To view the Meconium Testing Panels and Collection Instructions, click here.
Maternal Marijuana Use by Joseph Jones
Meconium Collection Overview
The Importance of Following Forensic Principles in Newborn Drug Testing by Dr. Irene Shu
Ask the Tox 01-Aug-2017
Meconium Collection: Nothing More, Nothing Less 01-Aug-2017
Why is Confirmation Testing Necessary? 01-Aug-2017
Newborn Testing For Alcohol Biomarkers 11-Nov-2016
Who Cares About Chain of Custody? 11-Nov-2016
THCA Meconium State Law 28-Jul-2016
A Moment In Time 02-Feb-2015
Lost Opportunities 02-Feb-2015
Marijuana Use in Pregnancy 01-May-2013
USDTL Meconium Research
The Detection of Oxycodone in Meconium Specimens 01-Jan-2005
Determination of drugs of abuse in meconium 21-Aug-1998
Cocaethylene in meconium specimens 01-Jan-1994
Meconium Poster Presentations
Assessment of Maternal Drinking Patterns from Self-Report Screening and Two Direct Alcohol Biomarkers in Newborns
The Detection of Prenatal Marijuana Exposure using Meconium and Umbilical Cord: A Comparison using Matched Pairs
The Increased Sensitivity of Phosphatidylethanol Over Fatty Acid Ethyl Esters in Identifying Neonates Exposed to Dangerous Level of Alcohol In Utero
USDTL Meconium Assisted Research
Meconium Slide Presentations
The Importance of Following Forensic Principles in Newborn Drug Testing by Dr. Irene Shu
Foundational Meconium Research
To help you have the best possible solutions that science can offer, we are consistently evaluating our processes to keep them ahead of the curve. As science progresses, so do our capabilities. Because of such progress, we have some important updates to the meconium collection process.
Effective July 18, 2016, USDTL will be implementing a new way of reporting quantitative results. In order to satisfy accreditation requirement, the concentrations of drugs exceeding the Upper Limit of Quantification (ULOQ) for any given drug will be reported as > ULOQ (greater than ULOQ). The ULOQ will be provided.
Quantity Not Sufficient (QNS) is a result of not having a sufficient quantity (volume) of specimen to test for the panels ordered. The amount of specimen required for collection is directly related to the amount of specimen needed to screen and confirm for the panels we offer. The initial screening uses a portion of the original specimen and the confirmation testing uses another portion of the original specimen. To forensically confirm positives, means running a new test, with a new portion of the original specimen, using a different analytical technique.
It is our first priority to deliver testing results that provide the most valuable information possible for your substance abuse testing needs. To better accomplish this duty to our clients, we are updating our policy concerning specimens that do not have sufficient volume for both preliminary testing and confirmation. Effective April 1, 2015, confirmatory tests that cannot be completed due to insufficient specimen volume will be canceled on an individual drug class and/or analyte basis. We will report confirmation results for each test for which there is sufficient volume of specimen available, giving you access to more information.
*Click the green and white plus sign beside each question to view the answer.
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 drugs administered to the mother during labor or delivery be detected in the newborn’s meconium or umbilical cord tissue specimen?
Yes. Drugs such as fentanyl or morphine only take a few minutes to reach the meconium and umbilical cord tissue. Although we do not see it every time, we routinely pick up morphine administered to the mother during labor and delivery. The appropriate question is whether there is a prescription or medical record that can provide a reasonable explanation for the specimen to test positive.
Can the drug test from a maternal specimen (such as maternal hair, nail or urine) differ from the result from a neonatal specimen such as neonatal urine, meconium or umbilical cord tissue?
Yes, the results can be different. Each specimen type has its own advantages, disadvantages, threshold to positivity, and detection time window. One test does not refute the other. The test results are cumulative. For instance, if the maternal urine is positive for cocaine and newborn meconium is positive for methamphetamine, the results do not rule each other out. The appropriate interpretation is that the mother consumed both cocaine and methamphetamine.
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.
Can the use of any isopropanol (rubbing alcohol) containing product explain a positive ethyl glucoronide (EtG) or fatty acid ethyl esters (FAEE) result?
No. The use of any product that contains isopropanol, such as isopropyl rubbing alcohol will not explain the present of a direct ethyl alcohol biomarker such as EtG or FAEE. Isopropanol forms its own glucoronide, isopropyl glucoronide and does not interfere with the detection of EtG or FAEE.
Does the sample need to be frozen?
No, the sample may be shipped ambient.
Does the use of lidocaine explain a positive cocaine or cocaine metabolite in any specimen type?
No, lidocaine will not explain a GCMS or LC-MS/MS confirmed positive cocaine or cocaine metabolite in any specimen type. The compounds are structurally very different and breakdown into different metabolites.
Have results been used in court cases?
