Neonatal Cord Tox Panel and Maternal Perinatal Fentanyl Exposure: A Retrospective Chart Review

Joseph Jones, Donna Coy, Ryan Mitacek, Stephanie Thompson, Stefan Maxwell
First published: September 2021 https://doi.org/10.4236/ajac.2021.129020

Abstract

Model of embryo and ultrasound of uterus | Sourced by Freepik©Stock

Objective

The specific aim of this study was to determine if the currently available cutoff for fentanyl in the umbilical cord (UC) was appropriate to distinguish illicit fentanyl exposure from therapeutic in-hospital administration of fentanyl.

Study Design

A medical record review was conducted for the perinatal administration of fentanyl and the detection of fentanyl in the corresponding routine UC toxicology. Specimens were initially tested with immunoassay followed by mass spectrometry (n = 62).

Result

Excluding a single specimen that was confirmed positive, specimens were below the assays’ limit of quantification. The immunoassay’s mean b/b₀ for the cases that received and did not receive fentanyl prior to delivery was 91.3% ± 10.6% and 98.2% ± 6.5%, respectively (p = 0.003).

Conclusion

We demonstrated that UC is a suitable specimen type for the detection of fentanyl and that the cutoff selected adequately identifies illicit fentanyl use while not flagging cases where fentanyl was administered by the hospital prior to birth.

Keywords: Fentanyl, Norfentanyl, Umbilical Cord, Prenatal Fentanyl Exposure\

Introduction

Neonatal abstinence syndrome (NAS) occurs in newborns whose mothers use a neuroactive (affecting brain and nervous tissue) substance such as opioids while pregnant. The rate of NAS has been growing due to the increasing use of opioids in recent years. Fentanyl is a common pain medication used in the obstetric management of labor. Chronic exposure to fentanyl prior to birth can potentially result in NAS. Fentanyl can either be used illicitly, abused, or clinically to control chronic pain or pain during labor.

The umbilical cord presents a unique opportunity for drug testing and potential identification of NAS. It is available immediately after birth, and each birth produces sufficient quantities of specimens for analysis, unlike other specimen types routinely used for newborn toxicology. As a newborn toxicology specimen, umbilical cord analysis can identify maternal drug use during approximately the third trimester of pregnancy.

There are limited options for commercial assays to test for in-utero fentanyl exposure. In addition, data to guide the selection of an appropriate cut-off for umbilical cord fentanyl detection to distinguish illicit substance exposure from therapeutic in-hospital administration of fentanyl is currently lacking. The specific aim of this study was to determine if the currently available cutoffs for fentanyl in the umbilical cord (500 pg/g) distinguish illicit fentanyl exposure from therapeutic in-hospital administration of fentanyl.

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