SALT LAKE CITY—Every baby born that enters this world, arrives with an umbilical cord in tow. For
those babies born addicted to drugs, that umbilical cord is now a key connection—a hard to hide
clue—for identifying what drugs are coursing through a newborn’s veins. The drug(s) detected will
help physicians determine the best treatment and what withdrawal symptoms to expect.
“We may already know the mom has an opioid dependency at delivery because most women disclose
this to avoid risking withdrawal, but we also need to know what else is she taking that might affect
the baby’s central nervous system,” says Karen Buchi, MD, president, Primary Children’s Hospital
Medical Staff and chief of the Division of General Pediatrics at the University of Utah. Buchi points
out these babies suffer from “drug exposure” as opposed to “addiction, ”which is the behavior around
drug dependency exhibited by the mother.
As the baby is delivered—when a mother is suspected of being high risk for drug use—a member of
the delivery team snips off six inches of the umbilical cord and sends it to ARUP Laboratories.
Because umbilical cord tissue can be sent for testing immediately after birth, this specimen type
offers logistical advantages over meconium, the traditional specimen for detecting drug-exposed
newborns.
As the second medical laboratory in the country to start offering cord testing (since August 2012),
ARUP experts immediately begin analysis looking for more than 40 specific drugs and drug
metabolites. The most common drug ARUP identifies is marijuana; the second most common drug
class is opioids (e.g., heroin, prescription pain killers). Often there is a mix of illicit drugs and
prescription drugs.
According to a Utah Health Status Update released in July 2013, between 2009 and 2012, 1,476 Utah
mothers were reported to have used illicit drugs. As a result, 29.5 percent of babies born to these
mothers tested positive for illicit drugs at birth—approximately 109 babies per year.
“Utah is right up there with the rest of the nation in the rate of drug exposure among newborns,” adds
Buchi, citing that the U of U Hospital averages about one opioid-exposed newborn a month.
Each month, thousands of cord, and meconium, specimens arrive at ARUP from around the country.
In Utah, the majority of cord specimens come from the Intermountain Medical Center while the
University of Utah hospital still primarily sends ARUP meconium specimens. Though it varies based
on the hospital, generally no consent from the mother is necessary for testing the infant if there is a
medical reason to believe the child has been drug exposed in utero.
Turning around results fast is crucial, because neonatal specialists need to identify and treat the
symptoms to mitigate suffering and even possible death from withdrawals, before the typical 48-hour
window closes when healthy mothers and their infants typically leave the hospital.
While cord tissue testing can take up to 72 hours, for babies who exhibit signs of withdrawals or have
mothers considered high-risk for drug use, the baby is frequently monitored longer. In this time period,
the clinician can attain more information about the kinds of drugs in the baby’s system and determine
the best treatment.
“Sometimes babies are already in the throes of withdrawal symptoms but physicians can’t determine
what drugs they are dealing with until test results are available,” says Gwen McMillin, PhD, DABCC, a
medical director of the Clinical Toxicology Laboratories at ARUP.
The Rough Road of Withdrawals for Newborns
Known as neonatal abstinence syndrome, once the baby is born, and is no longer receiving drugs
through the placenta from the mother, withdrawal symptoms begin. They can appear from one to ten
days after birth, ranging from diarrhea, excessive or high-pitched crying, fever, seizures,
hypersensitivity to light, touch, and sound, rapid breathing, trembling, hyperactive reflexes, to name a
few. Some infants will carry the effects of their mothers’ neonatal drug abuse for life, suffering longterm
complications including brain damage and learning disabilities.
Like any addict that immediately stops drug intake, a baby experiences the same physiological impact
on the body and brain. In the case of a baby being exposed to opiates, if the opiate is not replaced, the
baby can die.
Affected newborns will spend their first months in a newborn intensive care unit; it can take more
than a year for the effects of some drugs to wear off. Evidence reveals that these babies are more
susceptible to drug addiction issues later.
“Ten years ago we were seeing significant prenatal methamphetamine use, now its opioids; the
difference is the babies exposed to opioids have longer lengths of stay in the hospital because they
go through physiological withdrawal,” explains Buchi, who has helped set up a care process for the
management of opioid-exposed newborns.
“The symptoms of neonatal abstinence syndrome depend on the type of drug the mother used, how
long it takes for the body to metabolize and eliminate the drug, how much of the drug she was taking
and for how long,” explains McMillin, adding that whether the baby was born full-term or premature
can also be a variable. Whether a baby is addicted to stimulants or “downers” will result in different
withdrawal symptoms and require different treatment.
The American Medical Association estimated that in the United States approximately one
infant, suffering from neonatal abstinence syndrome, was born every hour in 2009.
“The work we’re doing here is about the human condition; it is about the safety of children—as the risk
of child abuse and neglect increases in cases of maternal drug abuse,” emphasizes McMillin, who has
visited some of the babies in NICU, as well as testified in court when called to present evidence. “This
is also about getting mothers the care and support they need through rehab and social services so
they can take care of their children.”
Why Is The Cord the Best Evidence of Drug Use?
Traditionally meconium (an infant’s first stool) has been tested for detecting the presence of drugs,
forming in the second trimester, and absorbing over time. However, waiting for this first stool to pass
may waste valuable time, or the mother may try to dispose of it secretly, or it may pass during a
difficult delivery, as happens in 10 percent of cases. The samples may be too small or sent too late for
viable testing. Hair was considered as a possible specimen, but many babies don’t have enough hair
to provide a sizable enough sample.
“About six years ago, we started looking for alternative specimens,” recalls McMillin, considering the
placenta, the vernix caseosa (a white, creamy, film covering the baby’s skin during the last trimester),
and the umbilical cord. The cord became the specimen of choice because of its practical size, easy
transportability, and accessibility. “Every child comes into this world with one and it can be sent the
minute the baby is born,” points out McMillin. What makes the turn-around time quicker for the cord is
there is no waiting to collect the specimen.
About ARUP Laboratories
Founded in 1984, ARUP Laboratories is a leading national reference laboratory and a nonprofit
enterprise of the University of Utah and its Department of Pathology. ARUP offers more than 3,000
tests and test combinations, ranging from routine screening tests to esoteric molecular and genetic
assays. ARUP serves clients across the United States, including many of the nation’s top university
teaching hospitals and children’s hospitals, as well as multihospital groups, major commercial
laboratories, group purchasing organizations, military and other government facilities, and major
clinics. In addition, ARUP is a worldwide leader in innovative laboratory research and development, led
by the efforts of the ARUP Institute for Clinical and Experimental Pathology®.
CONTACTS:
Gwendolyn A. McMillin, PhD, DABCC, ARUP Laboratories medical director of Clinical Toxicology and
Pharmacogenomics and Professor of Pathology at the University of Utah.
gwen.mcmillin@aruplab.com, (801) 583-2787 x2671
Karen Buchi, MD, chief, Division of General Pediatrics and president, Primary Children’s Hospital
Medical Staff, (801) 585-6943, karen.buchi@hsc.utah.edu
Peta Owens-Liston, ARUP Laboratories, public relations specialist II, (801) 583-2787, ext. 3635,
peta.owens-liston@aruplab.com