Newborn Drug Testing - Meconium and Umbilical Cord Tissue

Exposure to maternal drug use during gestation may adversely affect neonatal development and may lead to acute adverse events, including neonatal abstinence syndrome (NAS) and infant mortality. Prenatal drug exposure may also contribute to long-term behavioral effects and developmental deficits.

Timely detection of in utero drug exposure is critical for effective detection and management of intoxication, withdrawal syndrome, and long-term needs (social and medical) for exposed neonates.

Detection of drugs depends on extent of maternal drug use, drug stability, drug analyte deposition in meconium and umbilical cord tissue, and performance of the analytical method.

Tabs Content

Clinical Overview

Quick Answers

When should I consider newborn drug testing?

Consider newborn drug testing for infants born to mothers with high-risk behaviors including a history of drug misuse and/or addiction, minimal or no prenatal care, or unexplained obstetric events. Infants with unexplained neurological complications, intrauterine growth retardations, or drug withdrawal symptoms should also be considered for testing. Refer to the Newborn Drug Testing algorithm for more information.

What specimens are acceptable for newborn drug testing?

ARUP offers testing of umbilical cord tissue and meconium. Urine and blood tests are generally not recommended for newborn drug testing. Refer to Available Specimen Type below.

What are the advantages/disadvantages of umbilical cord drug testing? Meconium drug testing?

Umbilical cord tissue is easy to collect at birth, drugs deposit evenly across the length of the cord, and the cord grows with the fetus throughout development. Concentrations of some drug analytes are lower in cord than in meconium, but can be detected with the appropriate methodology. Meconium is the traditional newborn drug testing specimen and usually passes within 48 hours of birth. Collection requires coordinated efforts, and detection depends on many factors, including quality and completeness of collection. Refer to the ARUP Drug Test Table – Meconium and Umbilical Cord for more information.

Newborn Drug Testing Algorithm

Newborn Drug Testing

Indications for Testing

Infants born to

Mothers with high-risk behaviors (eg, history of drug use/abuse, prostitution, nicotine use)
Mothers with minimal or no prenatal care
Mothers with unexplained obstetric events (eg, placental abruption, premature labor)

Infants

With unexplained neurological complications
With unexpected intrauterine growth retardation
Who develop drug withdrawal symptoms (eg, neonatal abstinence syndrome [NAS])

Available Specimen Type

ARUP offers testing of two specimen types for newborn drug testing – umbilical cord tissue and meconium. Urine as a specimen type for neonatal drug testing has limited success; the first void is often missed because it may occur during or immediately after delivery. Urine tests generally detect only recent maternal drug use in the days prior to delivery.

Newborn Drug Testing Specimen Types
Meconium	Umbilical Cord Tissue
First stool of the newborn Used for drug testing for ~25 yrs Begins to form at ~12-16 wks gestation Accumulates over remainder of pregnancy (nonlinear process) Usually passes within 48 hrs of birth Collection requires coordinated efforts and may not be available Detection depends on many factors (eg, quality and completeness of collection, drug use patterns)	Drugs appear to deposit consistently across length of cord Forms ~5^th wk of gestation Grows with fetus throughout pregnancy (nonlinear process) Easy to collect at time of birth Concentrations of drug analytes are lower in cord than in meconium, but can be detected with appropriate methods Detection depends on many factors (eg, quality and completeness of collection, drug use patterns)
NOTE: Umbilical cord tissue and meconium drug tests are performed to support clinical and social management decisions and do not usually require chain of custody. ARUP offers a specimen tracking form for documentation of the collection, handling, and shipping of specimens. Contact ARUP Client Services for more information.

There are several factors to consider when selecting umbilical cord tissue vs meconium for drug testing.

Umbilical Cord Tissue vs Meconium Testing
Factors to Consider	Umbilical Cord Tissue	Meconium
Preferred process for collection is at birth, for all infants; test immediately for high-risk births, store for low-risk births	X
Preferred collection based on need only (eg, history of drug exposure, maternal urine screen results, neonatal abstinence syndrome [NAS] symptoms/diagnosis)	X	X
Tracking of specimen collection and handling process required	X	X
Fastest available time to result when positive results are expected	X
Traditional testing approach (screen with reflex to confirmation testing) preferred		X
Most sensitive and definitive testing for cannabis use is desired		X
Most sensitive and definitive testing for heroin use is desired	X
Detection of the following drug(s) is preferred – fentanyl, meperidine, propoxyphene, tramadol, tapentadol, phentermine, and/zolpidem	X
Meconium specimen is limited or unavailable	X
Cord tissue specimen is limited or unavailable		X

ARUP’s Umbilical Cord Tissue Testing

Routine analysis by ARUP’s drug detection panel includes qualitative detection by mass spectrometric methods for all compounds (eg, opioids, stimulants, sedative-hypnotics), including marijuana metabolites. Presence of metabolites improves confidence in results and lengthens detection window.

