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Test ID DASM4 Drugs of Abuse Screen, Meconium 4

Reporting Name

Drugs of Abuse Screen, Meconium 4

Useful For

Identifying amphetamines (and methamphetamines), opiates, as well as metabolites of cocaine and marijuana in meconium specimens

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
AMPHM Amphetamines, Confirmation, M Yes No
COKEM Cocaine and Metabolites, Confirm, M Yes No
OPATM Opiate Confirmation, M Yes No
THCM Carboxy-THC Confirmation, M Yes No

Testing Algorithm

Testing begins with immunoassay screen. Positives are confirmed and quantitated by liquid-chromatography/tandem-mass spectrometry (LC-MS/MS) at an additional charge.

Specimen Type

Meconium


Advisory Information


For chain-of-custody testing, order DSM4X / Drugs of Abuse Screen 4, Chain of Custody, Meconium.



Specimen Required


Supplies: Stool container, Small (Random), 4 oz (T288)

Container/Tube: Stool container (T288)

Specimen Volume: 1 g (approximately 1 teaspoon)

Collection Instructions: Collect entire random meconium specimen.


Specimen Minimum Volume

0.45 g (approximately 0.5 teaspoon)

Specimen Stability Information

Specimen Type Temperature Time
Meconium Frozen (preferred) 14 days
  Refrigerated  24 hours

Reference Values

Negative

Positives are reported with a quantitative LC-MS/MS result.

Cutoff concentrations

Amphetamines by ELISA: 100 ng/g

Methamphetamine by ELISA: 100 ng/g

Benzoylecgonine (cocaine metabolite) by ELISA: 100 ng/g

Opiates by ELISA: 100 ng/g

Tetrahydrocannabinol carboxylic acid (marijuana metabolite) by ELISA: 20 ng/g

Day(s) and Time(s) Performed

Monday through Saturday

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information

80307

See individual reflex tests for appropriate CPT codes

LOINC Code Information

Test ID Test Order Name Order LOINC Value
DASM4 Drugs of Abuse Screen, Meconium 4 In Process

 

Result ID Test Result Name Result LOINC Value
32078 Amphetamine 26895-3
32080 Methamphetamine 27289-8
32082 Cocaine 26956-3
32084 Opiate 29158-3
32086 Tetrahydrocannabinol 26893-8
32087 Chain of Custody No LOINC Needed

Clinical Information

Illicit drug use during pregnancy is a major social and medical issue. Drug abuse during pregnancy is associated with significant perinatal complications, which include a high incidence of stillbirths, meconium-stained fluid, premature rupture of the membranes, maternal hemorrhage (abruption placenta or placenta praevia), and fetal distress.(1) In the neonate, the mortality rate, as well as morbidity (eg, asphyxia, prematurity, low birthweight, hyaline membrane distress, infections, aspiration pneumonia, cerebral infarction, abnormal heart rate and breathing problems, drug withdrawal) are increased.(1)

 

The disposition of drug in meconium is not well understood. The proposed mechanism is that the fetus excretes drug into bile and amniotic fluid. Drug accumulates in meconium either by direct deposit from bile or through swallowing of amniotic fluid.(2) The first evidence of meconium in the fetal intestine appears at approximately the tenth to twelfth week of gestation, and slowly moves into the colon by the sixteenth week of gestation.(3) Therefore, the presence of drugs in meconium has been proposed to be indicative of in utero drug exposure during the final 4 to 5 months of pregnancy, a longer historical measure than is possible by urinalysis.(2)

Interpretation

A positive result indicates that the baby was exposed to the drugs indicated.

Clinical Reference

1. Ostrea EM Jr: Understanding drug testing in the neonate and the role of meconium analysis. J Perinat Neonatal Nurs 2001 Mar;14(4):61-82; quiz 105-106

2. Ostrea EM Jr, Brady MJ, Parks PM, et al: Drug screening of meconium in infants of drug-dependent mothers: an alternative to urine testing. J Pediatr 1989 Sep;115(3):474-477

3. Ahanya SN, Lakshmanan J, Morgan BL, Ross MG: Meconium passage in utero mechanisms, consequences, and management. Obstet Gynecol Surv 2005 Jan;60(1):45-56; quiz 73-74

Analytic Time

2 days

Method Name

Enzyme-Linked Immunosorbent Assay (ELISA)