Ryan R M, Wagner C L, Schultz J M, Varley J, DiPreta J, Sherer D M, Phelps D L, Kwong T
Department of Pediatrics (Neonatology), School of Medicine and Dentistry, University of Rochester, New York 14642.
J Pediatr. 1994 Sep;125(3):435-40. doi: 10.1016/s0022-3476(05)83291-3.
We screened anonymously all mothers and infants born during a 3 1/2-month period to determine the prevalence of intrapartum cocaine use, test the maternal characteristics that are specific predictors of intrauterine cocaine exposure (IUCE), and compare the sensitivity of infant urine versus meconium samples for identification of IUCE. Of 1237 live births during the study period, a sample was obtained from 1201 mother-infant pairs. The overall prevalence of documented intrapartum cocaine exposure was 66 (5.5%) of 1201 pairs. Previously developed drug screening guidelines had a sensitivity of 89% for detecting IUCE in infants. Direct comparisons of samples from the same mother-infant pair revealed that there were no cases in which cocaine was found in infant urine but not in meconium; however, infant urine testing missed 25% of the infants who had positive findings in meconium. We conclude that (1) meconium testing was more likely than urine testing to identify an infant with IUCE, detecting an additional 33%; (2) there was significant maternal cocaine use (5.5%) in a teaching hospital with a mixed patient population; (3) maternal characteristics known to identify infants at risk of having IUCE were useful in our population; and (4) IUCE of neonates admitted to the neonatal intensive care unit was more common than that of infants admitted to the regular newborn nursery.
我们对在3个半月期间出生的所有母亲和婴儿进行了匿名筛查，以确定产时可卡因使用的患病率，测试作为宫内可卡因暴露（IUCE）特定预测指标的母亲特征，并比较婴儿尿液与胎粪样本对识别IUCE的敏感性。在研究期间的1237例活产中，从1201对母婴中获取了样本。记录在案的产时可卡因暴露的总体患病率为1201对中的66例（5.5%）。先前制定的药物筛查指南检测婴儿IUCE的敏感性为89%。对同一母婴对的样本进行直接比较发现，不存在婴儿尿液中检测到可卡因而胎粪中未检测到的情况；然而，婴儿尿液检测漏检了25%胎粪检测呈阳性的婴儿。我们得出以下结论：（1）胎粪检测比尿液检测更有可能识别出有IUCE的婴儿，多检测出33%；（2）在一家有混合患者群体的教学医院中，母亲使用可卡因的情况较为显著（5.5%）；（3）已知的用于识别有IUCE风险婴儿的母亲特征在我们的人群中是有用的；（4）入住新生儿重症监护病房的新生儿的IUCE比入住常规新生儿病房的婴儿更为常见。
