Method performance and clinical workflow outcomes associated with meconium and umbilical cord toxicology testing

Neonatal abstinence syndrome (NAS) is a rising concern with unknown long-term effects. It is apparent that higher cost of care, impact on the community and reduced quality of life are associated with similar etiologies (e.g., fetal alcohol syndrome). Detection of drug exposure in utero allows for ea...

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Bibliographic Details
Published in:Clinical biochemistry 2017-12, Vol.50 (18), p.1093-1097
Main Authors: Labardee, Ruth M., Swartzwelder, Jaime R., Gebhardt, Karen E., Pardi, Justine A., Dawsey, Anna C., Brent Dixon, R., Cotten, Steven W.
Format: Article
Language:English
Subjects:
Drug testing
Female
Humans
Infant, Newborn
Male
Maternal-Fetal Exchange
Meconium
Meconium - chemistry
Meconium - metabolism
Neonates
Newborns
Pregnancy
Prenatal Exposure Delayed Effects
Substance Abuse Detection - methods
Umbilical cord
Umbilical Cord - chemistry
Umbilical Cord - metabolism
Workflow
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Summary:Neonatal abstinence syndrome (NAS) is a rising concern with unknown long-term effects. It is apparent that higher cost of care, impact on the community and reduced quality of life are associated with similar etiologies (e.g., fetal alcohol syndrome). Detection of drug exposure in utero allows for earlier intervention to potentially reduce undesired outcomes. Umbilical cord tissue (UCT) has been documented as a readily accessible specimen for detection of drug exposure and has emerged as an alternative specimen to meconium. The analytical and clinical impact of umbilical cord tissue relative to meconium was evaluated for assessment of in utero drug exposure. Quality metrics relating to turnaround-time and diagnosis of NAS were investigated after switching from meconium to UCT. Umbilical cord tissue showed higher clinical sensitivity but lower specificity for prediction of NAS diagnosis. Birth to result time decreased with adoption of UCT. Birth to result time decreased by the switching to UTC as well as the number of missed collections. The clinical sensitivity and negative predictive value for NAS increased with UCT; however both meconium and UTC samples were negative for opiates for a significant percentage of newborns with a diagnosis of NAS. •Processing efficiency was lower in umbilical cord tissue compared to meconium.•Our UCT assay showed higher clinical sensitivity but lower specificity for predicting NAS than our meconium assay.•Both meconium and UCT samples were negative for opiates in a significant percentage of newborns with a diagnosis of NAS.
ISSN:0009-9120
1873-2933
DOI:10.1016/j.clinbiochem.2017.09.016