Umbilical Cord Tissue Testing ARUP Drug Detection Panel – Indications for Use
ARUP test	Indications	Primary drugs detected
Drug Detection Panel, Umbilical Cord Tissue, Qualitative 2006621	Detect and document maternal drug use during approximately the last trimester of a full-term birth	Opioids – heroin metabolite (6-acetylmorphine), morphine, codeine, oxycodone, oxymorphone, hydrocodone, fentanyl, tramadol, tapentadol, propoxyphene, meperidine, buprenorphine, methadone Stimulants – cocaine, methamphetamine/amphetamine, ecstasy (MDMA), phentermine Sedative-hypnotics – benzodiazepines, barbiturates Other drugs – zolpidem, PCP
Marijuana Metabolite, Umbilical Cord Tissue, Qualitative 3000256	Detect in utero exposure to cannabis (marijuana) in neonates consistent with maternal use during approximately the last trimester of pregnancy	Cannabinoid (THC)
Ethyl Glucuronide, Umbilical Cord Tissue, LC-MS/MS 3000443	Detect and document maternal use of ethyl glucuronide during approximately the last trimester of pregnancy	Ethyl glucuronide
Umbilical cord collection instructions Umbilical cord tissue collection video – https://www.youtube.com/watch?v=joN-xhTrlxo Additional Technical Information – ARUP's Drug Detection Panel, Umbilical Cord Tissue (Qualitative) and Ethyl Glucuronide, Umbilical Cord Tissue, Qualitative

ARUP’s Meconium Testing

Routine analysis by ARUP’s panel includes a qualitative screen for nine drug classes; specimens testing positive for ≥1 drugs are reflexed to confirmatory testing by highly sensitive and specific mass spectrometric methods. Directed (confirmation only) tests are available when only one drug class is of clinical interest or when quantity of meconium available for testing is very small (eg, <1 g).

Meconium Testing ARUP Drug Detection Panel – Indications for Use
ARUP Test	Indications		Panel Detects
Meconium Panel– Screen with Reflex to Confirmation/Quantitation 0092516	Preferred meconium test to detect and document maternal drug use during pregnancy (~last trimester of a full-term birth). Targeted single drug class testing is appropriate if only a particular drug class or classes are of clinical interest, or when quantity of meconium available for testing is very small (eg, <1 g).		See confirmation tests below for all components Opioids Stimulants Sedative-hypnotics Phencyclidine (PCP) Cannabinoids (11-nor-9-carboxy-THC) Several drug metabolites are also included to increase likelihood of detection and increase confidence in results
Confirmation/Quantitation Meconium Tests – use for infant drug testing when specific drug exposure is of clinical interest or when quantity of meconium available for testing is very small (eg, <1 g).
ARUP Test		Panel Detects
Amphetamines (Amphetamine and Methamphetamine) 0092310		Amphetamine, methamphetamine, methylenedioxymethamphetamine (MDMA-ecstasy), methylenedioxyethylamphetamine (MDEA-Eve), methylenedioxyamphetamine (MDA)
Benzodiazepines 0092520		Alprazolam, alpha-hydroxyalprazolam, clonazepam, 7-aminoclonazepam, diazepam, chlordiazepoxide, lorazepam, midazolam, alpha-hydroxymidazolam, nordiazepam, oxazepam, temazepam
Cannabinoids (Marijuana) 0092316		9-carboxy-THC
Methadone and Metabolite 0092313		Methadone and metabolite (EDDP)
Opiates 0092314		Codeine, morphine, 6-acetylmorphine, hydrocodone, hydromorphone, oxycodone, oxymorphone
Barbiturates 0092311		Butalbital, phenobarbital
Buprenorphine 2011601		Buprenorphine, norbuprenorphine
Cocaine and Metabolites 0092312		Cocaine, benzoylecgonine, M-hydroxybenzoylecgonine (qualitative only), cocaethylene
Phencyclidine (PCP) 0092315		Phencyclidine

Evaluation and Interpretation of Results

Drugs administered to the mother during labor and delivery may be detected in meconium or umbilical cord tissue. Drugs administered to the newborn after birth may be detected in meconium, if the meconium is collected after drug administration.

