Knowledge Is Power, and More Is Readily Available through Neonate Screening for Drugs of Abuse

Every single baby born in the US is required to be screened for phenylketonuria (PKU), which is “a rare condition in which a baby is born without the ability to properly break down an amino acid called phenylalanine” (Medline). Annually in the US, 1 in every 10,000 to 15,000 babies born is diagnosed with PKU (March of Dimes), and in Wisconsin, PKU is only one of forty eight disorders tested for (SLH).

Compare this to the stat that the Centers for Disease Control and Prevention (CDC) reports for Fetal Alcohol Syndrome: “The CDC estimates that more than 8,000 babies in the US could be born each year with full FAS” (emphasis is mine) (UTMB).

However, we know that those with full FAS constitute approximately only 10% of those with FASDs (SHAAP), so that means that of the 3,659,289 babies born in the US annually, given that FASDs affect up to 5% of the population, almost 183,000 babies are born with Fetal Alcohol Spectrum Disorders (FASD). In the United States. Every. Single. Year (NIAAA). But we don’t always screen for that. In fact, we rarely do.

The number of babies born with neonatal abstinence syndrome (NAS) increased by 82% nationally from 2010 to 2017. Increases were seen for nearly all states and demographic groups (CDC), and neonatal abstinence syndrome (NAS) is diagnosed every 20 minutes in the United States (NCBI NBK551498). Actually, different references say 15 or 25, so I just averaged. But we don’t always screen for that, either.

Math is not my strongest suit. And, when statistics lie, as we know they do, and we count only what we test, the information we have isn’t what we need. But I still try to make sense of the numbers. That’s to say that we ought to be doing more for neonates born with substances of abuse in their bodies. Alcohol is a teratogen…a substance that can cause birth defects…but it’s a legal one, so too often we dismiss it as harmless.

The more we learn about cannabis, the more we know that it, too, can be damaging to a fetus. And what about opioids? We know that shaking and seizures, excessive crying, slow weight gain, diarrhea, fever, and other symptoms of neonatal abstinence syndrome/neonatal opioid withdrawal syndrome (NAS/NOWS) are taking their toll on our most vulnerable population.

So why aren’t we screening neonates more regularly? One reason is to PREVENT RACISM…but that’s not the actual outcome. Racism still happens in screening.

The University of Michigan’s Medicine’s Department of Family Medicine and its Antiracism and Health Equity Program wanted to see if Black newborns continued to be screened for prenatal drug exposure in greater numbers than “other racial and ethnic groups, even in the absence of risk factors for substance use disorders.” Spoiler alert: they are.

The report indicates that “Racial inequities in newborn drug testing rates persisted during the seven-year study period before and after the cannabis law change. Among tests that did detect newborn drug exposure, the most commonly identified substance was tetrahydrocannabinol, or THC, the active chemical in cannabis.” But, remember, just because a drug is LEGAL doesn’t mean a drug is harmless, especially to neonates!

A Journal of the American Medical Association (JAMA) study from January 2022 indicated that exposure to THC prenatally leads to seven significant adverse neonatal outcomes: birth weight less than 2500 g; small for gestational age; preterm delivery; NICU admission; decreased mean birth weight; Apgar score at 1 minute; and infant head circumference (JAMA).

Racism in testing is leading to worse outcomes for white babies, not to mention the problems that occur in Black families. The report states, “Newborns born to white parents were 24% less likely to receive a drug test than those in Black families, according to the study, but were more likely to have a drug test positive for opioids” (IHPI). Again, the emphasis is mine.

And the researchers aren’t suggesting NOT testing! Rather, “This suggests undertesting (emphasis is mine here, too) of white newborns and potentially missed opportunities to detect and treat opioid use disorder” (IHPI).

So why aren’t we screening neonates for drugs of abuse more often?

Research says we should.

Outcomes would be improved if we did.

We’d have more information to provide early intervention.

Parents would be able to act accordingly and seek appropriate care and support, given the information they would have.

Why not screen?

Do we not believe the research?

Is it because we just don’t care?

Do we believe that screening doesn’t work, despite knowing that knowledge is power?

Do we not want to deal with the answers?

Johns Hopkins Medicine says that “A screening test is done to detect potential health disorders or diseases in people who do not have any symptoms of disease. The goal is early detection […] to detect it early enough to treat it most effectively” (Hopkins).

So, to recap: we screen for PKU but not for FASD, despite FASDs happening over 12 times more; we test Black babies more than white ones, despite knowing that the white ones have more negative outcomes; we treat legal substances as harmless substances, despite knowing otherwise.

Why not screen, indeed.

References:

www.cdc.gov/pregnancy/opioids/data.html

www.marchofdimes.org/find-support/topics/birth/pku-phenylketonuria-your-baby

www.hopkinsmedicine.org/health/treatment-tests-and-therapies/screening-tests-for-common-diseases

https://ihpi.umich.edu/news/study-shows-racial-inequities-newborn-drug-testing

www.jamanetwork.com/journals/jamanetworkopen/fullarticle/2788451

www.medlineplus.gov/ency/article/001166.htm

www.ncbi.nlm.nih.gov/books/NBK551498/

www.niaaa.nih.gov/research/fetal-alcohol-spectrum-disorders

www.shaap.org.uk/blog/383-fetal-alcohol-spectrum-disorder-it-s-not-all-about-the-face.html

www.slh.wisc.edu/clinical/newborn/parents-guide-to-newborn-screening/disorders-on-the-screening-panel