Perinatal Drug Testing Lab

Meconium Drug Testing

USDTL was the first laboratory to commercially introduce meconium testing to the market in 1991 and has remained a pioneer in research and development in the newborn toxicology industry.
Maternal substance abuse continues to be a significant issue in the United States. The rate of current illicit drug use among pregnant women has been reported as:

ages 15 to 17 - 16.2 percent
ages 18 to 25 - 7.4 percent
ages 26 to 44 - 1.9 percent

Among pregnant women aged 15 to 44 who reported alcohol use: 10.8 percent reported current alcohol use, 3.7 percent reported binge drinking, and 1.0 percent reported heavy drinking with 10.1 percent of pregnant women reporting binge drinking during the first trimester.* Early identification of exposed newborns provides for early treatment and better results for the baby.

Meconium contains the amniotic fluid swallowed by the fetus in the last half of pregnancy and is released as the first stools after birth. Meconium is easier to collect than neonatal urine and provides a much longer window of exposure of up to 20 weeks. A sample of 3 grams (1 teaspoon) of meconium is needed for maximum sensitivity. USDTL will analyze smaller amounts, but with a reduction in sensitivity and/or the window of exposure. We recommend weighing the specimen on a jeweler's scale.

Click here to download the meconium drug panels.

Meconium collection for FAEE changed as of October 1, 2016. Please see the announcement for full details. Click Here

Click here to view the Meconium Resources page.

For information about umbilical cord tissue drug testing, please click here.

*http://www.samhsa.gov/data/NSDUH/2k10NSDUH/2k10Results.htm#3.1.3

Drug Panels

  • 13 Panel
  • 12 Panel
  • 9 Panel
  • 7 Panel
  • 5 Panel
Amphetamines
amphetamine, MDA, MDMA, methamphetamine
Cannabinoids
carboxy-THC
Cocaine
benzoylecgonine, cocaethylene, cocaine, meta- hydroxybenzoylecgonine
Opiates
codeine, hydrocodone, hydromorphone, morphine
Phencyclidine
phencyclindine (PCP)
Methadone
EDDP, methadone
Barbiturates
amobarbital, butalbital, pentobarbital, phenobarbital, secobarbital
Benzodiazepines
oxazepam
Propoxyphene
norpropoxyphene
Oxycodone
oxycodone
Meperidine
normeperidine
Tramadol
tramadol
Buprenorphine
buprenorphine, norbuprenorphine
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*Click the green and white plus sign beside each drug class to view the substances within each class.
Add-Ons Available
FAEE (Direct Ethanol Biomarker)
Fatty Acid Ethyl Ester
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Collection

Collection Instructions
Collection Steps
Collect 2-3 grams of meconium
Strategically place a liner in the diaper so as meconium is passed, it collects on the liner instead of the diaper.

Collect by transferring the meconium from the diaper liner to the collection container using the spatula provided. (If collection supplies are not available, a nonsterile, screw-top urine container and wooden tongue depressor may be used.)
Record name and I.D. number
Place name and I.D. number on the Custody and Control Form and meconium container. Enter date of birth and time of birth.
Document each separate collection
Document each separate collection with a collector signature and date/time of collection on the Custody and Control form. Be sure to continue collecting specimen into the same collection container until all meconium has been excreted. Verify that the container ID# and the ID# on the form match before each collection.
Place tamper evident seal on top of lid
When collection is completed, place the bar-coded, tamper evident seal (from the bottom of the form) over the top of the lid, sealing the matching meconium container. Initial and date the seal.
Mark meconium box on form
Mark the meconium box on the form and (5a) select all test(s) that have been ordered.
Complete and sign the form
Check the box for Collector or Processor. Complete and sign the form.
Place in bag
Place the top copy of the completed Custody and Control form in the large pouch of the plastic specimen bag provided. Place the meconium container in the small pouch of the specimen bag, and seal the bag.
Place the specimen bag in the box, then place the box in a courier overwrap
Place the specimen bag in the box, then place the box in a courier overwrap.
Contact courier
Contact your courier for pick-up.
Client Services

By Phone: 1.800.235.2367

Business Hours (CST)

Monday 6am - 8pm
Tuesday 6am - 8pm
Wednesday 6am - 8pm
Thursday 6am - 8pm
Friday 6am - 8pm

Contact Client Services

Testing Details

Panel Name: MeconiumTesting

Panel Description: Meconium Testing Drug Panel

Type: Profile

Matrix: Meconium

Collection Container: Leakproof Polypropylene

Collection Notes: Pool of Multiple Collections

Sample Amount: 3 grams     (We recommend weighing the specimen on a jeweler's scale.)