Yes, the analysis of a number of tissue types for the presence of drugs of abuse has been used in every state for decades. Specifically, our umbilical cord testing has been used to provide evidence of drug use by the mother in numerous states. Additionally, the detection of drug in umbilical cord was used as evidence of maternal drug consumption in a murder case in South Carolina and that interpretation was upheld on appeal to the SC Supreme Court.
Have USDTL’s newborn test results been used in court cases?
Yes. Testing results are forensically defensible when they are “confirmed results” or results that went through confirmation testing. Forensic testing is performed through two separate, validated laboratory procedures based on different scientific principles. The first procedure screens the specimen using one scientific method, and the second procedure confirms the results using a different scientific method. As an accredited forensic laboratory, we confirm all positive screening test results and our procedures follow strict guidelines laid out and overseen by our accrediting bodies. Our test results have been upheld in court because we follow strict internationally accepted forensic protocols.
How are newborn drug testing results reported toe the hospital?
Results are reported through USDTL’s client access web portal or, for an additional cost, can be distributed via an approved Health Level Seven International (HL7) method. Under no circumstances are results given via telephone.
How does using a forensic drug test help the child later in life?
There are several reasons why testing a newborn for potential substances is important. Early detection provides many more options than detection at a later stage in the child’s life including:
- Early detection of alcohol biomarkers allows 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.
- The forensic identification of fetal alcohol exposure allows future corroboration of alcohol related disorders in childhood.
How long does the laboratory keep remaining specimens?
Generally, negative specimens are kept for 7 days, and confirmed positive specimens are kept for 1 year.
How much meconium is needed for the test?
A minimum of 3 grams of meconium (about a teaspoon) is normally required. However, for best results, we recommend collection of the entire passage of meconium until the milk stool appears.
If a mother was prescribed a particular drug during her pregnancy will it produce a positive result in the newborn’s meconium or umbilical cord tissue test?
Maybe. There is no guarantee that the drug is in the meconium or umbilical cord tissue at or above the threshold to positivity cutoff level. There are numerous factors that may affect the outcome, such as dose, metabolism, medication compliance, and recall bias. The appropriate question is whether there is a prescription or medical record that can provide a reasonable explanation for the specimen to test positive. A negative specimen does not prove that the donor was abstinent.
Is there a time frame in which meconium must be collected for testing?
Only with regard to being able to test for fatty acid ethyl esters (FAEE), the ethyl alcohol biomarker in meconium. To be able to test for FAEE, the meconium specimens must be collected within 18 hours after birth. All other drug testing can be done on meconium regardless of when the meconium is passed as long as it is meconium that is being collected and not milk stool.
What are the meconium specimen storage requirements?
Drugs and metabolites are stable in meconium for up to 2 weeks at room temperature. Storage in a refrigerator or freezer is preferred. Alcohol biomarkers specifically fatty acid ethyl esters (FAEE), are sensitive to heat and light; therefore, the preferred shipping method is frozen on dry ice. Since shipping via this method is both difficult and expensive, most institutions send specimens at room temperature and realize that the FAEE concentrations may be reduced. USDTL accept specimens that are shipped at room temperature.
What is meta-hydroxybenzoylecgonine (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.*
*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 turnaround time for testing results?
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.
What is the window of drug exposure for drugs of abuse in meconium and umbilical cord tissue and why?
The detection window for most drugs of abuse in meconium and umbilical cord tissue testing is up to approximately 20 weeks prior to birth. Meconium begins to accumulate in the fetal gut near mid-term of the pregnancy. Prior to this time frame there is no meconium to trap the drug or drug metabolites. The umbilical cord tissue cutoffs were selected to emulate the positivity rate of meconium through side-by-side studies inferring a similar detection window.
What newborn alcohol tests are available at USDTL?
USDTL offers three different tests that can be used for detecting direct ethyl alcohol biomarkers in newborns.
- Ethyl glucoronide (EtG) can be detected in umbilical cord tissue with a window of detection up to approximately 20 weeks prior to birth. EtG can be tested in umbilical cord tissue as a stand-alone test or it can be added to any umbilical cord tissue panel.
- Fatty acid ethyl esters (FAEE) can be detected in meconium with a window of detection up to approximately 20 weeks prior to brith. FAEE can be tested in meconium with a window of detection up to approximately 20 weeks prior to birth. FAEE can be tested in meconium as a stand-alone test or it can be added to any meconium panel. Collection must occur within the first 18 hours after birth to be viable for FAEE testing. See the meconium collection instructions for details.
- Phosphatidylethanol (PEth) can be detected in blood. Collection is done via heel stick on a dried blood spot card anytime during routine newborn screenings. It has a unique window of detection in blood up to approximately 2-4 weeks prior to collection.
Will drugs administered or taken by the mother affect the newborn drug test result?
Any drugs administer or taken during pregnancy, labor, or delivery have a possibility of being detected. The appropriate questions is whether there is a prescription or medical record that can provide a reasonable explanation for the specimen to test positive.