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

Abstract

Objective: The specific aim of this study was to determine if the currently available cutoff for fentanyl in umbilical cord (UC) was appropriate to distinguish illicit fentanyl exposure from therapeutic in-hospital administration of fentanyl. Study Design: Medical record review was conducted for 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/b 0 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.

Umbilical Cord Tissue

“…In a hospital comparison study of meconium and UCT testing, Palmer et al 14 found that UCT testing generally avoided detection of medications administered during labor and delivery, although they noted that oxycodone was more commonly detected by UCT. Similarly, studies of mothers administered fentanyl before delivery demonstrate that while very rare, fentanyl may be detected in UCT because of recent medical administration 27,29 …”

“…Similarly, studies of mothers administered fentanyl delivery demonstrate that while very rare, fentanyl may be detected in UCT because of recent medical administration. 27,29 There are currently no regulations defining how clinical newborn testing must be conducted and thus no standardization of processes among the laboratories that perform testing. Test methods are developed and validated in-house by each testing facility, based on the accreditation requirements governing that facility, which may or may not align with forensic requirements.…”

Toxicology as a diagnostic tool to identify the misuse of drugs in the perinatal period

“…Several techniques exist to monitor newborn specimens to preliminarily detect prenatal substance exposure. The most common initial tests utilize the sensitivity, speed, and cost effectiveness of a variety of immunoassay techniques, such as enzyme linked immunosorbent assay (ELISA), enzyme multiplied immunoassay test (EMIT®), cloned enzyme donor immunoassay (CEDIA), Diagnostics Reagents Inc immunoassay (DRI®), or homogenous enzyme immunoassay (HEIA™) (50)(51)(52). These methods provide a quick and economical way to identify negative specimens with adequate sensitivity, which in turn allows the laboratory to focus its attention on the presumptive positive specimens.…”