Umbilical cord tissue vs meconium for neonatal toxicology testing

Abstract

Most perinatal hospitals use a combination of maternal risk assessment and neonatal toxicology testing to identify infants at risk for substance withdrawal symptoms and to confirm the types of drugs that may have been used during pregnancy. Although meconium has been used for many years as the specimen of choice for toxicology testing, screening can also be performed on umbilical cord tissue. Due to the easy availability of umbilical cord tissue, this method is growing in popularity but there have been few studies that compare the equivalence of umbilical cord tissue with meconium. In this volume of The Journal, Colby et al reported the testing of both types of specimens in 501 newborn infants using paired samples sent to a national reference laboratory. The study found 80-100% agreement for the different groups of drugs tested, but umbilical cord tissue was more often positive for amphetamines, barbiturates, and benzodiazepines, and meconium was more often positive for buprenorphine, cannabinoids, cocaine, methadone, and other opioids. This study highlights issues for clinicians to consider when choosing a method of testing for their patients. Specimens chosen for testing will vary in the ease and success of obtaining the sample as well as the types and quantities of drugs that can be detected. Additionally, laboratory assays may differ from those used in this study and no doubt will change over time. Careful consideration of these factors in the context of community patterns of substance abuse during pregnancy can help with optimal identification of infants who need close observation and possible treatment for drug withdrawal. Article page 277 ▶ Umbilical Cord Tissue and Meconium May Not Be Equivalent for Confirming in Utero Substance ExposureThe Journal of PediatricsVol. 205PreviewIn a retrospective study of 501 neonates with potential in utero substance exposure, the drug detection performance of a commercially available umbilical cord tissue toxicology test was evaluated against a commercially available gold standard meconium toxicology test. Drugs detected in paired meconium and umbilical cord tissue samples were often discordant. Full-Text PDF