Umbilical Cord testing with CordStatSM
5-Panel
14-Panel HairStatSM
including Fentanyl and Sufentanil
Meconium testing for Alcohol exposure to newborn
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MecStatSM
How many days until I receive results?
How much meconium is needed for the test?
What is the window of detection?
What drugs are in the 5,7,9 and 12 panel?
What is the relationship between alcohol consumed and FAEE levels?
Have results been used in court cases?
What is m-OH-BZE?
Sample storage requirements?
Why test for fetal alcohol exposure when there is no treatment available?
How are results reported to the hospital?
What information can you give on testing of meconium and why some experts state
that it depends what part of the meconium is sent into labs as to what will test positive?
Mother tested negative for chemicals on a saliva test, 8 days later, her baby was born
and it’s meconium drug screen showed the presence of methamphetamine and amphetamine.
What does this mean?
How many days until I receive results?
a. From the day that the laboratory receives the sample, screen negative
results will be transmitted to your secure fax on the same day.
b. Screen positive results will be confirmed using a separate technique
and reported 2-3 business days after specimen receipt.
How much meconium is needed for the test?
A minimum of 2.0 g of meconium (a teaspoon) is normally required, although
some tests, such as "confirmatory tests only" can be performed with less.
However for best results, we recommend collection of the entire passage of
meconium, until the milkstool begins to appear.
What is the window of detection?
Meconium begins to form in week 16-20 of gestation. Therefore, depending on the
gestational age of the newborn, a complete collection of meconium will represent
approximately 20 weeks of maternal drug use history.
What drugs are in the 5,7,9 and 12 panel?
a. The 5-drug panel consists of:
- Cocaine and its metabolites, cocaethylene, benzoylecgonine, meta-hydroxybenzoylecgonine
- Methamphetamine, amphetamine, MDMA (Ecstasy), MDA (Ecstasy metabolite)
- Morphine, codeine, hydrocodone, hydromorphone
- Phencyclidine (PCP)
- Marijuana
b. The 7-drug panel consists of the 5 drug panel plus:
- Methadone and EDDP (metabolite)
- Barbiturates
c. The 9-drug panel consists of the 7-drug panel plus:
- Benzodiazepines (diazepam metabolites)
- Propoxyphene metabolite
d. The 12 drug panel consists of the 9-drug panel plus:
- Oxycodone
- Meperidine
- Tramadol
e. Oxycodone (OxyContin) is available as a separate test.
What is the relationship between alcohol consumed and FAEE levels?
Based on 2 research studies reported in peer-reviewed literature, the total
FAEE levels in excess of 10,000 ng/g show significant ethanol exposure in
the newborn.
(Moore C, Jones J, Lewis D, Buchi K. Prevalence of fatty acid ethyl esters in meconium specimens.
Clin Chem 2003;49(1):133-136)
Have results been used in court cases?
a. Yes, meconium results when determined using two separate, validated laboratory procedures
based on different scientific principles are forensically defensible.
b. Our laboratory procedures have been scrutinized by laboratory inspectors and our test
results have been upheld in court.
What is m-OH-BZE?
a. meta-hydroxybenzoylecgonine (m-OH-BZE) is a metabolite of cocaine which is often present
in the meconium of neonates born to cocaine using mothers. It is a minor metabolite in adults,
but it has been identified as the only cocaine metabolite present in 23% of meconium samples
screening positively for cocaine. If a laboratory does not include m-OH-BZE in its confirmation
profile, there is a risk of not identifying up to 23% of cocaine exposed newborns.
Lewis D, Moore C, Becker J, Leikin J. Prevalence of meta-hydroxybenzoylecgonine (m-OH-BZE)
in meconium samples. Bulletin of the lnt.Ass.Forens Toxicol 1995;25(3):33-36
Sample storage requirements?
a. Drugs and metabolites are stable in meconium for up to 2 weeks at room temperature.
However, refrigerated or freezer storage is preferred.
b. Alcohol metabolites, specifically FAEE, are sensitive to heat and light and therefore the PREFERRED
shipping method is frozen on dry ice. Since this method is both difficult and
expensive, most institutions send at room temperature and realize that the FAEE
concentrations may be reduced. USDTL accepts specimens that are shipped at room temperature.
Why test for fetal alcohol exposure when there is no treatment available?
There are several reasons why diagnosis of alcohol exposure is important. As with
any disease, early diagnosis provides for many more options and treatments than detection
at an advanced stage.
a. Early diagnosis of fetal alcohol syndrome (FAS) and fetal alcohol effect (FAE)
allow newborns to be identified and enrolled into early intervention and treatment
programs. New programs are showing dramatic improvements in children identified earlier
in life.
b. Detection of an alcohol affected child can allow help, intervention and treatment to
be offered to the mother, so that future FAS and FAE children may be prevented.
c. When cocaine and opiate exposed newborns were first detected, there was no
treatment. As programs, understanding and treatments improve, diagnosis at a very
early stage can only help the outcome of the child, mother and family.
How are results reported to the hospital?
a. Generally, results are reported to a secure fax at the hospital facility. This
number is confirmed as secure when your account is initiated. As encryption
programs improve, developments in e-mail and web-based internet reporting are being
developed.
b. Under no circumstances are results ever given via telephone, since the laboratory
has no definite indication of the identity of the caller.
What information can you give on testing of meconium and why some experts state
that it depends what part of the meconium is sent into labs as to what will test positive?
The single most important element of collecting meconium for drug and alcohol testing
is obtaining the entire quantity of meconium that the newborn passes. This is extremely
important in order to obtain the maximum time window of exposure for the
infant. Meconium is a HETEROGENEOUS material and each portion passed reflects a different
time of gestation. This is due to the extreme viscosity of the meconium mass and the
lack of significant mixing in the fetal intestine. If only a portion of the total
meconium is collected and sent for analysis, it may reflect a period of abstinence
and a truly drug or alcohol exposed infant will be misdiagnosed as non-exposed.
Mother tested negative for chemicals on a saliva test, 8 days later, her baby was born
and it’s meconium drug screen showed the presence of methamphetamine and amphetamine.
What does this mean?
This is an excellent example of the difference in the time window
between meconium and saliva. Saliva will reflect use for up to 48 hours after use of
Methamphetamine. Meconium reflects weeks of past exposure history. In this case the maternal
use did not fall into the time window available from a saliva sample but the meconium
specimen did provide a broad enough window to identify the newborn as Methamphetamine exposed.
The take home message is that meconium reflects weeks to months of exposure history whereas
urine and saliva provide hours to days of history.
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