Hair analysis of child and parents in the investigation of in utero and postnatal drug exposure: A study on 36 cases from the university hospital of Verona

Abstract

Worldwide, drug exposure in utero and in early childhood is a well-known major health issue. Hair analysis, taking into consideration its wide detection window, represents the most suitable investigative tool for these conditions. In this particular field, hair analysis of the parents, in addition to that of children, looks also important. The present study shows the results from 36 cases of suspected drug exposure in utero or in early childhood in which hair analysis of newborns/children and/or of parents has been carried. According a protocol established between the institute of forensic medicine and the institute of pediatrics of the university hospital of Verona, in case of suspected exposure to drugs in utero or in early childhood the physician asked the parents to give the consent to collect hair samples from the newborn or child as well as from the parents themselves to perform a toxicological evaluation of the case. In the years 2016–2018, overall 36 cases (26 in utero and 10 in early childhood) were identified, in 30 of which (20 in utero and 10 in early childhood) the parents gave the consent to collect hair samples. After digestion under acidic conditions, the hair samples underwent screening analysis by LC-MS/MS for opiates, cocaine, methadone, amphetamines, ketamine. The positive samples at the screening analysis underwent, after SPE extraction, a confirmation analysis by GC-MS. For the determination of cannabinoids, after digestion under basic conditions, the hair samples underwent LLE and GC-MS/MS analysis. In the case of parental hair analysis, a segmental study was carried out, when possible. Out of 20 in utero exposure cases, in 18 cases the consent to collect newborn hair samples was given. Fifteen (83%) out of these 18 cases were positive for the presence of illicit drugs: 66% for only 1 compound (5 for cannabinoids, 3 for cocaine and 2 for opiates) and 34% for 2 substances (4 for cocaine + opiates, 1 for cocaine + cannabinoids). In the two cases in which the parents did not provide the consent to collect hair samples from the newborn, it was possible to obtain hair samples from the mother, which resulted positive for cocaine and cannabinoids, respectively. Out of the 15 positive newborn cases, in 11 cases it was also possible to study the mother's hair by using a segmental analysis approach including segments referable to the pregnancy period and segments grown before the pregnancy. In all the cases, all the segments resulted positive for the presence of illicit drugs, sometimes with a decrease of concentrations in the segments referable to the last months of pregnancy. All the drugs found in the newborn hair were confirmed in the mother's hair but not vice versa. Out of the 10 early childhood cases, 7 (70%) resulted positive for the presence of illicit drugs (3 for cannabinoids, 3 for cocaine, 1 for cocaine and opiates). Out of these 7 cases, in 5 cases it was possible to study the hair of the parents which resulted positive for the same substances. Although often criticized as affected by environmental contamination, hair analysis of newborns and children, is very useful, particularly if integrated with the Results from the parents, to study the environment were the children live and consequently to take adequate actions for the protection of the minors.