Meconium Drug Testing

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.

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.

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.

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.

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.

The detection windows for meconium and umbilical cord have been established over time through experience as opposed to experimentation. Dose-response experiments using harmful addictive drugs with pregnant women would be highly unethical.

The detection window for most drugs of abuse in meconium and umbilical cord testing is up to approximately 20 weeks (some drugs such as methamphetamine may be less). Meconium begins to accumulate in the fetal gut near mid-term of the pregnancy; therefore prior to this time frame there is no meconium for the drug to become trapped in. The umbilical cord cutoffs were selected to emulate the positivity rate of meconium through side-by-side studies inferring a similar detection window.

No, the sample may be shipped ambient.

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.

No. These specimen types act as a 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.

No, Lidocaine will NOT explain a GCMS or LCMSMS confirmed positive cocaine or cocaine metabolite in any specimen type (blood, urine, hair, nails, meconium, umbilical cord segment, etc…). The compounds are very structurally different and breakdown into very different metabolites.

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.

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.

Yes, drugs such as morphine only take a few minutes to reach the meconium and umbilical cord. Although we do not see it every time, we routinely pick up morphine administered to the mother during labor and delivery.

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.

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 taking compliance, and recall bias. The appropriate question to ask is IF the specimen is positive is there a prescription or medical record that provides a reasonable explanation. Just because a specimen is negative, does not prove that the donor was abstinent.

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.

Yes. The umbilical cord tissue or meconium from a baby whose mother was administered morphine during delivery will only be positive for morphine. The umbilical cord of a baby that is positive for Meconin and/or Monoacetylemorphine (6-MAM) in addition to morphine is indicative of heroin exposure. 

Morphine is the predominant metabolite of heroin, but morphine is also a stand-alone drug and a metabolite of codeine. Some mothers are provided morphine during delivery. Historically, there have been instances where heroin-using moms could not be distinguished from moms given morphine during delivery. Meconin is a contaminating constituent from the poppy that is present in heroin. Therefore, like Monoacetylmorphine – a metabolite of heroin, the presence of Meconin indicates the use of heroin and when found in newborn specimens, indicates fetal exposure to heroin.

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.

Generally, negative specimens are kept for 7 days, and confirmed positive specimens are kept for 1 year.

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.

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.

There are too many variables for anyone to know time of use, dosage, or frequency from the result(s) of a drug test. Reservoir matrices such as hair, fingernail, umbilical cord, and meconium continuously collect drug and alcohol biomarkers. This makes it difficult to determine specific details of use. Because the biomarker is collected over a period of time, the results represent total accumulation that cannot be pin-pointed to specific times/dates/dosages, etc.

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.

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.

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.

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

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.

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.

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.

There are several explanations for this.

1. Different sample matrices have different detection time frames. The result of any second collected specimen has no bearing on the validity of a first collected specimen. For example, a hair sample with a 3-month detection window might test positive for a particular substance, while a urine sample from the same donor, with a 2-3 day detection window, might test negative. In this case, the donor has used that substance within the past 3-months, but may not have used it within the most recent 3-days.
2. The result of any second collected specimen has no bearing on the validity of a first collected specimen. Therefore, a negative result observed for the umbilical cord does not refute a positive result observed on the maternal urine specimen and the reverse is true as well. There are many legitimate reasons for discrepant urine and umbilical cord results.
3. The urine specimen was a screen-only result and was not confirmed using an appropriate mass spectrometric method. The screen-only urine result is a clinically valid result, however, without an appropriate mass spectrometric confirmation, the urine result has no value in a forensic proceeding.
4. Lastly, some placentas can prevent some compounds from reaching the fetus. There are documented cases of maternal ingestion without in utero exposure.

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.