Infant race affects application of clinical guidelines when screening for drugs of abuse in newborns.
Screening for illicit drugs in newborns has privacy, social, and legal risks for families of the infants. Established drug-screening criteria may be applied in a manner that considers nonproven risk factors such as race in addition to evidence-based factors. The goal of this study was to determine if race was used as a criterion for screening infants for intrauterine cocaine exposure. We hypothesized that infants of black mothers would be more likely to be screened regardless of whether they met the standard criteria for screening of our institution's NICU. We used the electronic medical records of newborn infants and their mothers to determine which mother-infant pairs had documented evidence of meeting the criteria for screening infants for prenatal exposure to illicit drugs set forth in the guidelines of our NICU. We then assessed the rates of drug screening to determine the strongest predictors of whether an infant would be screened. We assessed 2121 mother-infant pairs. Infants born to black mothers were more likely than those born to white mothers to have screening performed whether they met screening criteria (35.1% vs 12.9%; P < .001) or did not (5.3% vs 1.2%; P < .001). In a logistic regression analysis, black race remained independently associated (odds ratio: 2.17 [95% confidence interval: 1.25-3.79]) with drug screening even when we controlled for our standard screening criteria and income, insurance status, and maternal education. Providers seemed to have used race, in addition to recognized risk criteria, as a factor in deciding whether to screen an infant for maternal illicit drug use.