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Occult cocaine exposure in children
N M Rosenberg1, K L Meert, S R Knazik
1Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit 48201.
Insights
Occult cocaine exposure is prevalent in urban children under five. Urine tests revealed benzoylecgonine in 5.4% of children, highlighting risks of passive exposure.
Area of Science:
- Pediatric Emergency Medicine
- Toxicology
- Public Health
Background:
- Pediatric emergency departments encounter children with various complaints.
- Assessing environmental exposures is crucial for child health.
- Occult exposures can confound health outcome assessments.
Purpose of the Study:
- To determine the prevalence of cocaine and cannabinoid exposure in young children.
- To investigate asymptomatic children presenting to a pediatric emergency department.
- To understand the implications of passive exposure in urban settings.
Main Methods:
- Urine samples from 460 children (1-60 months) were screened.
- Enzyme multiplied immunoassay technique (EMIT) was used for cocaine metabolite (benzoylecgonine) and cannabinoids.
- Positive results were confirmed with radioimmunoassay and gas chromatography/mass spectrometry.
Main Results:
- Benzoylecgonine was detected in 25 children (5.4%).
- Confirmatory testing validated cocaine metabolite presence in all tested samples.
- No cannabinoid exposure was detected in any child.
Conclusions:
- A significant prevalence of occult cocaine exposure exists in young urban children.
- Passive cocaine exposure poses risks and impacts health outcome studies.
- Further research is needed on the long-term effects of such exposures.
Abstract:
We determined the prevalence of cocaine and cannabinoid exposure among young children presenting to an urban pediatric emergency department without signs or symptoms suggestive of the exposure. The study included 460 children between 1 and 60 months of age in whom urinalysis was required for investigation of routine pediatric complaints. Anonymously and without informed consent, an aliquot of urine was screened for cocaine metabolite (benzoylecgonine) and 11- or delta-9-tetrahydrocannabinol-9 carboxylic acid with the enzyme multiplied immunoassay technique. Positive specimens were rescreened with a radioimmunoassay and confirmed with gas chromatography/mass spectrometry, if a sufficient quantity of urine was available. Benzoylecgonine was identified in 25 patients (5.4%) by both screening techniques. Enough urine was available for confirmatory testing in eight patients, and all eight urine specimens contained benzoylecgonine. Neither 11- nor delta-9-tetrahydrocannabinol-9 carboxylic acid was detected in any patient. We documented the magnitude of the problem of occult passive cocaine exposure in young children living in an urban environment. Such exposure has serious implications for the assessment of outcomes in postnatal follow-up studies of prenatally exposed children as well as potential risks to children living in household environments where occult cocaine exposure occurs.