Numerous studies have shown that meconium specimens are too often unavailable for substance exposure testing. Universal collection of umbilical cord specimens offers a solution.

By Joseph Salerno

Unable, despite her best efforts to shake her addiction, a woman exposes her unborn child to drugs in the womb. The baby is born, healthy and beautiful with all the promise the future holds. Three days later, the withdrawal symptoms kick in. The baby wails, flush with the pains of withdrawal and inconsolable, unable to sleep, experiencing seizures. The NICU physician wants to know what the baby has been exposed to, but now it’s too late. The meconium has already been passed and discarded, and the umbilical cord is gone, lost opportunities for concrete answers. Now it’s a guessing game.

This isn’t just a “what-if” scenario, unfortunately, but a potential reality in a surprisingly large number of newborn substance exposure cases. Withdrawal symptoms in substance exposed newborns can be delayed up to three, five, even seven days after the baby is born. Cases of in utero barbiturate exposure may not manifest withdrawal signs until 14 days post-delivery. By that time it’s too late to test any of the baby’s specimens for biomarkers of substance exposure, because the specimens are gone.

Universal collection of umbilical cord specimens offers a solution to avoid this dilemma. Umbilical cord is the only universally available specimen for substance exposure testing. Numerous studies have shown meconium is not available for testing in up to 27% of births. Meconium may be passed in utero. In some cases, there is not enough meconium volume to test even when it is able to be collected.

And again, meconium may have been passed by the newborn and discarded well before they begin to exhibit withdrawal symptoms. Unfortunately, this can also be a problem when the signs of in utero substance exposure emerge after the umbilical cord has been discarded. Newborn urine testing is not a viable option in these cases, because urine provides only a 1-3 day window of detection for substance exposure biomarkers, compared to the 20 week look-back of umbilical cord.

Universal collection of umbilical cord specimens for every birth ensures there are no lost opportunities should the need for substance exposure testing arise. Umbilical cord collection is extremely easy, requiring very little additional effort during post delivery procedures. Only six inches of the cord is required for substance testing, taking up very little storage space.

Umbilical cord tissue is a very stable and reliable specimen. Cord tissue is stable up to 1 week at room temperature, and up to 3 weeks when refrigerated, without jeopardizing the testing results. This is ample time for the emergence of newborn withdrawal symptoms, even in the most extreme cases. Enough time to avoid a missed opportunity for real answers. Only one donor and one collector are present during the umbilical cord collection – in contrast to the multiple collections and multiple collectors involved with meconium – greatly improving chain-of-custody integrity. Umbilical cord specimens are ready for transport just minutes after the birth, greatly improving turnaround time for results reporting. Meconium passages can be delayed for days before being sent to the lab.

References

1. Arendt, R., Singer, L., Minnes, S. and Salvator, A. (1999). Accuracy in detecting prenatal drug exposure. Journal of Drug Issues. 29(2), 203-214.

2. Ostrea, E., Knapp, D., Tannenbaum, L., Ostrea, A., Romero, A., Salari, V. and Ager, J. (2001). Estimates of illicit drug use during pregnancy by maternal interview, hair analysis, and meconium analysis. Pediatrics. 138, 344-348.

3. Lester, B., ElSohly, M., Wright, L., Smeriglio, V., Verter, J., Bauer, C., Shankaran, S., Bada, H., Walls, C., Huestis, M., Finnegan, L. and Maza, P. (2001). The maternal lifestyle study: Drug use by meconium toxicology and maternal self-report. Pediatrics. 107(2), 309-317.

4. Derauf, C., Katz, A. and Easa, D.. (2003). Agreement between Maternal Self-reported Ethanol Intake and Tobacco Use During Pregnancy and Meconium Assays for Fatty Acid Ethyl Esters and Cotinine. American Journal of Epidemiology. 158, 705–709.

5. Eylera, F., Behnkea, M., Wobiea, K., Garvanb, C. and Tebb, I. (2005). Relative ability of biologic specimens and interviews to detect prenatal cocaine use. Neurotoxicology and Teratology. 27, 677 – 687.

Last week the CDC released a study that concluded: “Binge drinking is reported by one in eight U.S. adult women and one in five high school girls. Women who binge drink tend to do so frequently and with high intensity. Most high school girls who reported current alcohol use also reported binge drinking.”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6201a3.htm?s_cid=mm6201a3_w

This growing trend in “keeping up with the boys” can have long term public health implications. 

