Umbilical Cord Tissue: Faster Answers; Better Outcomes
My last blog was all about screening neonates for substances of abuse and why we don’t screen often enough. I didn’t answer that question – because I don’t understand why we don’t, but you can read the blog here: https://the4csofaddiction.wordpress.com/2023/12/01/knowledge-is-power-and-more-is-readily-available-through-neonate-screening-for-drugs-of-abuse/
Now, let’s say we learned our lesson, and we’re now going to screen every neonate for substances of abuse in order to give newborns their best possible chances in life!
Screen what? How?
Urine screens are the cheap and easy grandfather of screens. They were developed in the 1970s and first used to monitor Vietnam veterans undergoing methadone treatment when returning to the US. A urine screen tells us if someone has been misusing substances within the last 72 hours, at most, with cannabis being an outlier. But what does “misusing” mean? I really don’t know, and I’m not sure that anyone can answer that question well. We know that testing cannot determine time, dosage, or frequency of use. We simply know that someone with a positive test – a confirmed positive test – used the substance he tested positive for, with a fair degree of certainty.
Urine screens aren’t the best, and gathering the sample from newborns is difficult, to say the least. Sure, babies pee, but it may not go where you want it to when you want it. That is, the best practice of capturing the first void following birth may not happen, and those capturing it may not even know it hasn’t. Also, that 72-hour timeframe of the substance staying in the system is even shorter, since baby’s urine is more diluted, so there’s not a lot of information gathered.
Meconium is routinely used, and it holds a wealth of information. First, the lookback period is much longer than urine. Rather than only 72 hours, the lookback period is up to approximately 20 weeks, and, since it’s the baby’s first stool, it’s easier to collect than urine.
But it’s still not EASY to collect. There are myriad ways that meconium doesn’t provide the answers needed. First, it’s stool, so, again, baby goes when and where baby goes. That means it may be in utero or during birth, making the meconium outright impossible to gather. It also means that first bowel movement can occur after discharge from the hospital, particularly when baby is feeling the constipating effects of opioids, risking that the ones most needing the screening may not get it.
And, even if the meconium can be gathered, it’s not easy to gather…and it’s not easy to gather enough for testing.
That could mean that a sample is gathered, sent to the lab, and a report of “quantity not sufficient” is returned…a devastating end to the process. There’s no going back for more meconium, and the babies who need testing, generally the ones who have the following risk factors as identified by the University of Arkansas for Medical Sciences, need the most intervention. But that window has closed.
(1) History of maternal drug use or agitated/altered mental status in the mother
(2) No prenatal care
(3) Unexplained placental abruption
(4) Unexplained central nervous system (CNS) complications in the newborn (seizures, intracranial hemorrhage)
(5)Symptoms of drug withdrawal in the newborn (tachypnea, hypertonicity, excessive stooling/secretions
(6) Changes in behavioral state of the newborn (jittery, fussy, lethargic) (NCBI)
What babies need is a quick TAT with a wealth of information. A quick turnaround time (TAT) – the time it takes to turn around the sample that’s been collected until the report is received back from the lab – is vital when the most vulnerable patients are waiting on answers.
An initial urine screen can provide immediate results, but those results aren’t confirmed, and so they aren’t useful. A confirmation of a negative screen is generally swift upon receipt at the lab while a confirmation of a positive screen could take up to two days. But remember, urine is quite difficult to collect from a neonate, so focus on just the quick TAT may exclude crucial information.
Enter umbilical cord tissue testing, arguably the best sample to use for screening neonates for substances of abuse! What makes it so good is the availability of it: every baby comes out with a sufficient sample to test, plus it’s far less messy to gather than stool or urine. However, the best reason to test umbilical cord is that there’s no waiting for it. Once the baby is born, the cord is present to be gathered, readied, and immediately sent for testing, because those moments matter for neonates.
United States Drug Testing Laboratory (USDTL), in 1991, became the first lab to commercially introduce meconium testing to the market. The lab is also a leader in umbilical cord tissue testing. Researchers from USDTL, Joseph Jones, PhD; Donna Coy, PhD; and Mary Jones analyzed turnaround times for both meconium (700 samples) and umbilical cord tissue (5,358 samples) (USDTL.my.salesforce). The results are in, and umbilical cord tissue is the better test.
For starters, because of the immediate availability of umbilical cord tissue after birth, the lab receives the sample more quickly: 2.8 ± 1.9 days for umbilical cord tissue but 4.5 ± 2.9 days for meconium.
Next, even reports on negative tests using meconium took longer, preventing families from putting any of the stresses from this process behind them, 3.5 ± 2.2 days for negative umbilical cord tissue vs. 5.7 ± 3.3 days for negative meconium.
Confirmed positive results for meconium also took longer, meaning that a determination for what ails baby is undetermined while healthcare providers must guess at best next steps: 5.4 ± 2.2 days for positive umbilical cord tissue vs. 8.4 ± 3.8 days for positive meconium (USDTL.my.salesforce).
Overall, the TAT from birth to final report showed that umbilical cord tissue was better than meconium at a factor of 2.6 days – critical time for babies to receive appropriate care, both from healthcare providers and from their families. Additionally, a faster turnaround time leads to reduced hospitalization and therefore reduced costs.
Screening of neonates for substances of abuse offers a means to help immediately, a referral to early intervention, an opportunity for families to act accordingly and seek appropriate care and support, given the information they would have.
Screening is a tool – a very valuable tool – to give our most vulnerable population the best chance at healthy lives. Let’s not squander that chance.
References:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139193/
http://www.usdtl.com/perinatal-testing/newborn-drug-testing
Guided by Guida 
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