Storage Conditions: Refrigerated

Transport Conditions: Ambient

Method: Initial screening test with confirmation of presumptive positives

Turn-Around Time: 1 day for negatives / 2-3 days for positives

  • References
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  • FAQs
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Can Meconium Testing for FAEE be run in conjunction with testing for panels for illegal drugs?

Yes, Meconium Testing 5-, 7-, 9- and 12-drug panels can all be bundled with Meconium Testing for FAEE.

Do doctors know about Meconium Testing for FAEE? Does USDTL have a means of informing doctors of this new test?

Yes and No. Many physicians know about the test from scientific publications and literature from USDTL. There are, however, many physicians that are not yet knowledgeable about the test and have never ordered it. If your local physicians do not have the necessary information to order the test, call Client Services at 1-800-235-2367 and the scientific information will be supplied.

Have meconium results been used in court cases?

Yes. Meconium results, when determined using two separate, validated laboratory procedures based on different scientific principles, are forensically defensible. Our laboratory procedures have been scrutinized by laboratory inspectors, and our test results have been upheld in court.

How are meconium results reported to the hospital?

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. Under no circumstances are results ever given via telephone, since the laboratory has no definite indication of the identity of the caller.

How can DHS Methamphetamine specialists use information about Meconium Testing for FAEE to improve our protection of children?

Results from Meconium Testing for FAEE give DHS personnel direct information about newborns who have been exposed to high levels of Ethyl Alcohol. Approximately 3 percent of all newborns have been exposed to high levels of alcohol and these newborns’ meconium specimens have FAEE levels greater than 10,000 ng/gram. This “red flag” level represents only one quarter of the total number of alcohol exposed newborns. Three quarters of alcohol exposed newborns were exposed to small or moderate amounts of alcohol and represent lower risks of manifesting signs and symptoms of Fetal Alcohol Spectrum Disorder. The newborns with FAEE levels greater than 10,000 are at higher risk for Fetal Alcohol Spectrum Disorder, as well as a higher probability of living in a chaotic environment where abuse or neglect is more likely.

How can positive drug or alcohol test results be interpreted? If the quantity of drug or alcohol metabolite detected is high could that be an indication that the donor (1) was consuming a large amount, (2) was using recently, or (3) was using frequently?

There are too many variables for anyone to know time of use, dosage, or frequency from the result(s) of a drug test. Reservoir matrices such as hair, fingernail, umbilical cord, and meconium continuously collect drug and alcohol biomarkers. This makes it difficult to determine specific details of use. Because the biomarker is collected over a period of time, the results represent total accumulation that cannot be pin-pointed to specific times/dates/dosages, etc.

How does NIDA and the court system view the validity of Meconium Testing for FAEE?

NIDA (The National Institute on Drug Abuse) actually is NOT the institute that funded the original research for FAEE in meconium. It was the National Institute for Alcohol Abuse and Alcoholism (NIAAA) that provided USDTL with the grant funds to develop Meconium Testing for FAEE. This test has become the de facto standard for laboratory diagnosis of fetal alcohol exposure and is in routine use all over the United States and Canada. Courts have held that Meconium Testing for FAEE meets both the Fry and Daubert standards, and the results are admissible in adversarial proceedings.

How many days until I receive results?

Screen negative results will be transmitted to your secure fax on the same day on which the laboratory receives the sample. 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 grams 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 milk stool appears.

Mother tested negative for chemicals on a saliva test, 8 days later, her baby was born and its 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.

Please describe the new meconium test for alcohol.

Meconium Testing for FAEE is a test of the non-oxidative metabolites of ethanol called Fatty Acid Ethyl Esters. These metabolites are the chemical combination for endogenous fatty acids present in the blood of a fetus and Ethyl Alcohol. These new compounds, which only form when the fetus is exposed to Ethyl Alcohol, are deposited into the fetus’s meconium and can then be detected and quantified from the newborn’s meconium after delivery. The amount of the Fatty Acid Ethyl Esters found in the meconium is representative of the amount of Ethyl Alcohol the fetus was exposed to during the last half of the pregnancy.

What are the meconium sample storage requirements?

Drugs and metabolites are stable in meconium for up to 2 weeks at room temperature. However, refrigerated or freezer storage is preferred. 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.

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.

What is m-OH-BZE?

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 percent 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 percent 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

What is the relationship between alcohol consumed and FAEE levels?

Based on two 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)

What is the window of detection for meconium?

Meconium begins to form in weeks 16 through 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.

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.

  1. 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.
  2. 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.
  3. 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.

Why was one matrix positive and another negative on the same donor?

Different sample matrices have different detection time frames. The result of any second collected specimen has no bearing on the validity of a first collected specimen. For example, a hair sample with a three month window of detection might test positive for a particular substance, while a urine sample from the same donor, with a 2-3 day window of detection, might test negative. In this case, the donor has used that substance within the past three months, but may not have used it within the most recent three days.




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