Newborn Drug Screening - Meconium and Umbilical Cord Testing

  • Diagnosis
  • Background
  • Lab Tests
  • References
  • Related Content

Indications for Testing

  • Detect prenatal exposure to drugs in meconium or umbilical cord tissue for infants
    • Born to mothers with high risk (eg, history of drug use, prostitution, sexually transmitted disease)
    • Born to mothers with little or no prenatal care
    • Born to mothers with unexplained placental abruption or premature labor
    • Born with unexplained neurological complications
    • Born with unexpected intrauterine growth retardation
    • Born with evidence of intoxication and/or drug withdrawal symptoms

Laboratory Testing

  • Meconium drug testing
    • For more information, refer to Drug Analytes Detected in Meconium and Umbilical Cord
    • Routine analysis includes a qualitative screen for nine drug classes; specimens testing positive for one or more drugs are reflexed to confirmatory testing
    • Directed (confirmation only) tests are available when only one drug class is of clinical interest or when quantity of meconium available for testing is very small (eg, <1g)
  • Umbilical cord tissue testing
    • For more information, refer to Drug Analytes Detected in Meconium and Umbilical Cord
    • Routine analysis includes qualitative detection by mass spectrometric methods for >30 other prescription and illicit drugs (opioids, stimulants, sedative hypnotics); qualitative screen for cannabinoids also included
    • Umbilical cord blood may be used for directed (confirmation only) tests
  • Maternal drug testing may detect very recent use; urine is the preferred specimen

Differential Diagnosis

Exposure to maternal drug use during gestation may adversely affect neonatal development and may lead to acute adverse events including neonatal abstinence syndrome and infant mortality and may contribute to long-term behavioral and developmental deficits.

Epidemiology

  • Prevalence – approximately 30% of the drug-abuse population is female, and most are of childbearing age

Pathophysiology

  • Meconium (dark, tarry material passed from the neonate’s rectum in the first days after birth until milk or formula-based stool appears) is the best specimen for assessing in utero exposure of the neonate to maternal drug use
    • Meconium begins to form during the 12th–16th week of gestation and is usually passed within first 3 days of birth
      • Passage may be delayed when the baby is exposed to opioids or with premature birth
      • May also be expelled in utero or during birth
    • Meconium is preferred over urine for testing of neonates
      • Urine testing indicates drug use only over the last 1–10 days, depending on the drug
      • Meconium documents drug use over an extended period of time, covering at least the last trimester of pregnancy
      • Meconium is easier to obtain than urine (combining all meconium voids can be helpful if sample size is small)
    • Umbilical cord tissue is the preferred specimen for assessing in utero exposure of the neonate to maternal drug use when meconium is not available
      • Deposition of drugs in umbilical cord tissue is not well studied, but window of detection appears similar to meconium
      • Umbilical cord tissue can be sent to the laboratory immediately after birth
      • Umbilical cord tissue avoids detection of drugs administered directly to the newborn after birth

Clinical Presentation

  • Stimulants
    • Cocaine
      • Infant
        • Irritability and withdrawal at birth
        • Subarachnoid and intracerebral hemorrhage
        • Small neonatal head size
        • Reduced birth weight
        • Fetal death
        • Childhood behavioral disorders (eg, attention deficit hyperactivity disorder – ADHD)
      • Mother
        • Premature labor
        • Ruptured uterus, abruptio placentae
        • Adult behavioral disorders (eg, ADHD)
    • Amphetamines (particularly methamphetamine)
      • Infant
        • Effects are similar to cocaine
        • Medical problems in early life
      • Mother
        • Effects are similar to cocaine
        • Complications during pregnancy – reduced fetal growth, stillbirth, congenital anomalies
        • Increased rates of premature birth
  • Cannabinoid (marijuana)
    • Infant
      • Negative effect on attentional behavior and on visual analysis/hypothesis testing
      • No effect on global IQ
  • Opiates, barbiturates, benzodiazepines
    • Infant and mother – withdrawal symptoms
      • Irritability
      • Tremors
      • Hyperactivity
      • Seizures

Detection

  • Timely detection of in-utero drug exposure is critical for effective detection and management of intoxications, withdrawal syndrome, and long-term needs (social and medical) for exposed neonates
    • Actual time window for detecting exposure is unknown but is thought to represent at least the last trimester
  • Detection of drugs depends on
    • Extent of maternal drug use
    • Drug stability
    • Deposition of drug analytes in umbilical cord tissue
    • Performance of the analytical method
  • Umbilical cord tissue testing may be preferable to meconium due to
    • Ease of collection of a larger volume of specimen
    • Relatively fast turnaround time
    • Reflex/confirmation testing typically not required

