What are the medicolegal implications of screening an infant for neonatal abstinence syndrome (NAS)?

Updated: Dec 20, 2017
  • Author: Ashraf H Hamdan, MD, MBBCh, MSc, MRCP, FAAP; Chief Editor: Santina A Zanelli, MD  more...
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The medicolegal implications of screening the infant who has been exposed to drugs for the purpose of providing clinical care are complex. Screening creates a conflict between maternal, fetal, and neonatal interests. Although the state courts have granted unborn children some rights in other contexts, any attempt to grant unborn children greater protection against actions taken by their mothers during pregnancy is subject to strict scrutiny. Screening neonates for illicit drugs without maternal consent is not recommended. In addition, performing these tests without maternal approval may be illegal in certain areas.

Evidence of maternal substance abuse should alert the infant's medical caretaker that the mother may have medical, psychological, or behavioral problems that could have an impact on the infant's long-term health and welfare. Testing the mother, infant, or both, with informed consent, is useful in some clinical situations, even when drug use is not suspected. Some infants may be ill served if the physician relies solely on urine toxicology testing for screening. These test findings may be negative if drugs were used early in pregnancy or during the immediate 48 hours prior to delivery. Results also depend on laboratory variability.

Special concerns

Infants exposed in-utero to drugs have a higher than expected risk of subsequent abuse compared with children in the general population. [46]

Women who abuse substances face multiple stressors, including poverty, mental illness, and past and present physical, emotional, and sexual abuse. In turn, their children must cope with the consequences of living in a home environment where their developmental needs may not be met, and where they are at risk of out-of-home placement.

Prenatal maternal alcohol and drug use predicted child maltreatment and postnatal exposure to substances, as well as increased risk for maternal involvement with a substance-abusing partner. [47]

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