title: Patterns of Drugs and Drug Metabolites Observed in Meconium: What Do They Mean?
abstract: BACKGROUND
  Meconium drug testing is performed to detect potentially harmful drug exposures in a newborn. Interpretation of meconium drug testing results can be complicated based on the patterns and proportional concentrations of the drug(s) and/or drug metabolite(s) detected.
  
  
  METHODS
  The objective of this study was to analyze meconium drug testing patterns in a de-identified dataset from a national reference laboratory (n = 76,631) and in a subset of the data, wherein specimens originated at a single academic medical center for which detailed chart review was possible (n = 3635). Meconium testing was performed using 11 immunoassay-based drug screens. Specimens that were positive for one or more drug screens were reflexed to corresponding confirmation tests performed by gas chromatography or liquid chromatography with mass spectrometric detection, targeted to identify and quantitate specific parent drug(s) and metabolite(s).
  
  
  RESULTS
  The positivity rate was the highest for the cannabis metabolite 11-nor-9-carboxy-delta-9-tetrahydrocannabinol (25.2%, n = 18,643), followed by opiates/oxycodone (23.2%, n = 17,778), amphetamine/methamphetamine (6.7%, n = 5134), cocaine metabolites (5.5%, n = 4205), methadone (5.3%, n = 4093), benzodiazepines (3.4%, n = 2603), barbiturates (1.1%, n = 834), propoxyphene (1.0%, n = 749), and phencyclidine (0.1%, n = 44). Based on documented pharmacy history, drugs administered to either the mother or newborn during the birth hospitalization were detected in meconium, providing evidence that drugs can be incorporated into meconium rapidly. Drugs administered directly to the newborn after birth were recovered in meconium as both parent drug and metabolites, providing evidence of neonatal metabolism. Overall, patterns observed in meconium exhibited many similarities to those patterns commonly reported with urine drug testing.
  
  
  CONCLUSIONS
  Interpretation of meconium drug testing results requires comparison of results with clinical and analytical expectations, including maternal admissions to drug use, pharmacy history, recognized metabolic patterns for drugs of interest, cutoff concentrations, and other performance characteristics of the test. Concentrations of drug(s) and drug metabolites(s) may not reliably predict timing of drug use, extent of drug use, or frequency of drug exposures.
authors.affiliation: *ARUP Institute for Clinical and Experimental Pathology, Department of Pathology, University of Utah School of Medicine, Salt Lake City; †Stead Family Department of Pediatrics, University of Iowa Children's Hospital; and ‡Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City.
authors.forename: Gwendolyn A
authors.initials: GA
authors.lastname: McMillin
authors.forename: Kelly E
authors.initials: KE
authors.lastname: Wood
authors.forename: Frederick G
authors.initials: FG
authors.lastname: Strathmann
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Krasowski
mesh_terms: D003042:Cocaine / Q000378:metabolism; D006801:Humans; D007231:Infant, Newborn; D008470:Meconium / Q000737:chemistry*; D004364:Pharmaceutical Preparations / Q000032:analysis* / Q000378:metabolism
chemical_list: D004364:Pharmaceutical Preparations; D003042:Cocaine