High-sensitivity neonatal urine drug testing has similar positivity rates to meconium for detecting in utero exposure to methamphetamine and cocaine.

This article evaluates the effectiveness of a rapid, sensitive liquid chromatography–tandem mass spectrometry (LC–MS-MS) method for neonatal urine drug testing compared to standard meconium testing in 1,424 neonates. The study found that urine testing using LC–MS-MS demonstrated equivalent sensitivity to meconium testing for detecting in utero exposure to cocaine and methamphetamine, while meconium testing showed higher positivity rates for cannabinoids and opiates. Urine testing offers advantages including faster turnaround times and easier specimen collection, which may facilitate more timely clinical decisions. The findings suggest that sensitive LC–MS-MS urine testing can be a valuable tool in neonatal drug exposure screening, though limitations include lower detection of certain drugs like cannabinoids and the exclusion of synthetic opioids such as fentanyl from the comparison.