Do They Check for Drugs When U Have a Baby in the State of Kansas
Indications for Testing
Newborn drug testing is recommended in infants born to mothers with high-risk behaviors (eg, history of drug use/abuse, prostitution, nicotine use), minimal or no prenatal care, or unexplained obstetric events (eg, placental abruption, premature labor).
Additionally, infants with unexplained neurologic complications, unexpected intrauterine growth retardation, or drug withdrawal symptoms (eg, NAS) should be tested for drug exposure.
Available Specimen Types
ARUP offers newborn drug testing for two specimen types: umbilical cord tissue and meconium. Urine as a specimen type for neonatal drug testing has limited success; the first void is often missed because it may occur during or immediately after delivery. Urine tests generally detect only recent maternal drug use in the days before delivery.
| Meconium | Umbilical Cord Tissue |
|---|---|
| First stool of the newborn Begins to form at ~12-16 wks gestation Accumulates over remainder of pregnancy (nonlinear process) Usually passes within 48 hrs of birth Used for drug testing for ~25 yrs Collection requires coordinated efforts and may not be available Drug detection in meconium depends on many factors (eg, quality and completeness of collection, drug use patterns) | Forms ~5th wk of gestation Grows with fetus throughout pregnancy (nonlinear process) Easy to collect at time of birth Drugs appear to deposit consistently across length of cord Concentrations of drug analytes are lower in cord than in meconium, but can be detected with appropriate methodology Drug detection in cord tissue depends on many factors (eg, quality and completeness of collection, drug use patterns) |
| NOTE: Umbilical cord tissue and meconium drug tests are performed to support clinical and social management decisions and do not usually require chain of custody. ARUP offers a specimen tracking form for documentation of the collection, handling, and shipping of specimens. Contact ARUP Client Services for more information. Sources: Wabuyele, 2018 ; Wu, 2018 | |
There are several factors to consider when deciding whether to use umbilical cord tissue or meconium for drug testing.
| Factors to Consider | Umbilical Cord Tissue | Meconium |
|---|---|---|
| Preferred process for collection is at birth, for all infants; test immediately for high-risk births, store for low-risk births | ✔ | |
| Collection based on need (eg, history of drug exposure, maternal urine screen results, NAS symptoms/diagnosis) | ✔ | ✔ |
| Tracking of specimen collection and handling process required | ✔ | ✔ |
| Fastest available time to result when positive results are expected | ✔ | |
| Traditional testing approach (screen with reflex to confirmation testing) preferred | ✔ | |
| Most sensitive and definitive testing for cannabis use | ✔ | |
| Most sensitive and definitive testing for heroin use | ✔ | |
| Preferred for the detection of gabapentin, fentanyl, meperidine, propoxyphene, tramadol, tapentadol, phentermine, and/or zolpidem | ✔ | |
| Meconium specimen is limited or unavailable | ✔ | |
| Cord tissue specimen is limited or unavailable | ✔ |
ARUP Umbilical Cord Tissue Testing
Routine analysis by the ARUP drug detection panel includes qualitative detection by mass spectrometric methods for all compounds (eg, opioids, stimulants, sedative-hypnotics). The presence of metabolites improves confidence in results and lengthens the detection window. Umbilical cord testing is thought to reflect maternal drug use during approximately the last trimester of a full-term birth. Tests to detect marijuana metabolite and ethyl glucuronide (alcohol metabolite) are available separately from the panel.
Further Resources
- Umbilical cord tissue collection instructions
- Umbilical cord tissue collection video
- Test Fact Sheets: ARUP Drug Detection Panel, Umbilical Cord Tissue (Qualitative) and Ethyl Glucuronide, Umbilical Cord Tissue, Qualitative
ARUP Meconium Testing
Routine analysis by the ARUP panel test includes a qualitative screen for nine drug classes; specimens that test positive for one or more drugs are reflexed to confirmatory testing by highly sensitive and specific mass spectrometric methods. Directed (confirmation only) tests are available when only one drug class is of clinical interest or when the quantity of meconium available for testing is very small (ie, <1 g).
The panel is the preferred meconium test to detect and document maternal drug use during pregnancy (approximately the last trimester of a full-term birth). Targeted single drug-class testing is appropriate if only a particular drug class or classes are of clinical interest, or when the quantity of meconium available for testing is very small (ie, <1 g).
Evaluation and Interpretation of Results
Drugs administered to the mother during labor and delivery may be detected in meconium or umbilical cord tissue. Drugs administered to the newborn after birth may be detected in meconium if the meconium is collected after drug administration.
Negative results do not exclude the possibility that the mother used drugs during pregnancy; only the drugs targeted by the testing can be detected. Maternal history and urine testing may also identify a possible infant drug exposure and should be used in combination with other laboratory results and the infant's clinical presentation to diagnose a drug exposure.
Specimen variations can contribute to false-negative results. When definitive analytical methods (eg, liquid chromatography-tandem mass spectrometry [LC-MS/MS], gas chromatography-mass spectrometry [GC-MS]) are used, false-positive results are extremely unlikely.
Refer to the Drug Testing topic for test result interpretation organized by drug class.
Further Resources
Opioid Metabolic Pathway
Benzodiazepine Metabolic Pathway
Do They Check for Drugs When U Have a Baby in the State of Kansas
Source: https://arupconsult.com/content/newborn-drug-testing
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