ABSTRACT
Anonymous urine toxicology screening among parturient women during 1 month in 1990
and selective newborn testing during this and the subsequent 4-month period was done
to assess prevalence of drug use among parturients in a municipal hospital in the
Bronx and to assess impact of infant urine toxicology screening on discharge placement.
Infant testing was performed for maternal history of drug use, poor prenatal care
(5 or fewer visits), or infant symptoms. Urine was screened for cocaine, opiates,
methadone, barbiturates, amphetamines, and benzodiazepines. Of 204 women screened,
9.3% were positive. Of these, 74% were positive for cocaine and 21% revealed polysubstance
use. Only 28.6% of cocaine-positive mothers gave a history of use. Selective testing
of 1196 newborns during this 5-month period revealed an apparent prevalence of cocaine
exposure of 4.9%. Selective infant testing failed to identify 42.1% of newborns of
cocaine-positive women. Social work evaluation was performed on all families and was
the basis for reporting to state agencies for protective services. Only 6 of 83 drug-positive
infants entered foster care, none because of positive toxicology per se. Selective
infant toxicology studies miss many cocaine-exposed infants and has little impact
on placement. Universal social work evaluation of families may be as effective and
freer of bias than selective urine screening.
