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Objective <p>To determine whether fetal exposure to maternal epidural fentanyl can result in a positive meconium drug test.</p> Study design <p>Quantitative evaluation of fentanyl levels in cord blood and meconium of infants ≥37 weeks whose mothers received epidural analgesia was performed using High Performance Liquid Chromatography-tandem Mass Spectrometry. The association between dose and duration of maternal epidural and fentanyl levels in cord blood and meconium was evaluated.</p> Results <p>In 298 mother-infant dyads, median duration of fentanyl epidural was 6.8 hours. There was a strong positive correlation between epidural duration and fentanyl levels in meconium (Spearman rho = 0.70, 95%CI [0.64-0.76]), <i>p</i> &lt; 0.001). Positive predictive value for fentanyl detection in meconium &gt;0.05 ng/g for epidural exposure of &gt;4 hours was 93.9%.</p> Conclusion <p>There is a strong positive correlation between maternal epidural duration and fentanyl in meconium. Providers can anticipate a positive meconium drug screen for fentanyl in the setting of a maternal epidural.</p>

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Prospective observational study quantifying maternal-fetal fentanyl transmission in epidural analgesia infusion using umbilical cord blood and neonatal meconium

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月18日

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  • Nanyaly M. Santiago-Aponte,
  • Dongxiao Sun,
  • Tonya S. King,
  • Tammy E. Corr

摘要

Objective

To determine whether fetal exposure to maternal epidural fentanyl can result in a positive meconium drug test.

Study design

Quantitative evaluation of fentanyl levels in cord blood and meconium of infants ≥37 weeks whose mothers received epidural analgesia was performed using High Performance Liquid Chromatography-tandem Mass Spectrometry. The association between dose and duration of maternal epidural and fentanyl levels in cord blood and meconium was evaluated.

Results

In 298 mother-infant dyads, median duration of fentanyl epidural was 6.8 hours. There was a strong positive correlation between epidural duration and fentanyl levels in meconium (Spearman rho = 0.70, 95%CI [0.64-0.76]), p < 0.001). Positive predictive value for fentanyl detection in meconium >0.05 ng/g for epidural exposure of >4 hours was 93.9%.

Conclusion

There is a strong positive correlation between maternal epidural duration and fentanyl in meconium. Providers can anticipate a positive meconium drug screen for fentanyl in the setting of a maternal epidural.