Detection of Intrauterine Illicit Drug Exposure by Newborn Drug Testing (Nacb Symposium‪)‬

Intrauterine drug exposure (IUDE) remains a major health concern [1, 2]. (3) Prenatal cocaine use has been associated with placental abruption and premature labor [3-9]. Intrauterine cocaine exposure has also been associated with an increased risk of prematurity, small for gestational age status, microcephaly, congenital anomalies including cardiac and genitourinary abnormalities, necrotizing enterocolitis, and central nervous system stroke or hemorrhage [3-7, 9-22]. Infants born to mothers using amphetamines have many of the same problems as cocaine-exposed infants, including increased rates of maternal abruption, prematurity, and decreased growth parameters such as low birth weight [2]. In addition to an increased risk of prematurity and being small for gestational age, striking withdrawal symptoms often requiring treatment are frequently observed in infants after in utero opioid exposure. Symptoms include irritability, hypertonia, wakefulness, jitteriness, diarrhea, increased hiccups, yawning and sneezing, and excessive sucking and seizures, with onset of withdrawal earlier in heroin-exposed babies compared with methadone-exposed infants [23, 24]. Some intrauterine cocaine-exposed infants may manifest symptoms of withdrawal including hypertonicity, jitteriness, and seizures [7, 9, 15, 25, 26]. Intrauterine amphetamine-exposed infants may also have similar postnatal symptoms including hypertonia, tremors, poor feeding, and abnormal sleep patterns [27]. Long-term follow-up of IUDE infants suggests that in addition to the potential for difficult social situations, such as increased risk for child abuse and neglect [28, 29], abnormal neurocognitive and behavioral development may occur [18, 30-34], as well as an increased risk of sudden infant death syndrome [35-38]. GUIDELINES FOR MEDICALLY INDICATED NEWBORN DRUG TESTING