Negative results do not exclude the possibility that a mother used drugs during pregnancy; only the drugs targeted by the testing can be detected. Maternal history and urine testing may also identify a possible infant drug exposure and should be used in combination with other laboratory results, as well as clinical presentation of the infant, to diagnose a drug exposure.

Specimen variations can contribute to false-negative results. When definitive analytical methods (eg, LC-MS/MS, GC-MS) are used, false-positive results are extremely unlikely.

Refer to the Pain and Addiction Management topic for test result interpretation organized by drug class.

Additional Resources

Opioid Metabolic Pathway

Benzodiazepine Metabolic Pathway

Newborn Drug Testing Algorithm

ARUP Drug Cut-Off Limits for Meconium and Umbilical Cord

Includes drug classes/metabolites, common trade/street names, and lowest concentration reported

ARUP Lab Tests

Tests generally appear in the order most useful for common clinical situations. Click on number for test-specific information in the ARUP Laboratory Test Directory.

Umbilical Cord Tissue Testing

Drug Detection Panel, Umbilical Cord Tissue, Qualitative 2006621
Method: Qualitative Liquid Chromatography/Tandem Mass Spectrometry

Marijuana Metabolite, Umbilical Cord Tissue, Qualitative 3000256
Method: Qualitative Liquid Chromatography-Tandem Mass Spectrometry

Ethyl Glucuronide, Umbilical Cord Tissue, Qualitative 3000443
Method: Qualitative Liquid Chromatography-Tandem Mass Spectrometry

Meconium Testing

Drugs of Abuse Panel, Meconium - Screen with Reflex to Confirmation/Quantitation 0092516
Method: Qualitative Enzyme-Linked Immunosorbent Assay/Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Targeted Drug Class Testing

Drugs of Abuse Confirmation/Quantitation - Amphetamines (Amphetamine and Methamphetamine) - Meconium 0092310
Method: Quantitative High Performance Liquid Chromatography-Tandem Mass Spectrometry

Barbiturates - Confirmation - Meconium 0092311
Method: Quantitative Gas Chromatography-Mass Spectrometry/Quantitative Liquid Chromatography-Tandem Mass Spectrometry/Qualitative Liquid Chromatography/Time of Flight Mass Spectrometry

Drugs of Abuse Confirmation/Quantitation - Benzodiazepines - Meconium 0092520
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Buprenorphine, Meconium, Quantitative 2011601
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Drugs of Abuse Confirmation/Quantitation - Cannabinoids (Marijuana) - Meconium 0092316
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Cocaine and Metabolites - Confirmation/Quantitation - Meconium 0092312
Method: Quantitative Gas Chromatography-Mass Spectrometry/Liquid Chromatography-Tandem Mass Spectrometry

Drugs of Abuse Confirmation/Quantitation - Methadone and Metabolite - Meconium 0092313
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Drugs of Abuse Confirmation/Quantitation - Opiates - Meconium 0092314
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Phencyclidine (PCP) - Confirmation/Quantitation - Meconium 0092315
Method: Quantitative Gas Chromatography-Mass Spectrometry/Liquid Chromatography-Tandem Mass Spectrometry

Medical Reviewers

McMillin, Gwendolyn A., PhD, Medical Director, Toxicology, and Medical Director, Pharmacogenetics, at ARUP Laboratories; Professor of Clinical Pathology, University of Utah

References

Cited References

McMillin GA, Colby JM, Wabuyele SL. (September 2017). Drug Exposure in Newborns: Many Specimen Types Have Been Used In Drug Testing, But No Type Is Ideal. Clinical and Forensic Toxicology News (Quarterly, AACC/CAP), 1-5. https://www.aacc.org/publications/clinical-and-forensic-toxicology-news.

Additional Resources

Haglock-Adler CJ, McMillin GA, Strathmann FG. Development of a liquid chromatography-tandem mass spectrometry method to address the increased utilization of umbilical cord in the assessment of in utero drug exposure. Clin Biochem. 2016; 49(13-14): 1092-5. PubMed

Wabuyele SL, Colby JM, McMillin GA. Detection of Drug-Exposed Newborns. Ther Drug Monit. 2018; 40(2): 166-185. PubMed

Wu F, Scroggin TL, Metz TD, McMillin GA. Development of a Liquid Chromatography-Tandem Mass Spectrometry Method for the Simultaneous Determination of Four Cannabinoids in Umbilical Cord Tissue. J Anal Toxicol. 2018; 42(1): 42-48. PubMed

References from the ARUP Institute for Clinical and Experimental Pathology^®

Barakauskas VE, Davis R, Krasowski MD, McMillin GA. Unresolved discrepancies between cannabinoid test results for infant urine. Clin Chem. 2012; 58(9): 1364-7. PubMed

