all meconium has been passed when suspicion of drug abuse arises, a hair-screen can be sent if making the diagnosis is imperative.  (A hair screen requires 50mg of clipped hair.)

If the infant has a positive drug screen, the physician should inform the mother of the results and the medical implications of the drug exposure/withdrawal symptoms.

The nursery and obstetric social workers should be notified.  The NICU social worker following the baby will obtain an in depth history from the mother.

The infant should be assessed frequently.  A modified Neonatal Withdrawal Inventory in HED  is available to monitor and quantitate the infantís withdrawal symptoms.  The infant should be swaddled and receive minimal stimulation. Consider pharmacologic therapy for withdrawal if symptoms are severe enough.

            Both the motherís situation and behavior and the infantís symptoms and needs must be considered with regard to discharge planning.  During the babyís stay in the nursery, the nurses should document carefully the motherís visits, phone calls, behavior, and interaction with the infant.  The social workers will assist with family support and discussions regarding maternal treatment programs.  The social workers will also assist with DCS referral where appropriate.  Even if the infant has no signs of withdrawal while in the nursery and the mother is completely appropriate, home assessment and early/frequent pediatric follow-up are indicated.

            The primary care provider should be contacted prior to discharge, and the discharge plan should be carefully documented in the medical record.

Resolved at the Collaborative Pathways Committee meeting 11/17/99.


Lester BM, ed. Prenatal Drug Exposure and Child Outcome. Clinics in Perinatology 1999; 26:1.