Indications for Laboratory Testing

Tests generally appear in the order most useful for common clinical situations.
Click on number for test-specific information in the ARUP Laboratory Test Directory

Drugs of Abuse Panel, Meconium - Screen with Reflex to Confirmation/Quantitation 0092516
Method: Qualitative Enzyme-Linked Immunosorbent Assay/Quantitative Gas Chromatography-Mass Spectrometry/Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Limitations

Result verifies drug use only

Cannot determine date of maternal drug use, what specific drug was taken, or amount taken

Detects only drugs and toxicants listed

Follow Up

See the pediatric peer-reviewed literature for neonate treatment recommendations

Drug Detection Panel, Umbilical Cord Tissue, Qualitative 2006621
Method: Qualitative Liquid Chromatography/Time of Flight Mass Spectrometry/ Liquid Chromatography/Tandem Mass Spectrometry/Enzyme-Linked Immunosorbent Assay

Limitations

Details regarding the specific formulation, amount/dose, or time and length of exposure cannot be established by this testing

Minimum reporting limits (ng/g, pg/g) are established for each compound, but quantitation of detected drugs is not performed

Deposition of drugs in umbilical cord is not identical to meconium; concentrations of drugs and metabolites in cord tissue are generally lower than those found in meconium

Marijuana metabolites (eg, THC) are detected by immunoassay and are not confirmed

This test is qualitative and does not provide quantitative results

While testing may be performed with chain of custody, ARUP is not a forensic laboratory; this test is intended for clinical use

Results based on immunoassay detection that do not match clinical expectations should be interpreted with caution

Follow Up

Confirmation testing usually not required due to specificity of technology employed (mass spectometry)

Additional Tests Available

Drugs of Abuse Confirmation/Quantitation - Amphetamines (Amphetamine and Methamphetamine) - Meconium 0092310
Method: Quantitative High Performance Liquid Chromatography-Tandem Mass Spectrometry

Comments

Neonatal testing

Barbiturates - Confirmation - Meconium 0092311
Method: Quantitative Gas Chromatography-Mass Spectrometry/Quantitative Liquid Chromatography-Tandem Mass Spectrometry/Qualitative Liquid Chromatography/Time of Flight Mass Spectrometry

Comments

Neonatal testing

Drugs of Abuse Confirmation/Quantitation - Cannabinoids (Marijuana) - Meconium 0092316
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Comments

Neonatal testing

Drugs of Abuse Confirmation/Quantitation - Methadone and Metabolite - Meconium 0092313
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Comments

Neonatal testing

Drugs of Abuse Confirmation/Quantitation - Opiates - Meconium 0092314
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Comments

Neonatal testing

Cocaine and Metabolites - Confirmation/Quantitation - Meconium 0092312
Method: Quantitative Gas Chromatography-Mass Spectrometry/Liquid Chromatography-Tandem Mass Spectrometry

Comments

Neonatal testing

Phencyclidine (PCP) - Confirmation/Quantitation - Meconium 0092315
Method: Quantitative Gas Chromatography-Mass Spectrometry/Liquid Chromatography-Tandem Mass Spectrometry

Comments

Neonatal testing

Drugs of Abuse Confirmation/Quantitation - Benzodiazepines - Meconium 0092520
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Comments

Neonatal testing

Buprenorphine, Meconium, Quantitative 2011601
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Comments

Neonatal testing

Amphetamines, Urine, Quantitative 2010075
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Comments

Maternal testing

Barbiturates, Urine, Quantitative 2012213
Method: Quantitative Gas Chromatography-Mass Spectrometry

Comments

Maternal testing

Benzodiazepines, Urine, Quantitative 2008291
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Comments

Maternal testing

THC Metabolite, Urine, Quantitative 0090369
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Comments

Maternal testing

Cocaine Metabolite, Urine, Quantitative 0090359
Method: Quantitative Gas Chromatography-Mass Spectrometry

Comments

Maternal testing

Phencyclidine (PCP), Urine, Quantitative 2010462
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Comments

Maternal testing

Propoxyphene and Metabolite, Urine, Quantitative 2010468
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Comments

Maternal testing

Hairstat 5 Reflexive Panel 0092068
Method: Qualitative Enzyme-Linked Immunosorbent Assay/Quantitative Gas Chromatography-Mass Spectrometry

Comments

May detect drug use or exposure over several months previous to specimen collection; each cm length of hair represents approximately 1 month

Note that drug use or exposure must have occurred at least one month prior to specimen collection

If screen is positive, confirmation will be added

Test includes amphetamines, cocaine, opiates, cannabinoids (marijuana), and phencyclidine (PCP)

