Maureen A. O’Reilly, DNP, NNP-BC
Clinicians are searching for quicker and easier collection methods and more accurate toxicology testing for infants affected by intrauterine substance exposure. Umbilical cord testing offers some striking advantages over the “gold standard” of meconium testing, making the switch to cord testing increasingly attractive.
Pregnancy and Drugs of Abuse
Women in their reproductive years are at high risk for substance use disorder. Unfortunately, many women continue unhealthy and addictive substance use behaviors throughout their pregnancies. In a 2012 national survey,5.9% of pregnant women admitted to illicit drug use, 8.5% drank alcohol, and 15.9% smoked cigarettes. The opioid crisis and increased substance use in pregnancy have triggered a national debate, politicizing both detection and treatment for women and their infants. This mix of politics, money, science, and social opinion pressures healthcare clinicians to constantly re-examine how they detect and treat substance use in pregnancy.
The Impact on Newborns
As many as 400,000-440,000 newborns (10%-11% of all births) are exposed to tobacco, alcohol, or illicit drugs each year. In-utero substance exposure is associated with birth defects, premature delivery, fetal alcohol spectrum disorders, and developmental, behavioral, and cognitive problems in affected children.[5,6]
Neonatal abstinence syndrome is a disorder of central and autonomic nervous and gastrointestinal systems that occurs when intrauterine substance exposure causes the newborn to experience withdrawal after birth. Rapid, accurate newborn toxicology testing is crucial in identifying affected newborns, allowing timely initiation of treatment.
Toxicology Testing Matrices
Meconium toxicology has long been the “gold standard” in detecting newborn exposure to drugs of abuse.[8,9] Meconium samples can be difficult to collect. Fetal stressors during labor or delivery can induce meconium passage, or it can be delayed up to a week, depending on gestational age.[9,10] Alternatively, meconium may be passed but not collected because drug use is neither suspected nor reported until after the sample is no longer available, or a parent may discard a diaper with meconium to avoid illicit drug detection.
Other sample matrices for newborn testing have drawbacks. Cutting a hair sample from a newborn is protested by parents for cosmetic reasons and frequently results in inadequate sample size. Fingernails are small and inadequate for sampling in newborns. Vernix caseosa can be used to detect maternal drug use after 24 weeks of gestation; however, the volume is often inadequate for testing. The window of drug detection in urine is narrow.Newborns often void at the time of birth and may not void again for hours. Furthermore, urine samples can be difficult to obtain in the newborn.
A New Method: Umbilical Cord Toxicology
Dianne Montgomery, a neonatal nurse practitioner, was debating the pros and cons of various tissues and waste products for drug detection in newborns, while also trying to address nursing complaints about sample collection difficulties. She approached the United States Drug Testing Laboratory in 2001 to suggest the umbilical cord as an alternative tissue for infant toxicology.Cord toxicology testing first became available commercially in 2012 and is now offered by several US laboratories.
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Cite this article: Umbilical Cord Tissue: A Better Way to Test for Prenatal Drug Exposure? – Medscape – Jun 05, 2018.
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