Why screen newborns for cocaine: Service patterns and social outcomes at age one year

Objective: To compare baseline characteristics, service provision, and chil d placement for infants exposed to cocaine in utero based on postnatal scre ening results. Methods: We studied a retrospective cohort of 40 consecutive drug-exposed, but seemingly healthy term infants who underwent urine drug screening in th e newborn nursery of a community hospital. Using clinical and service agenc y data, two cocaine-exposed cohorts were compared (a) screen-positive at bi rth (n = 22) versus (b) screen-negative at birth (n = 18). Results: Both cocaine-exposed groups had similar infant birth weights, leve ls of paternal involvement, maternal ages, gravidity, parity, and lengths o f gestation. Mothers in both groups had similar histories of prostitution, Door home environment, drug use, and prenatal drug rehabilitation. Mothers of screen-positive infants were more likely than mothers of screen-negative infants to have other children in foster carl (27% vs. 6%, p = .07), to ha ve experienced previous interventions by child protective services (CPS) (5 5% vs. 17%, p < .01), to have had no prenatal care (32% vs. 6%, p = .09), a nd fewer prenatal visits (4.7 vs. 8.6, p = .02). Compared to screen-negativ e infants, more screen-positive infants were referred to a high-risk infant tracking program (91% vs. 6%), referred to CPS (100% vs. 33%), placed outs ide the mother's home (50% vs. 22%), and had their mothers referred to drug rehabilitation (36% vs. 11%), (p < .01 for each). By 1 year of age, suppor t services differed little between exposed cohorts. However, 6 of 22 screen -positive infants were in foster care and 3 were placed for adoption, while only 1 of the 18 screen-negative infants was in foster care and only 1 had been placed for adoption. There were no services available in this communi ty to provide coordinated or comprehensive services or drug treatment speci fic to the needs of drug using mothers and drug exposed infants. Conclusions: Despite similarities between cocaine-exposed infants cared for in a normal newborn setting (with and without positive urine drug screens at birth), differences in referral services were noted. More striking than these differences was that services for families with drug-exposed infants are inadequate to even meet the needs of those families in our setting deem ed to be at highest risk. Neonatal drug screening needs to be paired with e ffective services. (C) 1999 Elsevier Science Ltd.