Umbilical Cord Resources
Umbilical Cord Resources
To view the Umbilical Cord Testing Panels and Collection Instructions, click here.
Umbilical Cord Videos
Targeted vs. Universal Umbilical Cord Collection
The Impact of Neonatal Abstinence Syndrome on One West Virginia Community by Dr. Loudin
The Importance of Following Forensic Principles in Newborn Drug Testing by Dr. Irene Shu
Umbilical Cord Collection Training Video
Umbilical Cord Drug Testing: A Discussion of Prevalent Issues
USDTL Live episode 2 CordStat Origin with Dianne Montgomery
Why Test For Designer Stimulants Bath Salts in Umbilical Cord
Umbilical Cord Infographics
Umbilical Cord Articles
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
Breaking the Blood Barrier 01-Dec-2015
Real Time Data 03-Aug-2015
A Moment In Time 02-Feb-2015
Lost Opportunities 02-Feb-2015
Marijuana Use in Pregnancy 01-May-2013
Identifying Alcohol-Exposed Newborns 01-Oct-2012
Newborn Direct Ethanol Biomarker 01-Oct-2012
USDTL Umbilical Cord Research
Umbilical Cord Poster Presentations
13-Panel Toxicological Drug Screen of Umbilical Cord Tissues with Enzyme-Linked Immunosorbent Assays
An Evaluation of the Immunalysis Buprenorphine Direct ELISA Kits for the Detection of Buprenorphines in Umbilical Cord
The Collection of Umbilical Cord Blood on Filter Paper Cards for Detection of Phosphatidylethanol in Newborns at Risk for Prenatal Alcohol Exposure
The Detection of Prenatal Marijuana Exposure using Meconium and Umbilical Cord: A Comparison using Matched Pairs
USDTL Umbilical Cord Assisted Research
Umbilical Cord Slide Presentations
Umbilical Cord Testing: A Discussion of Prevalent Issues
The Impact of Neonatal Abstinence Syndrome on One West Virginia Community
The Importance of Following Forensic Principles in Newborn Drug Testing by Dr. Irene Shu
Foundational Umbilical Cord Research
There are currently no Foundational Research articles available. Please check back later.
Umbilical Cord Announcements
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.
We are proud to announce that we are the first laboratory in the world to be ISO/IEC 17025 accredited for drug and alcohol testing in umbilical cord, fingernail, and toenail specimens. On September 4, 2015, USDTL attained ISO/IEC 17025 accreditation showing full compliance with the international testing standards. We have received our accreditation from ANSI-ASQ National Accreditation Board, demonstrating technical competence in the field of forensic testing. The scope of our ISO/IEC 17025 accreditation encompasses all specimen types and methods of analysis utilized in our laboratory.
USDTL has succeeded in improving their umbilical cord screening assay for buprenorphine by reducing the positive result cutoff from 1.0 ng/g down to 0.5 ng/g. The improved umbilical cord buprenorphine assay gives the best possible detection of buprenorphine exposure, making it possible to identify more newborns exposed to buprenorphine in utero.
Umbilical Cord FAQs
*Click the green and white plus sign beside each question to view the answer.
How does the addition of the fentanyl analytes, acetyl fentanyl and its metabolite acetyl norfentanyl, help the interpretation of umbilical cord tissue results?
While acetyl fentanyl is not in every batch of illicit fentanyl, its presence is evidence of street fentanyl. Pharmaceutical grade fentanyl does not contain acetyl fentanyl. In the absence of acetyl fentanyl and acetyl norfentanyl, we would need to accept administration of fentanyl during labor and delivery as a reasonable explanation for a positive fentanyl umbilical cord tissue test result.
Can a second test of a different specimen type be used to prove that a previously taken test was inaccurate?
No. The results of any second collected specimen have absolutely no bearing on the validity of the results of the first collected specimen. Furthermore, each matrix has its own advantages, disadvantages and limits of interpretation.
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 I use the reported value (the number) from a hair, nail, meconium, umbilical cord tissue, or urine test to determine how much or how often someone is using a drug (either prescription of illicit)?
No. These specimen types act as reservoir, where drugs and their metabolites may accumulate and/or degrade over time. When testing any reservoir matrix, it is impractical to back-track to determine time, dosage, or frequency. There are too many variables involved. The reported values (the numbers) have no therapeutic or clinical value. You cannot use the number to estimate how much the donor used or to what extent the donor was exposed.
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.
Can you test for alcohol exposure in umbilical cord?
Yes, alcohol exposure can be tested individually or by adding the Umbilical Cord Testing EtG add-on to any of the Umbilical Cord Testing drug panels. The EtG add-on screens for Ethyl Glucuronide, a direct alcohol biomarker, indicating exposure to ethanol (drinking alcohol).
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.
Does USDTL’s Umbilical Cord Test use umbilical cord blood or umbilical cord tissue?
Umbilical Cord Testing uses 6 inches of umbilical cord tissue that and has a window of detection up to approximately 20 weeks prior to birth. Umbilical cord blood has the same blood drug detection window as standard blood drug tests, up to approximately 2-3 days prior to collection.
Note: Testing the direct ethyl alcohol biomarker phosphatidylethanol (PEth) in newborn blood (via heel stick with a dried blood spot card) has a window of detection up to approximately 2-4 weeks prior to collection due to the unique half-life of PEth in the blood. PEth testing is not available in umbilical cord tissue. Visit our newborn PEth testing page for more information.
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 to 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 should umbilical cord tissue be stored?
The sample is stable at room temperature for 7 days, can be refrigerated (2-8° C) for up to 3 weeks, or frozen (< -10° C) for up to 1 year.
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 umbilical cord genetically fetal tissue or tissue of the mother?
The fetus generates umbilical cord during the first five weeks, therefore, it is fetal tissue.
The umbilical cord was fixed in formalin. May it still be used for the Umbilical Cord Testing?
No, Umbilical cord tissue testing has not been validated for tissues that have been fixed in formalin. Specimens that arrive to the laboratory fixed in formalin are rejected for testing.
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.
When will I receive umbilical cord results?
|Test||Negative Result||Positive Result|
|Umbilical Cord Drug Panel||1 working day||2 working days|
|Umbilical Cord EtOH||2 working days||3 working days|
Why is umbilical cord testing becoming the gold standard in newborn testing over meconium?
USDTL’s umbilical cord tissue testing is groundbreaking in newborn toxicology because it solves several problems:
- Every newborn has an umbilical cord; meconium is not available for testing; meconium is not obtainable for every birth and may only be available in small quantities.
- Umbilical cord tissue testing improves the integrity of the chain of custody: only one donor and one collector are present during the collection. Meconium has multiple collections and multiple collectors.
- Umbilical cord tissue testing improves turnaround time (TAT) because umbilical cord is ready for transport a few minutes after birth, while meconium passages can be delayed for days before being sent to the lab.
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.