Newborn 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.

Meconium specimens can only be submitted through hospital or health system accounts.


*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, or newborn ID sticker, on the Custody and Control Form and collection 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.
Close and latch the lid. Place tamper evident seal on top of lid
When collection is completed, close and latch the lid. Place the bar-coded, tamper-evident seal (from the bottom of the Custody and Control form) over the top of the lid, opposite the latch and hinge (Fig. 1). The collection container should be sealed so that opening the lid would break the seal, indicating tampering. Do NOT place the seal over the container latch or hinge. Failure to properly place a tamper-evident seal over the lid will result in a rejected specimen. 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
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
Saturday 8am - 5pm

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 screen and confirmation

Turnaround Time: Generally, the standard turnaround time for reporting negative screening test results is the next business day, with an additional 1-2 business days for specimens that require confirmatory testing. Turnaround time begins from receipt of the valid specimen – accompanied by a properly documented valid order – into the laboratory. Some tests require additional time to process and will fall outside the standard turnaround time window.

  • References
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Can a hair test be manipulated by the donor?

Yes. Bleaching, perming, dyeing and straightening can affect the outcome of a hair test. Cosmetically treated hair should not be collected.

Can the reported quantitation of drug or metabolite in hair, nail, meconium, umbilical cord, or urine be used to determine the timing of the drug use, how often the donor uses the drug, or the extent of the donor's drug use?

No, when testing a reservoir specimen type, a specimen type where analytes tend to accumulate, you may not backtrack to determine time, dosage, or frequency. The result is positive or negative for the appropriate detection window associated with the specimen type.

Have meconium results been used in court cases?

Yes, meconium results, when determined using two separate, validated laboratory procedures based on different scientific principles (also referred to as "confirmed" results), are forensically defensible. Our laboratory procedures have been scrutinized by laboratory inspectors, and our test results have been upheld in court because we follow strict internationally accepted forensic protocol.

How does using a forensic drug test help the child later in life?

There are several reasons detecting a substance exposed new born is important. Early detection provides many more options than detection at a later stage in the child's life, and

  • Early detection of fetal alcohol syndrome (FAS) and fetal alcohol effect (FAE) allow newborns to be identified and enrolled into early intervention and community programs. New programs are showing dramatic improvements in children identified earlier in life.
  • Detection of an exposed child can allow help, intervention and treatment to be offered to the mother, so that exposure during future pregnancies may be prevented.
  • As programs, understanding, and treatments improve, substance exposure detect, at a very early stage can only help the outcome of the child, mother and family.

How many days until I receive results?

Screen negative results will be transmitted to your web portal on the same day in which the laboratory receives the specimen. 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 3 grams of meconium (a teaspoon) is normally required. However, for best results, we recommend collection of the entire passage of meconium until the milk stool appears.

How should staff proceed with sending a specimen for testing on premature neonates that often do not stool for 3-5 days?

While these meconium specimens are fine for the routine drugs of abuse, these specimens (due to the delayed passage) should not be testing for FAEE.

May the reported quantitation of drug or metabolite in hair, nail, meconium, umbilical cord, or urine be used to determine the timing of the drug use, how often the donor uses the drug, or the extent of the donor’s drug use?

No. When testing a reservoir specimen type, a specimen type where analytes tend to accumulate, you may not backtrack to determine time, dosage, or frequency. The result is positive or negative for the appropriate detection window associated with the specimen type.

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 specimen 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 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 specimen 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 hear 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 positivity 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, being careful that it is not to mix in the milk stool. This is extremely important in order to obtain the maximum time window of exposure for the infant. Meconium is a HETEROGENOUS 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 an exposed newborn may go undetected.

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 specimen 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.


Reference: 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. Reference: (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 turnaround time for testing results?

Turnaround time (TAT) goal is 24 hours for screen negative with an additional 24-48 hours for specimens that require confirmatory testing. TAT begins from receipt of the specimen with valid order into our laboratory.

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 the mother's urine positive and the umbilical cord tissue / meconium negative?

There are several explanations for this. Different specimen types have varying thresholds for positivity. For example, a single dose of methamphetamine 12 hours prior to collection is highly likely to produce a positive urine result. However, it would be less likely to generate a positive result for a specimen type with a longer detection window such as umbilical cord, meconium or hair.




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