Toxicology Testing of Neonates: Do a Mother's Demographics Influence Decisions to Test? [35C

Abstract

INTRODUCTION: Toxicology testing of newborns carries substantial consequences to families, with implications for social service involvement, limitations on breast milk administration, and custody concerns. Clear guidelines for testing of neonates do not exist, and obstetric providers may have opportunities to influence practices of our pediatrician colleagues. We aimed to evaluate whether patterns concerning for implicit bias could be seen in toxicology testing of newborns. METHODS: We reviewed charts of all babies born at a single tertiary academic center between 1/1/18 and 12/31/18 on whom toxicology testing was sent. Demographic data was taken from mothers' charts as newborn demographics are not routinely recorded, and compared to sociodemographic data of all mothers with infants born in 2018, including age, race, marital status, ZIP code. Data was analyzed with Wilcoxon Rank Sum test, Chi Square test, or ANOVA where appropriate. RESULTS: Of 6438 births in 2018, Tox was sent on infants of 86 mothers (1.3%). Mothers of babies with toxicology testing sent were younger (P<.0001), less likely to be white (P<.0001), reported “single” as marital status (P<.0001), and lived in the lowest income ZIP code (P<.0001). CONCLUSION: Maternal age, race, marital and socioeconomic status appeared to significantly impact pediatricians' decisions to order toxicology testing on neonates. Evidence based guidelines may decrease implicit bias in neonatal toxicology testing, and better identify babies at risk of substance exposures.