Neonatal Withdrawal Inventory

 

Guidelines to Test for Perinatal Substance Exposure

Goal:The following guidelines should help to make the process of drug testing of neonates unbiased.  This should also lead to more consistent identification and effective care of the infants who screen positive.  Click here to view the Neonatal Withdrawl Inventory Flow Sheet.

Consider newborn drug screen if any of these risks are present

  • Maternal 

    •      Known drug use

    •      History of drug use

    •      Erratic behaviors

    •      STD

    •      Multiple partners

     

  • Perinatal

    • Placental abruption

    • Maternal hypertension

     

  • Neonatal

    • Abnormal behaviors

    • Physical findings (i.e., IGUR, stroke)

    • FAS/FAE

     

  • Other possible considerations  

    • no stable home

    • lack of/no PNC

    • excessive/teenage smoking

    • PTL/Asphyxia

 

Evaluation

Drug screening specimen from infant should be obtained as soon as suspicion arises.  At that time, the parents will need to be notified that drug screening has been ordered.

  • Step 1: < 48 hours of age:  urine drug screen and save all meconium

  • Step 2:  If urine drug screen is negative but suspicion remains, send all meconium for drug screen

  •  Step 3:  If meconium has been passed and the suspicion of drug abuse arises, send hair screen (send 50mg)

 

Consideration:

  • All drug specimens should be stored in blue tops (non-sterile) or urine cups and need to be sealed i.e. with patient label and initialed by RN at the bedside.

  • Keep specimen refrigerated, wrap specimen in aluminum foil to shelter from light, if LSD use is suspected.  Each patient will have a specimen bag or container in the specimen refrigerator.

  • Nurse will notify MD when all meconium is passed and collection complete and can be sent to the laboratory.

  • Case managers will follow up on drug screen results if infant has been discharged.

  • Urine drug screen:  limited in detection of THC however least expensive and most rapid screen.

  • Meconium drug screen:

    • can detect usage back to 20 weeks gestation.

    • less dependable in ELBW

    • 1st meconium often negative, 2nd or 3rd passage have higher yield

    • limited use of meconium-stained amniotic fluid or transitional stools, best to send all meconium stools

    •  Meconium ETOH screen still limited due to false positive O

  • Hair drug screen

    • limited in extremely premature infants secondary to little or no hair

    • THC difficult to detect, requires excessive abuse of THC