Chittamma A, Marin SJ, Williams JA, Clark C, McMillin GA. Detection of in utero marijuana exposure by GC-MS, ultra-sensitive ELISA and LC-TOF-MS using umbilical cord tissue. J Anal Toxicol. 2013; 37(7): 391-4. PubMed

Coles R, Clements TT, Nelson GJ, McMillin GA, Urry FM. Simultaneous analysis of the Delta9-THC metabolites 11-nor-9-carboxy-Delta9-THC and 11-hydroxy-Delta9-THC in meconium by GC-MS. J Anal Toxicol. 2005; 29(6): 522-7. PubMed

Coles R, Kushnir MM, Nelson GJ, McMillin GA, Urry FM. Simultaneous determination of codeine, morphine, hydrocodone, hydromorphone, oxycodone, and 6-acetylmorphine in urine, serum, plasma, whole blood, and meconium by LC-MS-MS. J Anal Toxicol. 2007; 31(1): 1-14. PubMed

Marin SJ, Christensen RD, Baer VL, Clark CJ, McMillin GA. Nicotine and metabolites in paired umbilical cord tissue and meconium specimens. Ther Drug Monit. 2011; 33(1): 80-5. PubMed

Marin SJ, Coles R, Merrell M, McMillin GA. Quantitation of benzodiazepines in urine, serum, plasma, and meconium by LC-MS-MS. J Anal Toxicol. 2008; 32(7): 491-8. PubMed

Marin SJ, Coles R, Urry FM, McMillin GA. Confirmation of cannabinoids in meconium using two-dimensional gas chromatography with mass spectrometry detection. J Chromatogr B Analyt Technol Biomed Life Sci. 2007; 858(1-2): 59-64. PubMed

Marin SJ, Keith L, Merrell M, McMillin GA. Comparison of drugs of abuse detection in meconium by EMIT II and ELISA. J Anal Toxicol. 2009; 33(3): 148-54. PubMed

Marin SJ, Keith L, Merrell M, McMillin GA. Evaluation of a new ELISA kit for the detection of benzodiazepines in meconium. J Anal Toxicol. 2009; 33(3): 177-81. PubMed

Marin SJ, McMillin GA. Quantitation of Total Buprenorphine and Norbuprenorphine in Meconium by LC-MS/MS. Methods Mol Biol. 2016; 1383: 59-68. PubMed

Marin SJ, Moore C, McMillin GA. Cross-reactivity of phentermine with an immunoassay designed to detect amphetamine in a meconium specimen. Clin Chem. 2009; 55(3): 589-90. PubMed

Marin SJ, Roberts M, Wood M, McMillin GA. Sensitive UPLC-MS-MS assay for 21 benzodiazepine drugs and metabolites, zolpidem and zopiclone in serum or plasma. J Anal Toxicol. 2012; 36(7): 472-6. PubMed

McMillin GA, Wood KE, Strathmann FG, Krasowski MD. Patterns of drugs and drug metabolites observed in meconium: What do they mean? Ther Drug Monit. 2015; 37(5): 568-80. PubMed

Wood KE, Krasowski MD, Strathmann FG, McMillin GA. Meconium drug testing in multiple births in the USA. J Anal Toxicol. 2014; 38(7): 397-403. PubMed

Wood KE, Sinclair LL, Rysgaard CD, Strathmann FG, McMillin GA, Krasowski MD. Retrospective analysis of the diagnostic yield of newborn drug testing. BMC Pregnancy Childbirth. 2014; 14: 250. PubMed

Testing Algorithms

Newborn Drug Testing

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Content Review:

June 2018

Last Update: June 2018


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Newborn Drug Testing - Meconium and Umbilical Cord Tissue

Quick Answers

When should I consider newborn drug testing?

What specimens are acceptable for newborn drug testing?

What are the advantages/disadvantages of umbilical cord drug testing? Meconium drug testing?

Newborn Drug Testing Algorithm

Indications for Testing

Available Specimen Type

ARUP’s Umbilical Cord Tissue Testing

ARUP’s Meconium Testing

Evaluation and Interpretation of Results

Additional Resources

ARUP Lab Tests

Umbilical Cord Tissue Testing

Meconium Testing

Targeted Drug Class Testing

Medical Reviewers

References

Cited References

Additional Resources

References from the ARUP Institute for Clinical and Experimental Pathology®

Newborn Drug Testing

References from the ARUP Institute for Clinical and Experimental Pathology^®