Universal maternal drug testing in a high-prevalence region of prescription opiate abuse.

Abstract

OBJECTIVE:

To evaluate the efficacy of a universal maternal drug testing protocol for all mothers in a community hospital setting that experienced a 3-fold increase in neonatal abstinence syndrome (NAS) over the previous 5 years.

STUDY DESIGN:

We conducted a retrospective cohort study between May 2012 and November 2013 after the implementation of universal maternal urine drug testing. All subjects with positive urine tests were reviewed to identify a history or suspicion of drug use, insufficient prenatal care, placental abruption, sexually transmitted disease, or admission from a justice center, which would have prompted urine testing using our previous risk-based screening guidelines. We also reviewed the records of infants born to mothers with a positive toxicology for opioids to determine whether admission to the special care nursery was required.

RESULTS:

Out of the 2956 maternal specimens, 159 (5.4%) positive results were recorded. Of these, 96 were positive for opioids, representing 3.2% of all maternity admissions. Nineteen of the 96 (20%) opioid-positive urine tests were recorded in mothers without screening risk factors. Seven of these 19 infants (37%) required admission to the special care nursery for worsening signs of NAS, and 1 of these 7 required pharmacologic treatment.

CONCLUSION:

Universal maternal drug testing improves the identification of infants at risk for the development of NAS. Traditional screening methods underestimate in utero opioid exposure.

• Authors: Scott L Wexelblatt, Laura P Ward, Kimberly Torok, Elizabeth Tisdale, Jareen K Meinzen-Derr, James M Greenberg
• Journal: The Journal of pediatrics (J Pediatr) Vol. 166 Issue 3 Pg. 582-6 (Mar 2015) ISSN: 1097-6833 [Electronic] United States
• PMID: 25454935 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Chemical References

• Analgesics, Opioid
• Prescription Drugs

Topics

• Adult
• Analgesics, Opioid (adverse effects)
• Female
• Follow-Up Studies
• Humans
• Infant, Newborn
• Male
• Neonatal Abstinence Syndrome (diagnosis, epidemiology, etiology)
• Ohio (epidemiology)
• Opioid-Related Disorders (complications, diagnosis)
• Pregnancy
• Pregnancy Complications
• Prescription Drugs (adverse effects)
• Prevalence
• ROC Curve
• Retrospective Studies