Newborn Drug Screening - Meconium and Umbilical Cord Testing

  • Diagnosis
  • Background
  • Lab Tests
  • References
  • Related Topics
  • Videos

Indications for Testing

  • Detect prenatal exposure to drugs in meconium or umbilical cord tissue for infants
    • Born to mothers with high risk (eg, history of drug use, prostitution, sexually transmitted disease)
    • Born to mothers with little or no prenatal care
    • Born to mothers with unexplained placental abruption or premature labor
    • Born with unexplained neurological complications
    • Born with unexpected intrauterine growth retardation
    • Born with evidence of intoxication and/or drug withdrawal symptoms

Laboratory Testing

  • Meconium drug testing
    • For more information, refer to Drug Analytes Detected in Meconium and Umbilical Cord
    • Routine analysis includes a qualitative screen for nine drug classes; specimens testing positive for one or more drugs are reflexed to confirmatory testing
    • 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, <1g)
  • Umbilical cord tissue testing
    • For more information, refer to Drug Analytes Detected in Meconium and Umbilical Cord
    • Routine analysis includes qualitative detection by mass spectrometric methods for >30 other prescription and illicit drugs (opioids, stimulants, sedative hypnotics); qualitative screen for cannabinoids also included
    • Umbilical cord blood may be used for directed (confirmation only) tests
  • Maternal drug testing may detect very recent use; urine is the preferred specimen

Differential Diagnosis

Exposure to maternal drug use during gestation may adversely affect neonatal development and may lead to acute adverse events including neonatal abstinence syndrome and infant mortality and may contribute to long-term behavioral and developmental deficits.


  • Prevalence – approximately 30% of the drug-abuse population is female, and most are of childbearing age


  • Meconium (dark, tarry material passed from the neonate’s rectum in the first days after birth until milk or formula-based stool appears) is the best specimen for assessing in utero exposure of the neonate to maternal drug use
    • Meconium begins to form during the 12th–16th week of gestation and is usually passed within first 3 days of birth
      • Passage may be delayed when the baby is exposed to opioids or with premature birth
      • May also be expelled in utero or during birth
    • Meconium is preferred over urine for testing of neonates
      • Urine testing indicates drug use only over the last 1–10 days, depending on the drug
      • Meconium documents drug use over an extended period of time, covering at least the last trimester of pregnancy
      • Meconium is easier to obtain than urine (combining all meconium voids can be helpful if sample size is small)
    • Umbilical cord tissue is the preferred specimen for assessing in utero exposure of the neonate to maternal drug use when meconium is not available
      • Deposition of drugs in umbilical cord tissue is not well studied, but window of detection appears similar to meconium
      • Umbilical cord tissue can be sent to the laboratory immediately after birth
      • Umbilical cord tissue avoids detection of drugs administered directly to the newborn after birth

Clinical Presentation

  • Stimulants
    • Cocaine
      • Infant
        • Irritability and withdrawal at birth
        • Subarachnoid and intracerebral hemorrhage
        • Small neonatal head size
        • Reduced birth weight
        • Fetal death
        • Childhood behavioral disorders (eg, attention deficit hyperactivity disorder – ADHD)
      • Mother
        • Premature labor
        • Ruptured uterus, abruptio placentae
        • Adult behavioral disorders (eg, ADHD)
    • Amphetamines (particularly methamphetamine)
      • Infant
        • Effects are similar to cocaine
        • Medical problems in early life
      • Mother
        • Effects are similar to cocaine
        • Complications during pregnancy – reduced fetal growth, stillbirth, congenital anomalies
        • Increased rates of premature birth
  • Cannabinoid (marijuana)
    • Infant
      • Negative effect on attentional behavior and on visual analysis/hypothesis testing
      • No effect on global IQ
  • Opiates, barbiturates, benzodiazepines
    • Infant and mother – withdrawal symptoms
      • Irritability
      • Tremors
      • Hyperactivity
      • Seizures


  • Timely detection of in-utero drug exposure is critical for effective detection and management of intoxications, withdrawal syndrome, and long-term needs (social and medical) for exposed neonates
    • Actual time window for detecting exposure is unknown but is thought to represent at least the last trimester
  • Detection of drugs depends on
    • Extent of maternal drug use
    • Drug stability
    • Deposition of drug analytes in umbilical cord tissue
    • Performance of the analytical method
  • Umbilical cord tissue testing may be preferable to meconium due to
    • Ease of collection of a larger volume of specimen
    • Relatively fast turnaround time
    • Reflex/confirmation testing typically not required

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.

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


Negative results do not exclude the possibility that a mother used drugs during pregnancy

Cannot determine date of maternal drug use, what specific drug was taken, or amount taken

May detect drugs administered directly to the newborn if meconium is collected after drug administration

Follow Up

See the pediatric peer-reviewed literature for infant treatment recommendations

Drug Detection Panel, Umbilical Cord Tissue, Qualitative 2006621
Method: Qualitative Liquid Chromatography/Tandem Mass Spectrometry/Enzyme-Linked Immunosorbent Assay


Negative results do not exclude the possibility that a mother used drugs during pregnancy

Cannot determine date of maternal drug use, what specific drug was taken, or amount taken

Marijuana metabolites (eg, THC) are detected by immunoassay and are not confirmed

Test results are qualitative; quantitative results are not provided

Related Tests

General References

Adrian M, Van Truong M, Osazuwa T. Measuring levels of comorbidity in drug user* emergency patients treated in Ontario hospitals. Subst Use Misuse. 2007; 42(2-3): 199-224. PubMed

Araojo R, McCune S, Feibus K. Substance abuse in pregnant women: making improved detection a good clinical outcome. Clin Pharmacol Ther. 2008; 83(4): 520-2. PubMed

Gareri J, Klein J, Koren G. Drugs of abuse testing in meconium. Clin Chim Acta. 2006; 366(1-2): 101-11. PubMed

Marcellus L. Is meconium screening appropriate for universal use? Science and ethics say no. Adv Neonatal Care. 2007; 7(4): 207-14. PubMed

Rayburn WF. Maternal and fetal effects from substance use. Clin Perinatol. 2007; 34(4): 559-71, vi. PubMed

Walsh MC, Fanaroff JM. Meconium stained fluid: approach to the mother and the baby. Clin Perinatol. 2007; 34(4): 653-65, viii. 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, 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

Medical Reviewers

Last Update: June 2016