Original Article
Universal Maternal Drug Testing in a High-Prevalence Region of Prescription Opiate Abuse

https://doi.org/10.1016/j.jpeds.2014.10.004Get rights and content

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.

Section snippets

Methods

We conducted a retrospective cohort study from May 2012 through November 2013 at Mercy Anderson Hospital, a community hospital in southwestern Ohio that serves the eastern Cincinnati metropolitan area. During the study period, the hospital cared for 2995 mothers for delivery of 2979 infants (with 38 intrauterine fetal deaths and 22 multiple births), of whom 95% were Caucasian, 52% were married, and 53% had private insurance. Hospital mother-infant services, including a level II nursery and

Results

During the study period (May 2012 through November 2013), there were 2995 maternal admissions. Hospital staff obtained 2956 urine drug tests; 38 tests were not done owing to precipitous delivery, emergent cesarean delivery, or inadvertent omission. One uninsured mother refused to provide a urine specimen for financial reasons. Among the 2956 specimens were 159 positive results, corresponding to 5.4% of the mothers. Of these 159 positive tests, 96 (60%) were positive for opioids, representing

Discussion

With the implementation of universal maternal drug testing, we identified 19 opioid-exposed infants who would have been missed with our previous screening approach. Owing to our standard of care of observing opioid-exposed infants for 72-96 hours, these 19 infants were prevented from premature discharge and possibly poor outcomes.8 We initiated Finnegan scoring earlier for infants with a positive maternal opioid drug test, and initiated the nonpharmacologic treatment bundle in affected infants.

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    The authors declare no conflicts of interest.

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