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Occult cocaine and opiate exposure in children and associated physical findings
N M Rosenberg1, K L Meert, D Marino
1Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit Medical Center 48201-2196, USA.
Insights
Occult cocaine exposure in young children is linked to physical differences, including higher blood pressure and lower weight. Opiate exposure showed no such associations in this pediatric emergency department study.
Area of Science:
- Pediatric Emergency Medicine
- Toxicology
- Neonatal Abstinence Syndrome
Background:
- Cocaine and opiate exposure in children can have significant health implications.
- Objective physical findings associated with substance exposure in pediatric patients require further investigation.
Purpose of the Study:
- To determine the prevalence of cocaine and opiate exposure in children presenting to a pediatric emergency department.
- To investigate the association between substance exposure and objective physical findings in these children.
Main Methods:
- Urine screening for benzoylecgonine (cocaine metabolite) and opiates using EMIT and FPIA.
- Confirmation of positive results using gas chromatography/mass spectrometry (GC/MS).
- Analysis of age- and sex-adjusted physical parameters including blood pressure, head circumference, and weight.
Main Results:
- Cocaine metabolite (benzoylecgonine) was identified in 4.4% of patients, and opiates in 4.9%.
- Cocaine exposure was associated with higher systolic and diastolic blood pressure percentiles.
- Cocaine exposure was linked to lower head circumference and weight percentiles.
- No significant associations were found between opiate exposure and the measured physical variables.
Conclusions:
- Occult postnatal cocaine exposure is associated with measurable physical and physiological differences in young children.
- These findings highlight potential health consequences of undiagnosed cocaine exposure in pediatric populations.
Abstract:
We determined the prevalence of cocaine and opiate exposure and the association of exposure with objective physical findings in children presenting to an urban pediatric emergency department. The study included 942 children between one and 60 months of age who required urinalysis for investigation of their chief complaint. Anonymously and without informed consent, urine was screened for benzoylecgonine (BE) and opiates, using an enzyme multiplied immunoassay technique (EMIT) with sensitivity of 50 ng/ml. EMIT-positive samples were rescreened using a fluorescence polarization immunoassay (FPIA). Specimens positive by both EMIT and FPIA were confirmed by gas chromatography/mass spectrometry (GC/MS) if sufficient quantity of urine was available. BE was identified in 41 (4.4%) and opiates in 46 (4.9%) patients by both EMIT and FPIA. The presence of BE or opiate was confirmed by GC/MS in all 34 cases where sufficient urine was available. The age- and sex-adjusted systolic and diastolic blood pressure percentiles were greater, and head circumference and weight percentiles were lower in BE-positive patients compared to those with negative drug screens. There were no associations between opiate exposure and any of these variables. We conclude that occult postnatal cocaine exposure is associated with measurable physical and physiologic differences.