Synthetic Cannabinoid Metabolites, Screen with Reflex to Confirmation, Urine 2008091
Method: Qualitative Enzyme-Linked Immunosorbent Assay/High Performance Liquid Chromatography-Tandem Mass Spectrometry

Comments

Maternal testing

General References

Adrian M, Van Truong M, Osazuwa T. Measuring levels of comorbidity in drug user* emergency patients treated in Ontario hospitals. Subst Use Misuse. 2007; 42(2-3): 199-224. PubMed

Araojo R, McCune S, Feibus K. Substance abuse in pregnant women: making improved detection a good clinical outcome. Clin Pharmacol Ther. 2008; 83(4): 520-2. PubMed

Gareri J, Klein J, Koren G. Drugs of abuse testing in meconium. Clin Chim Acta. 2006; 366(1-2): 101-11. PubMed

Marcellus L. Is meconium screening appropriate for universal use? Science and ethics say no. Adv Neonatal Care. 2007; 7(4): 207-14. PubMed

Rayburn W. Maternal and fetal effects from substance use. Clin Perinatol. 2007; 34(4): 559-71, vi. PubMed

Walsh M, Fanaroff J. Meconium stained fluid: approach to the mother and the baby. Clin Perinatol. 2007; 34(4): 653-65, viii. PubMed

References from the ARUP Institute for Clinical and Experimental Pathology®

Barakauskas V, Davis R, Krasowski M, McMillin G. Unresolved discrepancies between cannabinoid test results for infant urine. Clin Chem. 2012; 58(9): 1364-7. PubMed

Chittamma A, Marin S, Williams J, Clark C, McMillin G. Detection of in utero marijuana exposure by GC-MS, ultra-sensitive ELISA and LC-TOF-MS using umbilical cord tissue. J Anal Toxicol. 2013; 37(7): 391-4. PubMed

Coles R, Clements T, Nelson G, McMillin G, Urry F. Simultaneous analysis of the Delta9-THC metabolites 11-nor-9-carboxy-Delta9-THC and 11-hydroxy-Delta9-THC in meconium by GC-MS. J Anal Toxicol. 2005; 29(6): 522-7. PubMed

Coles R, Kushnir M, Nelson G, McMillin G, Urry F. Simultaneous determination of codeine, morphine, hydrocodone, hydromorphone, oxycodone, and 6-acetylmorphine in urine, serum, plasma, whole blood, and meconium by LC-MS-MS. J Anal Toxicol. 2007; 31(1): 1-14. PubMed

Marin S, Christensen R, Baer V, Clark C, McMillin G. Nicotine and metabolites in paired umbilical cord tissue and meconium specimens. Ther Drug Monit. 2011; 33(1): 80-5. PubMed

Marin S, Coles R, Merrell M, McMillin G. Quantitation of benzodiazepines in urine, serum, plasma, and meconium by LC-MS-MS. J Anal Toxicol. 2008; 32(7): 491-8. PubMed

Marin S, Coles R, Urry F, McMillin G. Confirmation of cannabinoids in meconium using two-dimensional gas chromatography with mass spectrometry detection. J Chromatogr B Analyt Technol Biomed Life Sci. 2007; 858(1-2): 59-64. PubMed

Marin S, Keith L, Merrell M, McMillin G. Comparison of drugs of abuse detection in meconium by EMIT II and ELISA. J Anal Toxicol. 2009; 33(3): 148-54. PubMed

Marin S, Keith L, Merrell M, McMillin G. Evaluation of a new ELISA kit for the detection of benzodiazepines in meconium. J Anal Toxicol. 2009; 33(3): 177-81. PubMed

Marin S, Moore C, McMillin G. Cross-reactivity of phentermine with an immunoassay designed to detect amphetamine in a meconium specimen. Clin Chem. 2009; 55(3): 589-90. PubMed

Marin S, Roberts M, Wood M, McMillin G. Sensitive UPLC-MS-MS assay for 21 benzodiazepine drugs and metabolites, zolpidem and zopiclone in serum or plasma. J Anal Toxicol. 2012; 36(7): 472-6. PubMed

McMillin G, Wood K, Strathmann F, Krasowski M. Patterns of Drugs and Drug Metabolites Observed in Meconium: What Do They Mean? Ther Drug Monit. 2015; 37(5): 568-80. PubMed

Wood K, Krasowski M, Strathmann F, McMillin G. Meconium drug testing in multiple births in the USA. J Anal Toxicol. 2014; 38(7): 397-403. PubMed

Wood K, Sinclair L, Rysgaard C, Strathmann F, McMillin G, Krasowski M. Retrospective analysis of the diagnostic yield of newborn drug testing. BMC Pregnancy Childbirth. 2014; 14: 250. PubMed

Medical Reviewers

Last Update: February 2016