title: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.affiliation: Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Family Birthing Center, Mercy Anderson Hospital, Cincinnati, OH. Electronic address: scott.wexelblatt@cchmc.org.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Wexelblatt
authors.affiliation: Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Family Birthing Center, Mercy Anderson Hospital, Cincinnati, OH.
authors.forename: Laura P
authors.initials: LP
authors.lastname: Ward
authors.affiliation: Family Birthing Center, Mercy Anderson Hospital, Cincinnati, OH.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Torok
authors.affiliation: Family Birthing Center, Mercy Anderson Hospital, Cincinnati, OH.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tisdale
authors.affiliation: Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Jareen K
authors.initials: JK
authors.lastname: Meinzen-Derr
authors.affiliation: Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Family Birthing Center, Mercy Anderson Hospital, Cincinnati, OH.
authors.forename: James M
authors.initials: JM
authors.lastname: Greenberg
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009357:Neonatal Abstinence Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D009820:Ohio / Q000453:epidemiology; D009293:Opioid-Related Disorders / Q000150:complications / Q000175:diagnosis*; D011247:Pregnancy; D011248:Pregnancy Complications; D055553:Prescription Drugs / Q000009:adverse effects*; D015995:Prevalence; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D055553:Prescription Drugs