Neonatal Perinatal Medicine Fellow Penn State Health Children's Hospital Harrisburg, Pennsylvania, United States
Background: Fentanyl epidural infusions are standard of care for pain control during labor, but the ability of fentanyl to move from the maternal epidural space to fetal cord blood and newborn meconium has yet to be fully elucidated. Accurate identification of the source of opioid exposure in newborns allows for appropriate medical interventions and social support. Objective: The objectives of this prospective, observational study are to determine whether fetal exposure to maternal fentanyl, delivered via epidural analgesia during labor, can lead to a positive meconium drug test for fentanyl in infants, and if so, to determine whether a linear relationship exists between fentanyl dose delivered via maternal epidural and fetal accumulation by quantitatively evaluating levels of fentanyl in umbilical cord blood and meconium. Design/Methods: Male and female infants of >37 weeks’ gestation whose mothers received intrapartum epidural fentanyl analgesia were included. Quantitative evaluation of fentanyl levels in umbilical cord blood and newborn meconium was performed using High Performance Liquid Chromatography with tandem Mass Spectrometry (HPLC-MS/MS). Demographic information was collected with an online questionnaire. Spearman rank correlation, logistic regression, area under the curve (AUC) of receiver operating characteristic curves, and Kappa statistics were used for statistical analysis.