CDC: “Implications for Public Health Practice: More widespread implementation of evidence-based interventions, such as those recommended by the Guide to Community Preventive Services and the U.S. Preventive Services Task Force, would be expected to reduce the frequency and intensity, and ultimately the prevalence of binge drinking among women and girls, and the harms related to it. “

Phosphatidylethanol (PEth)* is an alcohol biomarker (an evidence based marker) that can detect the difference between binge drinking and steady state use without worry of adulteration, bias, or incidental exposure for as far back as three weeks. The chart below shows the ability to detect drinking behaviors.

Go to www.USDTL.com to learn more about our BloodSpot™ assay, PEth and other long term alcohol biomarkers.

United States Drug Testing Laboratories, Inc. has an active research department. Our latest scientific paper is on “The Detection of 1-Palmitoyl-2-oleoyl-sn-glycero-3-phosphoethanol and Ethyl Glucuronide in Human Umbilical Cord. ” was published in the American Journal of Analytical Chemistry, 2012, 3, 800-810 doi:10.4236/ajac.2012.312106 Published Online December 2012 (http://www.SciRP.org/journal/ajac) 

Video links from “The Doctors” re: Newborns Exposed to Drugs And Alcohol in The Womb.

Methamphetamine Babies
Registered nurse Linda West and fellow Angels in Waiting nurses join The Doctorsto share their experiences fostering abandoned methamphetamine babies. OB/GYN Dr. Lisa Masterson explains how using methamphetamine while pregnant affects a growing fetus.

Angels In Waiting
More than 550,000 babies are born every year after exposure to drugs and alcohol in the womb. These babies are often born premature and with serious health issues, which make them “unpopular” for adoption. Registered nurse Linda West took matters into her own hands and founded the organization Angels in Waiting, a network of neonatal intensive care unit nurses who become foster parents for abandoned babies

Where are the babies now?

How We Can Help

USDTL CordStat® definitively confirms opioid exposure. Many NAS babies are poly-substance exposed in utero. CordStat 12 and 13 drug panels identify the majority of opioids along with many drugs often associated with NAS. Positive results are an objective measure and often times the only flag that baby’s home life may need extra care. Go to www.USDTL.com to learn more.

As promised we are offering this week’s News You Can Use in Newborn Health.

Heart test that saved baby now recommended for all newborns: http://www.king5.com/health/Heart-test-that-saved-baby-now-recommended-for-all-newborns-135614093.html 

A Warning for pregnant women who want a holiday drink: http://abcnews.go.com/Health/pregnant-women-holiday-drinking-fetal-alcohol-syndrome-disorder/story?id=15099090 (FASD)

Acetaminophen concentrations changing; for infant safety check the dosage: http://www.examiner.com/healthy-living-in-huntsville/infant-safety-know-concentration-before-giving-acetaminophen-to-babies?utm_source=twitterfeed&utm_medium=twitter

Following are links to recent neonatal news reports:

· WSAZ Huntington, W. Va.
Hospitals and treatment centers are overwhelmed as the medical, social and legal challenges regarding addicted moms and newborns spark problems and progress: http://www.wsaz.com/news/headlines/WSAZ_INVESTIGATES_Drug_Addicted_Pregnant_Women_Reach_Crisis_Stage_133996608.html

· USA Today reports in florida, the number of babies with withdrawl syndrome is up 26% from 2006. http://yourlife.usatoday.com/parenting-family/babies/story/2011-11-13/Doctors-see-surge-in-newborns-hooked-on-mothers-pain-pills/51186076/1

· Babies born at a very low birth weight are more likely to have memory and attention problems when they become adults than babies born at a low to normal weight, according to a study published in the December 6, 2011, print issue of Neurology®, the medical journal of the American Academy of Neurology http://www.newswise.com/articles/view/583427/?sc=dwhp

gy • Maternal exposure to oxycodone during breastfeeding was associated with a 20.1% rate of infant CNS depression…http://www.jpeds.com/article/S0022-3476(11)00678-0/abstract?elsca1=etoc&elsca2=email&elsca3=0022-3476_201201_160_1&elsca4=pediatrics