605 Universal urine drug screening upon admission to labor and delivery - phase 2 study

Objective: Illicit drug use or narcotic prescription use during pregnancy is a growing epidemic and can affect the neonate. The benefit of universal urine drug screening (UDS) in pregnancy is controversial. Previously, we reported a 47% false positive (FP) rate when implementing universal UDS in pregnant women admitted to Labor and Delivery (L&D). Gas chromatography was used for confirmation with a turnaround time (TT) of one week, carrying a legal and emotional burden on parents. In 2019 our hospital implemented an inhouse confirmation with mass spectrometry (MS) with TT of 24 hours. This phase 2 study aims to examine the FP, true positive (TP) rates and “new catches” after establishing a more rapid confirmation test. Study Design: This is a retrospective cohort study of all pregnant women admitted to L&D between 10/2019 and 9/2020. All positive UDS tests were reflexed for inhouse confirmation via MS except for fentanyl which was sent to an outside lab with a TT of one week. For some mothers the infant’s meconium was sent for drug screening. Positive results were determined to be TP or FP based on MS results. New catches were defined as TP results in mothers who did not admit to drug use. Results: A total of 2395 deliveries occurred during this time period of which 2122 (88.6%) had available UDS results. Sixty women (60/2122, 2.8%) had a positive UDS for at least one drug with a total of 69 positive drugs. Of 63 positive tests with available confirmation, 32 (32/63, 50.7%) were TP and 31 (31/63, 49.2%) were FP. Of the TP results, 11 babies were “new catches” (11/32, 34.3%), 16 babies developed neonatal abstinence syndrome (NAS) (16/32, 50%) and five babies were discharged to the Administration of Child Services (ACS) (5/32, 15.6%). Seven babies with NAS (7/16, 43.7%) required treatment with morphine. ACS was not called for any of the FP cases. Conclusion: In our phase 2 study with rapid UDS confirmation, the FP rate was similar but there was a higher percentage of new catches. This approach may improve the efficiency of universal UDS since actions are taken only for confirmed results. [Formula presented]