Drug testing in support of the diagnosis of neonatal abstinence syndrome: The current situation.

• Clinical tools and diagnostic signs and symptoms remain adequate at diagnosing NAS. • There is a significant gap in knowledge whether drug testing results are being used to confirm the diagnosis of NAS. • Each matrix (meconium, umbilical cord, and urine) has its own unique advantages and limitations. • There is a lack of standardization in the cut-off value and analyte profiles. • The goal of neonatal drug testing is to support the diagnosis of NAS, provide the appropriate follow-up and treatment for the mother-neonate dyad, not to identify maternal substance use disorder. Illicit drug use during pregnancy is a concern worldwide, with many international studies describing attempted strategies to mitigate this problem. Drug misuse during pregnancy is associated with significant maternal as well as perinatal complications, which include a high incidence of stillbirths, fetal distress, neonatal abstinence syndrome (NAS) and increased neonatal mortality. Unfortunately, the identification of a drug-exposed mother or neonate is challenging. Maternal disclosure of drug use is often inaccurate, principally due to psychosocial factors including behavioral denial or the fear of the consequences resulting from such admissions. Likewise, many infants who have been exposed to drugs in utero may appear normal at birth and initially show no overt manifestations of drug effects. Thus, the identification of the drug-exposed infant requires a high index of clinical suspicion. Conversely, analytical testing is an objective means of determining drug exposure when it may be necessary to document proof of the infant's exposure to illicit drugs. The review will discuss the different matrices that are most commonly used for testing (e.g., maternal urine, neonatal urine, meconium, and umbilical cord), the strengths and limitations for each matrix, which drugs and metabolites are appropriate for testing, the various testing methods, and the advantages and disadvantages of each method. [ABSTRACT FROM AUTHOR]