title: The Toxicology of Methadone-Related Death in Infants Under 1 Year: Three Case Series and Review of the Literature.
abstract: Methadone-related fatalities occur rarely in infants under 1 year, with five confirmed cases in the literature. The interpretation of pediatric postmortem toxicology relies on adult data; however, infants have crucial physiological differences that may impact interpretation of results. Retrospective case review included scene investigation, interviews, autopsy, and NIH/CDC Sudden Unexplained Infant Death Investigation Reporting Form. Methadone levels were confirmed by liquid chromatography/tandem mass spectrometry (LC-MS/MS). The fatal blood methadone levels in this case series ranged from 69 to 700 ng/mL. This review of the literature adds toxicological findings of three methadone-related infant fatalities and reviews the current literature on methadone-related death in infants under 1 year. With opioid use on the rise in today's society, forensic experts should have a high index of suspicion for the possibility of intentional or unintentional poisoning in infants.
authors.affiliation: Nuffield Department of Obstetrics & Gynecology, University of Oxford, Oxford, OX3 9DU, U.K.|Office of the Medical Examiner, Clark County Coroner's Office, Las Vegas, NV, 89106.
authors.forename: Anthea B Mahesan
authors.identifier: http://orcid.org/0000-0002-6463-6011
authors.initials: ABM
authors.lastname: Paul
authors.affiliation: Office of the Medical Examiner, Clark County Coroner's Office, Las Vegas, NV, 89106.
authors.forename: Lary
authors.initials: L
authors.lastname: Simms
authors.affiliation: Eastern Virginia Medical School, Jones Institute for Reproductive Medicine, Norfolk, VA, 23507.
authors.forename: Arnold M
authors.initials: AM
authors.lastname: Mahesan
mesh_terms: D002853:Chromatography, Liquid; D005260:Female; D005766:Gastrointestinal Contents / Q000737:chemistry; D006708:Homicide; D006801:Humans; D007223:Infant; D008099:Liver / Q000737:chemistry; D008691:Methadone / Q000032:analysis* / Q000506:poisoning*; D009294:Narcotics / Q000032:analysis* / Q000506:poisoning*; D053719:Tandem Mass Spectrometry; D014822:Vitreous Body / Q000737:chemistry
chemical_list: D009294:Narcotics; D008691:Methadone
keywords: forensic science; homicide; infant mortality; methadone; toxicology