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

Neonatal Opioid Withdrawal Syndrome

“…More recently, umbilical cord tissue testing has emerged as an alternative to meconium collection; given that umbilical cord tissue is readily available at the time of birth, it has logistic advantages to meconium collection. [49][50][51][52][53] Although some studies have suggested equivalence between meconium and umbilical cord tissue testing, 53 others studies have found the paired testing of meconium and umbilical cord tissue to be discordant. 54 Clinicians should be mindful of the differences in testing modalities when considering their needs for testing and work with their laboratories to determine the best testing modality in their setting.…”

Umbilical Cord Tissue and Meconium May Not Be Equivalent for Confirming in Utero Substance Exposure

“…Our study builds upon several smaller studies which previously used paired samples to assess confirmation of in utero substance exposure using UCT and MEC testing (14,15,18,22). Our results demonstrate that detection of drugs is variable between paired UCT and MEC samples as evidenced by lack of concordance and relatively low κ values (Table 2).…”

“…Meconium, the stool produced by the neonate during gestation, has a long window of drug detection and is often regarded as the gold standard test (7)(8)(9)(10); however, collections can be challenging and MEC is not always available in sufficient quantities (11)(12)(13). Umbilical cord tissue (UCT) has been proposed as an alternative to MEC because it is readily available in large quantities at the time of birth (14)(15)(16)(17); however, the window of drug detection in UCT is generally accepted to be shorter than that of MEC (7,9). Most studies assessing the comparability of UCT and MEC relied on small cohorts of paired samples where few subjects tested positive for drugs (15,(18)(19)(20)(21) or on large cohorts where samples were not paired (17).Larger cohorts with paired samples have been examined (9,14,22).…”

“…Umbilical cord tissue (UCT) has been proposed as an alternative to MEC because it is readily available in large quantities at the time of birth (14)(15)(16)(17); however, the window of drug detection in UCT is generally accepted to be shorter than that of MEC (7,9). Most studies assessing the comparability of UCT and MEC relied on small cohorts of paired samples where few subjects tested positive for drugs (15,(18)(19)(20)(21) or on large cohorts where samples were not paired (17).Larger cohorts with paired samples have been examined (9,14,22). Due to a combination of biochemical differences in drug or metabolite deposition and accumulation in UCT and MEC, cohort size, frequency of drug abuse in the test population, variation in drugs and metabolites included in the test panel and in test methodology, the existing literature is conflicted as to whether UCT is equivalent to MEC for confirming in utero substance exposure, and both tests are used in practice.…”

The importance of biomarkers of fetal exposure to alcohol and psychotropic drugs in early diagnosis: A case report

“…Nevertheless, different sensitivities and specificities exist between the 2 matrices; moreover, no data on the presence of EtG in the umbilical cord have yet been reported. 11,12 Neonatal hair provides information of eventual exposure in the last trimester of pregnancy. It can be obtained immediately after birth, but also subsequently taking into account the segment corresponding to intra-uterine life.…”