year, Iowa welcomes an average of 38,000 newborns. On
the basis of known rates of drug use, we would expect
7-8 percent, or about 2800 infants, to have been exposed
to drugs in utero. With an appropriate screening
program, health care providers would identify about
1,200 of these newborns, and then refer them for evaluation
Iowa in 2005, however, as a result of inadequate screening
and testing, only 537 newborns were confirmed as having
been exposed to drugs in utero. Infants who have
been exposed to drugs but who remain unidentified will
be discharged to homes in which mothers are likely to
continue to use drugs. Often these infants face continuing
exposure to drugs and to the chaotic lifestyle and lack
of nurturing so often associated with drug use.
states, such as California and Virginia, have mandated
maternal and neonatal drug screening protocols for hospitals.
Other states, such as Arizona, Washington, and Indiana,
have developed a statewide consensus on perinatal screening
for drugs, and established education programs in all
birthing hospitals. In addition to statewide efforts,
many individual hospitals, often in urban areas, have
developed structured screening and testing protocols.
State, community, and individual hospital efforts have
continued to grow in response to our increasing awareness
of the extent of perinatal drug exposure.
Iowa, health care professionals have long recognized
the need for programs to identify perinatal drug exposure.
Some Iowa hospitals have developed and implemented protocols
to guide medical staff in screening mothers and newborns
for specific high-risk factors.
to this, Iowa code encourages health professionals to
perform perinatal screening and testing for drugs when
risk factors are recognized and documented. However,
Iowa code leaves the specific definition of these risk
factors to the discretion of the clinician. In addition,
Iowa has not mandated that birthing hospitals develop
screening and testing protocols. As a result, tremendous
variation exists among Iowa birthing hospitals regarding
perinatal drug screening. Most community hospitals do
no screening at all. Some do randomized screening, such
as testing every 15th or 20th
infant. Often, whether a mother is screened, tested,
or exempted depends on the personal perceptions of the
study conducted in Iowa birthing hospitals found that
hospitals using a structured screening or testing protocol
test twice as many infants as hospitals that have no
protocol. At hospitals that use a screening protocol,
the rate of positive test results – infants identified
as having been exposed to illicit drugs in utero
-- is almost five times higher than in hospitals without
such a protocol. But less than half of the infants born
in Iowa are delivered in hospitals that use a structured
protocol for screening and testing.
Even hospitals that use protocols
often provide no specific training, which reduces the
effectiveness of screening and testing. In one urban
hospital in Iowa, and despite the availability of a
structured protocol, almost one-third of eligible infants
were not screened because staff did not follow the protocol.
a result of growing concern about perinatal drug exposure,
a statewide collaboration came together and developed
a targeted, risk-based perinatal drug screening, testing,
and intervention protocol to be adopted by every birthing
hospital in Iowa. This protocol is now available online
Participants in this collaboration include:
Department of Public Health
Perinatal Care Association
Academy of Pediatrics, Iowa Chapter
Endangered Children Alliance of Iowa
Child Protection Council
Perinatal Care Program Advisory Council of the Iowa
Department of Public Health has approved a screening
protocol (see Perinatal
Illicit Drug Exposure Risk Assessment Tool), and
this is now included in the State Perinatal Care Clinical
Guidelines. Members of the Perinatal Care Program staff
are currently disseminating this protocol to birthing
hospitals around the state. It calls for screening for
perinatal drug exposure to be performed in the prenatal
clinic, labor and delivery unit, and newborn nursery
unit or NICU, and for services to be provided to both
the mother and the newborn.
clinics play a key role in identifying perinatal drug
use, and in offering the mother the opportunity for
testing and intervention. Prenatal clinic staff should
screen mothers when they first visit the prenatal clinic.
If the initial screening is negative, staff should verify
abstinence from illicit drug use at every subsequent
Mothers who are reluctant to abstain
from drug use may not be willing to disclose addiction,
and may refuse to give consent for testing and intervention.
When that happens, hospitals need to have a system in
place to ensure that information about the status of
this at-risk mother and child is communicated from the
prenatal clinic to the labor and delivery unit and to
the newborn nursery or NICU.
a standard protocol allows health care providers to
identify most drug exposed newborns and provide treatment
or referral for treatment. Such a protocol also allows
providers to link the mother to the services she needs
to become the parent she wants and deserves to be.
Perinatal Drug Exposure - Additional