Palmer Kendra L, Wood Kelly E, Krasowski Matthew D
Department of Pathology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA.
Stead Family Department of Pediatrics, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA.
Clin Biochem. 2017 Apr;50(6):255-261. doi: 10.1016/j.clinbiochem.2016.11.026. Epub 2016 Nov 24.
The objective of this study was to compare detection rates of newborn drug exposure at an academic medical center transitioning from meconium to umbilical cord tissue toxicology testing.
We performed an Institutional Review Board-approved retrospective chart review on all newborns (n=2072) for whom newborn drug testing was ordered at our academic medical center between June 2012 and August 2015 (in August 2013, umbilical cord tissue became the preferred specimen).
Meconium toxicology testing was positive for at least one compound in 221 cases (21.3% of 1037 total specimens), with non-medical drug use identified in 85 cases (8.2%). Umbilical cord tissue toxicology testing was positive for at least one compound in 302 cases (29.2%), with non-medical drug use identified in 107 cases (10.3%). Of the cases involving non-medical drug use, the most common compounds detected were tetrahydrocannabinol and amphetamines. Non-medical drug use did not differ significantly between meconium and umbilical cord tissue, either as a total or for classes of drugs such as amphetamines, cannabinoids, and opiates. Maternal non-medical use of tramadol (not tested for in meconium) was identified in 5 cases (0.4%). There were significant differences in rate of detection of iatrogenic medications. Specifically, morphine, lorazepam, phenobarbital, and codeine were more commonly detected in meconium, while oxycodone was more commonly detected in umbilical cord tissue.
Umbilical cord tissue toxicology testing yielded a similar detection rate compared to meconium testing. The use of umbilical cord tissue avoids detection of medications given to the neonate prior to meconium collection.
本研究的目的是比较一家学术医疗中心从胎粪毒理学检测过渡到脐带组织毒理学检测时新生儿药物暴露的检出率。
我们对2012年6月至2015年8月期间在我们学术医疗中心接受新生儿药物检测的所有新生儿（n = 2072）进行了一项经机构审查委员会批准的回顾性病历审查（2013年8月起，脐带组织成为首选样本）。
221例（占1037份总样本的21.3%）的胎粪毒理学检测至少有一种化合物呈阳性，其中85例（8.2%）检测出非医疗性药物使用。302例（29.2%）的脐带组织毒理学检测至少有一种化合物呈阳性，其中107例（10.3%）检测出非医疗性药物使用。在涉及非医疗性药物使用的病例中，检测到的最常见化合物是四氢大麻酚和苯丙胺类。无论是总体还是苯丙胺类、大麻素类和阿片类等药物类别，胎粪和脐带组织中的非医疗性药物使用情况均无显著差异。在5例（0.4%）中发现产妇非医疗性使用曲马多（胎粪中未检测）。医源性药物的检出率存在显著差异。具体而言，吗啡、劳拉西泮、苯巴比妥和可待因在胎粪中更常被检测到，而羟考酮在脐带组织中更常被检测到。
与胎粪检测相比，脐带组织毒理学检测的检出率相似。使用脐带组织可避免检测到在采集胎粪之前给予新生儿的药物。
