Current Practice
Many urban hospitals are now routinely performing
neonatal toxicology screens when maternal illicit drug use is suspected. Grounds for suspicion vary and can include
clinical symptomatology in mother or newborn, or maternal
characteristics such as public patient status; inadequate
prenatal care or unregistered status at delivery; age under 20;
or residence in neighborhoods where drug use is widespread.
State legislation and practice has not yet been nationally
surveyed. New York is one state which deems parental
chronic drug use that results in functional impairment to be
prima facie evidence of child neglect.7 Positive neonatal urine
toxicology screens are being interpreted as evidence of
maternal drug-related impairment and are therefore being
reported to the child protective service agency. The child
protective service agency is then obligated to conduct an
investigation and make a determination regarding parental
fitness. If the parent is deemed neglectful, then the agency
staff devises a plan which can include supervision, protec-
tion, or foster care placement for the child. According to New
York State's Child Welfare Reform Act, preventive or
rehabilitative services are to be provided in such cases as
"the state's first obligation is to help the family with services
to prevent its break-up or to reunite it if the child has already
left home.