Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV.
Department of Pathology, Anatomy, and Laboratory Medicine, West Virginia University School of Medicine, Morgantown, WV.
J Appl Lab Med. 2021 Jan 12;6(1):285-297. doi: 10.1093/jalm/jfaa196.
West Virginia has high rates of opioid-related health crises and deaths that extend to pregnant women and newborns. Our institutional screening approach has included universal umbilical cord tissue drug analysis (UCTDA) since 2013. The objective of this study was to retrospectively report incidence of in utero drug exposure using UCTDA data.
Two sequential UCTDA data sets (October 2013 to September 2015, and October 2016 to September 2018) represent interrupted epochs given changes in interfaced data availability. UCTDA positivity (by drug class and parent drug) and numbers of drugs detected in each specimen were retrospectively analyzed. THC was removed from the analysis because of discontinuous testing, and 4 opioids were separated from the data set given the potential for both therapeutic and illicit use.
UCTDA specimens that were positive for drugs (22% overall) decreased between Epochs 1 and 2, from 25% to 20%. Increased positivity was noted for hydrocodone (+407%), oxycodone (+240%), amphetamines (+506%), and cocaine (+417%). Fentanyl and morphine positivity decreased by 75% and 18%, respectively, whereas buprenorphine detection increased 195%. Most positive specimens (80% overall) had 1 drug present, but specimens positive for 2 to 6 discrete drugs were found.
Universal UCTDA allows for unbiased assessment of drug exposure in infants. With the additional knowledge of therapeutic indications for drug use, UCTDA may allow for analysis of trends in illicit drug use and the impact of interventions to curb neonatal abstinence syndrome.
西弗吉尼亚州的阿片类药物相关健康危机和死亡人数居高不下，这一现象甚至延伸到了孕妇和新生儿身上。自 2013 年以来，我们的机构筛查方法包括对脐带组织进行普遍的药物分析（UCTDA）。本研究的目的是使用 UCTDA 数据回顾性报告胎儿药物暴露的发生率。
两个连续的 UCTDA 数据集（2013 年 10 月至 2015 年 9 月，以及 2016 年 10 月至 2018 年 9 月）分别代表了由于数据接口可用性变化而中断的时期。对 UCTDA 阳性（按药物类别和母体药物）和每个标本中检测到的药物数量进行回顾性分析。由于检测不连续，THC 被排除在分析之外，4 种阿片类药物也从数据集中分离出来，因为它们既有治疗用途，也有非法用途。
药物阳性的 UCTDA 标本（总体阳性率为 22%）在第 1 期和第 2 期之间有所减少，从 25%降至 20%。羟考酮（+407%）、氧可酮（+240%）、安非他命（+506%）和可卡因（+417%）的阳性率增加。芬太尼和吗啡的阳性率分别下降了 75%和 18%，而丁丙诺啡的检出率则增加了 195%。大多数阳性标本（总体阳性率为 80%）只检测到 1 种药物，但也发现了阳性标本中存在 2 到 6 种离散药物的情况。
普遍进行 UCTDA 可对婴儿的药物暴露情况进行无偏评估。通过了解药物使用的治疗指征，UCTDA 可能有助于分析非法药物使用的趋势以及抑制新生儿戒断综合征的干预措施的影响。
