Newborn Drug Testing Lab
Meconium Drug Testing
USDTL was the first laboratory to commercially introduce meconium testing to the market in 1991 and we have been seen as the leaders in newborn toxicology ever since.
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 approximately 20 weeks.
Meconium specimens can only be submitted through hospital or health system accounts.
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Panel Name: Meconium Testing
Panel Description: Meconium Testing Drug Panel
Collection Container: Leakproof Polypropylene
Collection Notes: Pool of Multiple Collections
Sample Amount: 3 grams (We recommend weighing the specimen on a jeweler’s scale.)
Stability Window: Drugs and metabolites are stable in meconium for up to 2 weeks at room temperature. Storage in a refrigerator or freezer is preferred.
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.
- White Papers
A Moment In Time 02-Feb-2015
Ask the Tox 01-Aug-2017
Lost Opportunities 02-Feb-2015
Marijuana Use in Pregnancy 01-May-2013
Meconium Collection: Nothing More, Nothing Less 01-Aug-2017
Newborn Testing For Alcohol Biomarkers 11-Nov-2016
THCA Meconium State Law 28-Jul-2016
Who Cares About Chain of Custody? 11-Nov-2016
Why is Confirmation Testing Necessary? 01-Aug-2017
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 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 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 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.