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Mayo Test ID DASM5 Drugs of Abuse Screen, Meconium 5


Ordering Guidance


For chain-of-custody testing, order DSM5X / Drugs of Abuse Screen 5, Chain of Custody, Meconium.



Specimen Required


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

Container/Tube: Stool container

Specimen Volume: 1 g (approximately 1 teaspoon)

Collection Instructions: Collect entire random meconium specimen.


Useful For

Identifying amphetamines (and methamphetamines), opiates, phencyclidine, 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
PCPMC PCP Confirmation, Meconium Yes No
THCM Carboxy-THC Confirmation, M Yes No

Testing Algorithm

Testing begins with immunoassay screen. Positive results are confirmed and quantitated by liquid chromatography tandem mass spectrometry at an additional charge.

Method Name

Competitive Chemiluminescent Immunoassay (CIA)

Reporting Name

Drugs of Abuse Screen, Meconium 5

Specimen Type

Meconium

Specimen Minimum Volume

0.45 g (approximately 0.5 teaspoon)

Specimen Stability Information

Specimen Type Temperature Time Special Container
Meconium Frozen (preferred) 21 days
  Refrigerated  21 days
  Ambient  72 hours

Reject Due To

Grossly bloody Reject; Pink OK
Stool
Diapers		 Reject

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 disease, infections, aspirations pneumonia, cerebral infarction, abnormal heart rate and breathing patterns, 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 10th to 12th week of gestation and slowly moves into the colon by the 16th 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)

Reference Values

Negative

 

Positive results are reported with a quantitative liquid chromatography tandem mass spectrometry result.

 

Cutoff concentrations by competitive chemiluminescent immunoassay:

Amphetamines : 100 ng/g

Methamphetamine: 100 ng/g

Benzoylecgonine (cocaine metabolite): 100 ng/g

Opiates: 100 ng/g

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

Phencyclidine: 20 ng/g

Interpretation

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

Cautions

If heroin use is suspected, specimen must be sent frozen to prevent loss of 6-monoacetylmorphine (6MAM, heroin metabolite). When refrigerated, a significant percentage of 6MAM will convert to morphine in fewer than 24 hours.

 

Unless sent frozen, the cocaine metabolite, m-hydroxybenzoylecgonine, will degrade within 72 hours of collection.

Clinical Reference

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

2. Ostrea EM Jr, Brady MJ, Parks PM, Asensio DC, Naluz A. Drug screening of meconium in infants of drug-dependent mothers; an alternative to urine testing. J Pediatr. 1989;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;60(1):45-56; quiz 73-74

4. Langman LJ Bechtel LK, Meier BM, Holstege C: Clinical toxicology. In: Rifai N, Horvath AR, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018:832-887

5.  Langman LJ, Rushton AM, Thomas D, et al. Drug testing in support of the diagnosis of neonatal abstinence syndrome: The current situation. Clin Biochem. 2023;111:1-10. doi:10.1016/j.clinbiochem.2022.11.002

6. Marin SJ, Merrell M, McMillin GA. Drugs of abuse detection in meconium: a comparison between ELISA and biochip microarray. J Anal Toxicol. 2011;35(1):40-45. doi:10.1093/anatox/35.1.40

Method Description

The meconium sample received is screened by competitive chemiluminescent immunoassay by Randox Evidence+ to detect the presence of any of the drugs or drugs that cross react with amphetamine, methamphetamine, cocaine metabolite, opiates, phencyclidine, and carboxy-tetrahydrocannabinol. Meconium specimens identified as positive by this screen are analyzed using liquid chromatography tandem mass spectroscopy for the specific drug or drug class indicated.(Unpublished Mayo method)

Day(s) Performed

Monday through Saturday

Report Available

1 to 2 days

Specimen Retention Time

2 weeks

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Test Classification

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

CPT Code Information

80307

80324 (if appropriate)

80359 (if appropriate)

80353 (if appropriate)

80361 (if appropriate)

80365 (if appropriate)

80349 (if appropriate)

83992 (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
DASM5 Drugs of Abuse Screen, Meconium 5 49046-6

 

Result ID Test Result Name Result LOINC Value
32197 Amphetamine 26895-3
32199 Methamphetamine 27289-8
32201 Cocaine 26956-3
32203 Opiate 29158-3
32205 Phencyclidine 26859-9
32207 Tetrahydrocannabinol 26893-8
32208 Chain of Custody 77202-0