322 - Social Determinants of Health correlated with screening of infants for exposure to maternal substance use in the setting of institutional guidelines

Poster Number: 322
Publication Number: 322.2258

Background: Social determinants of health (SDoH) are nonmedical factors influencing health outcomes by affecting all aspects of everyday life. Screening newborns for exposure to maternal substance use has legal, social and privacy implications in addition affecting health outcomes. We have previously reported that, among neonatal intensive care unit (NICU) admissions, infants of Black mothers were more likely to be screened that those of non-Black mothers, but this was explained by more infants meeting risk criteria for screening.

Objective: To determine what factors affected whether an infant was substance exposure screened in the newborn period. We hypothesized that infants identified as Black would be more likely to be screened than non-Black infants, and that this would correlate with SDoH.

Design/Methods: Maternal and infant records for NICU admissions from 1/2021 to 12/2022 and all non-NICU admission inborn infants from 1/2021 to 12/2021 were reviewed for documented evidence of meeting substance use screening criteria in our guidelines. Basic demographic data including NICU admission, inborn status, gender, race/ethnicity, home zip code, insurance status, gestational age and birth weight were collected on all infants. "Mandatory" criteria expected to trigger screening in all affected infants were maternal illicit substance use, limited prenatal care ( < 5 visits), and placental abruption without preeclampsia. We assessed whether infants had a urine drug screen for illicit substances performed, if they met mandatory criteria, and evaluated SDoH. Data were analyzed using Fisher exact test with relative risk and confidence intervals.

Results: We assessed 4196 infant-mother pairs, among whom 206 infants received substance exposure screens. Nearly all screened infants were NICU admissions. Infants screened were more likely to be admitted to the NICU, be Black, have public insurance, or have a home address in one of the 5 poorest zip codes in the metropolitan area (Table 1). 39% of infant screens were positive with cocaine, opiates and then marijuana being most common (31%, 30%, 24%). Infants that met mandatory screening criteria were also more likely to be Black, have public insurance and a home address in a lower income zip code(Table 2).

Conclusion(s): SDoH are correlated with which infants receive a substance exposure screen, even in the setting of being indicated by meeting screening guidelines. Black infants are screened more frequently but with a lower relative risk than public insurance or lower income with marginalization as the underlying SDoH that likely drives much of who is selected for screening.