A Novel Workflow to Screen for Illicit Drug Exposure in Newborns

摘要 一种新的新生儿非法药物暴露筛查工作流程 (RFA-DA-19-019) 新生儿禁欲综合征(NAS)指的是符合以下条件的新生儿的一系列戒断症状 在子宫内暴露于非法或上瘾的物质。患有NAS的婴儿胎儿畸形率较高 (先天性畸形、生长受限、缺血性胎盘并发症)和围产期问题(早产 分娩、喂养不良、睡眠困难、腹泻、癫痫)，这些因素共同增加了长期不利的风险 结果。在过去的十年里，NAS的发病率飙升，据估计，5%的母亲 在怀孕期间至少使用一种使人上瘾的药物。为了应对这场公共卫生危机，多个团体 包括美国妇产科学会和美国儿科学会 建议使用标准化的行为评分工具对怀孕期间使用的物质进行普遍筛查。 不幸的是，由于主观评分或自我报告错误，这类工具往往是有偏见的，无法识别 没有得到适当产前护理的婴儿。 早期识别NAS对于转诊受影响的婴儿进行干预是至关重要的，包括药物干预 为家庭提供治疗和行为/社会支持。俄亥俄州和德克萨斯州的部分医院已经参与了 在NAS的基于毒理学的普遍新生儿筛查(NBS)中，以及几个州公共卫生项目 评估将NAS筛查纳入其标准NBS小组的可行性。而国家统计局的毒理学 NAS正在美国扩张，目前有几个因素限制了这类项目的增长。这些措施包括： 现有的尿样和血样检测灵敏度有限，接触史短，具有挑战性 胎粪样本处理的方法，胎粪样本的有限测试选择，以及 现有为数不多的胎粪测试的周转时间。延迟或其他方面的潜在后果 NAS筛查不足包括药物治疗中错误和/或延迟的增加、成本高 与不必要的住院相关，并增加误诊风险。 为了应对这些挑战，我们提出了一种新的工作流程，可以对尿液或 医院里的胎粪样本。我们的系统将把一个简单的样品制备方案与一个高 同种酶免疫分析的敏感性小组识别五种常见的药物：芬太尼， 吗啡、安非他明/甲基苯丙胺、可卡因和苯二氮卓类药物。这些测试将在一个 创新的数字微流控分析仪，结果的总时间，包括样品处理时间，不超过2 几个小时。这项研究的产品符合RFA-DA-19-019的目标，即开发“创新方法来识别 并治疗接触阿片类药物的新生儿“，并将进一步支持美国科学院的目标 儿科扩大高灵敏度NAS筛查。实施我们的协议可能带来的好处 包括减少未受影响新生儿的住院时间，加快确诊结果的时间，更快 解决急性戒断症状，并改进转诊至家庭/产妇支助服务。

ABSTRACT A Novel Workflow to Screen for Illicit Drug Exposure in Newborns (RFA-DA-19-019) Neonatal abstinence syndrome (NAS) refers to a spectrum of withdrawal symptoms in newborns who were exposed to illicit or addictive substances in utero. Babies with NAS have higher rates of fetal anomalies (congenital malformations, growth restriction, ischemic placental complications) and perinatal issues (preterm delivery, poor feeding, sleep difficulties, diarrhea, seizures), which together raise the risk for adverse long term outcomes. Rates of NAS have skyrocketed during the last decade and estimates suggest that 5% of mothers use at least one addictive drug during their pregnancy. To address this public health crisis, multiple groups including the American College of Obstetrics and Gynecology and the American Academy of Pediatrics recommend universal screening of substance use in pregnancy using standardized behavioral scoring tools. Unfortunately, such tools are often biased due to subjective scoring or self-reporting errors, and fail to identify babies who did not receive proper prenatal care. Early identification of NAS is essential for referral of affected babies for interventions, including pharmacological treatments and behavioral/social support for the family. Select hospitals in Ohio and Texas are already engaged in universal toxicology based newborn screening (NBS) for NAS, and several state public health programs are evaluating feasibility to incorporate NAS screening into their standard NBS panels. While toxicology NBS for NAS is expanding in the U.S., several factors currently restrict the growth of such programs. These include: limited sensitivity and short history of exposure with existing tests for urine and blood samples, challenging methodologies for meconium sample processing, limited testing options for meconium samples, and long turnaround times for the few existing meconium tests. The potential consequences of delayed or otherwise insufficient NAS screening include increased errors and/or delays in pharmacologic treatments, high costs associated with unnecessary hospitalization, and increased risk for misdiagnosis. To combat these challenges, we propose a novel workflow that will enable rapid toxicology screening of urine or meconium samples in the hospital. Our system will pair a simple sample preparation protocol with a high sensitivity panel of homogeneous enzyme immunoassays recognizing five common classes of drugs: fentanyl, morphine, amphetamine/methamphetamine, cocaine, and benzodiazepines. The tests will be automated on an innovative digital microfluidic analyzer with a total time to result, including sample processing time, of under 2 hours. The product of this research meets the goals of RFA-DA-19-019 to develop “innovative methods to identify and treat newborns exposed to opioids” and will furthermore support the goals of the American Academy of Pediatrics to expand high sensitivity NAS screening. The potential benefits from implementation of our protocol include reduced length of hospitalization for unaffected newborns, accelerated time to confirmatory results, faster resolution of acute withdrawal symptoms, and improved referral to family/maternal support services.