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

J Pediatr. 2015 Mar;166(3):582-6. doi: 10.1016/j.jpeds.2014.10.004. Epub 2014 Nov 12.

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.

MeSH terms

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

Substances

  • Analgesics, Opioid
  • Prescription Drugs