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

Publication date: Available online 21 September 2017
Source:Clinical Biochemistry
Author(s): Ruth M. Labardee, Jaime R. Swartzwelder, Karen E. Gebhardt, Justine A. Pardi, Anna C. Dawsey, R. Brent Dixon, Steven W. Cotten
ObjectiveNeonatal 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.MethodsThe 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 UCTResultsUmbilical cord tissue showed higher clinical sensitivity but lower specificity for prediction of NAS diagnosis. Birth to result time decreased with adoption of UCTConclusionsBirth 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.



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