P2C377: Assessing the Efficiency of Umbilical Cord Tissue Drug Analysis

Background: Neonatal drug screening is a valuable resource utilized in the detection and management of Neonatal abstinence syndrome (NAS). In the Appalachian region, there is a growing number of opioid-related health crises and deaths. Umbilical cord tissue drug analysis (UCTDA) is one of the biomarkers to detect neonatal intrauterine exposure. However, there is conflicting data about the validity of the test. Previous data from a large universal UCTDA cohort reported the incidence of heroin. We aim to study the efficacy of UCTDA in detecting maternal drug usage in our only NICU in the Eastern panhandle of WV.

Methods: This is a retrospective single-center study looking at the efficacy of UCTDA in detecting maternal opioid exposure in neonates admitted to our NICU. UCTDA was obtained on risk-based cases as per AAP guidelines. Maternal and neonate data including demographic and clinical data such as gestational age, sex, birth weight, length of stay, UCTDA, discharge disposition, and status of the opioid maintenance program of the mother were obtained from records. Using the maternal history of drug use as a denominator, detection rates of various reported drugs on the UDTCA were analyzed.

Results: During the study period from January 2015 to December 2021, a total of 1253 babies were admitted to the NICU at our center. 200 babies who were diagnosed with NAS based on ICD 10 criteria were included in our study. 114 (57%) were male, the mean gestational age was 37 weeks and 4 days, mean birth weight was 2878 grams. The average length of stay was 15.6 days.
From maternal data, 110 (55%) mothers had regular prenatal care, 73(36.5%) had limited prenatal care and 17(8.5%) had no prenatal care. Eighty-six mothers (43%) were enrolled in opioid drug management programs prenatally. Fifty mothers (25%) reported heroin use, 23 mothers (11.5%) reported cocaine use, 36 mothers (18%) reported use of buprenorphine, and 15 mothers (7.5%) reported methadone use. For those mothers who admitted drug usage, the detection rate using UCTDA was 2% for heroin (1/50), 57% for cocaine (13/23), 61% for buprenorphine (22/36), and 67% for methadone (10/15). For those mothers who reported no history of drug usage, UCTDA was positive in 4% (6/150) for heroin, 8% (15/177) for cocaine, 26% (42/164) for buprenorphine, and 13% (24/185) for methadone.

Conclusion: The detection rate of heroin and its metabolites is noted to be extremely poor in UCTDA. For mothers who reported negative drug history, buprenorphine has recovered from UCTDA at a high percentage possibly indicating the easy accessibility and higher rate of abuse. UCTDA should be used cautiously since the rate of detection for illicit drugs such as heroin and cocaine are low. The reliability of positive UCTDA as an important indicator for discharge disposition should be discouraged.