(391) Maternal and neonatal substance screening discordance after implementation of an obstetric substance use screening protocol

This was a retrospective cohort study performed at a single tertiary care center using electronic health record data with pre- (July 1, 2020-June 9, 2021) and post-intervention (June 10, 2021-May 31, 2022) design after implementation of an obstetric substance use screening protocol incorporating pre-specified indications for maternal biologic testing and universal maternal consent. Concordances and discordances in neonatal and maternal drug screening were reported as frequency (percentage) in each time period. and compared by time period using test of two proportions. In the cohort of neonates with drug test and no maternal drug test, race, ethnicity, payor status, admission to the NICU, readmission, and neonate UDS results were compared by time period using Fisher’s exact tests.


Results: 6552 neonates were born in the study period with 3163 (48.3%) pre and 3389 (51.7%) post implementation. 349/6552 (5.3%) neonates were drug screened (195/3163 [6.2%] pre vs. 154/3389 [4.5%] post, p=0.004). 172 were ordered in the absence of a maternal test (63/195 [32.3%] pre, 109/154 [70.8%] post; p< 0.001) (Figure). Among 172 drug screens ordered in the absence of maternal tests, 80 were positive (24/63 [38.1%] pre, 56/109 [51.4%] post, p=0.093). The number of neonates testing positive for specific substances did not significantly differ between the pre- and post-periods (Table).

Conclusion:

After implementing the obstetric substance use screening protocol, neonatal substance use screening in the absence of maternal screening occurred more frequently post-intervention than pre-intervention despite similar rates of positive tests and substances for which neonates tested positive. These findings suggest a need for further investigation into the factors driving this increase in discordant testing and the potential implications for both neonatal and maternal care and support strategies in the future.