Newborn Toxicology Testing in the Diagnosis of Neonatal Abstinence Syndrome and the Comparison of Two Testing Specimens

As the opioid epidemic continues to rise, so does the incidence of neonatal abstinence syndrome. Neonatal abstinence syndrome, or NAS, is a withdrawal condition that occurs when a fetus has been exposed to addictive drugs prior to birth, most commonly opioids. Newborns with NAS can experience a variety of symptoms at and after birth, including trembling, sleep problems, seizures, and vomiting. Women who use opioids during pregnancy have a much higher risk of their newborn developing NAS. If a woman is suspected of using drugs during her pregnancy, the newborn will likely be tested toxicologically for NAS or other exposure to drugs. There is debate about the procedures that are used to determine who is tested and who is not. Institutions are currently being left to make their own decisions about how newborn toxicology tests will be performed and who receives such tests. Unless a mother self-reports her use, a test may not be performed unless certain factors are observed. This leaves room for variation and inconsistency across the board. Guidelines have been created in some institutions regarding several indicators of drugs abuse during pregnancy. However, this is not consistent between institutions across the nation and allows for the possibility of misdiagnosis or the lack of one altogether. Standards should be implemented regarding these toxicology tests for newborns to ensure all cases of infants with NAS are identified and able to be treated. This paper will examine neonatal abstinence syndrome, how toxicology testing is performed in newborns, why standards should be implemented, and provide a comparison between an upcoming and a current method of testing in newborns for NAS.