Review Article| Volume 32, ISSUE 3, P449-466, September 2012

Drug Testing in the Neonate

      A major portion of toxicology testing deals with urine drug screening for the adult population. This group can be divided into two major applications: preemployment urine drug screening and periodic scheduled pain management screening. Pain management clinics usually require patients to sign opiate contracts that allow for regular testing as a means to assess compliance. The presence or absence of drugs and metabolites must match the patient's prescribed medications, and any discrepant compounds found during routine screening are grounds for dismissal from the pain management program. In addition to these two applications, toxicology drug testing plays an important but often overlooked role in newborn drug screening. Testing this population comes with its own set of unique analytical, therapeutic, and legal issues that can make screening and result interpretation challenging.
      • Drug screening in the newborn population comes with a set of unique analytical, therapeutic, and legal issues that can make testing and result interpretation challenging.
      • Assessment of in utero drug exposure to cocaine, amphetamines, opiates, marijuana, and ethanol may allow better intervention and management of withdrawal symptoms for the neonate.
      • A range of maternal and neonatal specimens are available, but each comes with a unique set of limitations regarding sensitivity, invasiveness, and window of detection.
      • Preanalytical issues such as specimen collection and sample extraction can influence test accuracy, and the particular biological specimen evaluated determines the window of detection achieved.
      • Meconium provides the longest window, but the extraction technique greatly impacts sensitivity, and unique drug metabolites in meconium may lead to discrepancies between maternal and neonate results.


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