1. Universal maternal drug testing in a high-prevalence region of prescription opiate abuse
- Author
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Jareen Meinzen-Derr, Scott L. Wexelblatt, Laura P. Ward, Elizabeth A. Tisdale, Kimberly Torok, and James M. Greenberg
- Subjects
Sexually transmitted disease ,Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Prescription Drugs ,Urine ,Pregnancy ,Prevalence ,Medicine ,Humans ,Medical prescription ,Ohio ,Retrospective Studies ,Placental abruption ,business.industry ,Infant, Newborn ,Retrospective cohort study ,medicine.disease ,Opioid-Related Disorders ,Community hospital ,Analgesics, Opioid ,Pregnancy Complications ,ROC Curve ,Pediatrics, Perinatology and Child Health ,Female ,Opiate ,business ,Neonatal Abstinence Syndrome ,Follow-Up Studies - 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. 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. more...
- Published
- 2014