Universal Urine Drug Screening with Rapid Confirmation upon Admission to Labor and Delivery

Lylach Haizler-Cohen; Ana Collins; Dana M Kaplan; Priyadarshani Giri; Adi Davidov; Jonathan Blau; Gary Fruhman

doi:10.1055/a-2118-2841

Universal Urine Drug Screening with Rapid Confirmation upon Admission to Labor and Delivery

Am J Perinatol. 2023 Aug 4. doi: 10.1055/a-2118-2841. Online ahead of print.

Authors

Lylach Haizler-Cohen^{1

2}, Ana Collins¹, Dana M Kaplan³, Priyadarshani Giri³, Adi Davidov¹, Jonathan Blau³, Gary Fruhman^{1

3}

Affiliations

¹ Department of Obstetrics and Gynecology, Staten Island University Hospital, Northwell Health, Staten Island, New York.
² Department of Obstetrics and Gynecology, Medstar Washington Hospital Center, Washington, District of Columbia.
³ Department of Pediatrics, Staten Island University Hospital, Northwell Health, Staten Island, New York.

PMID: 37369238
DOI: 10.1055/a-2118-2841

Abstract

Objective: This study aimed to describe our experience with universal urine drug screening (UDS) with rapid confirmation (RC) via liquid chromatography mass spectrometry (LC-MS) before infant's discharge, in efforts to increase detection of neonates at risk of neonatal opioid withdrawal syndrome (NOWS) while reducing patient burden related to false positive results.

Study design: Two-phase retrospective study of all pregnant women admitted to our labor and delivery (L&D) unit before (phase 1, April 2018-March 2019) and after (phase 2, October 2019-September 2020) RC of UDS was initiated. Urine samples were obtained on admission and screened for drugs using an enzyme immunoassay with positive results reflexed to confirmation via LC-MS. The turnaround time for LC-MS was 1 week in phase 1 and 24 hours in phase 2. For mothers with positive LC-MS confirmation, the infant's meconium was sent for drug screening. Positive results were determined to be true or false positive based on urinary LC-MS results. The primary outcome was the rate of opioid-positive mothers who were unanticipated. The secondary outcome was the difference in rate of neonates who were observed for NOWS, before and after implementation of RC with LC-MS.

Results: In phase 2, a total of 2,395 deliveries occurred of which 2,122 (88.6%) had available UDS results. Fifty-two (2.5%) women had a positive UDS for at least one drug with LC-MS confirmation. Of those, 25 were true positive and 27 were false positive. Twenty-one (84%) true positive mothers were taking opioids and 8 (37%) of them were unanticipated positives. Among mothers with positive UDS for opioids, the neonatal observation rate for development of NOWS was 100% (22/22) and 48% (21/44) before and after implementation of LC-MS RC, respectively.

Conclusion: Universal UDS and LC-MS RC in L&D may improve detection of unanticipated positive mothers whose infants are at risk of NOWS. RC of positive results allows intervention only for confirmed cases.

Key points: · Universal UDS can detect more infants at risk of NOWS.. · Rapid confirmation of positive UDS reduces burden.. · Only confirmed infants should be observed in the neonatal intensive care unit.. · Child Protective Services should only be notified of confirmed opioid-positive results..