Occult cocaine exposure in children
N. M. Rosenberg, K. L. Meert, S. R. Knazik, H. Yee and R. E. Kauffman
Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit 48201.
We determined the prevalence of cocaine and cannabinoid exposure among
young children presenting to an urban pediatric emergency department
without signs or symptoms suggestive of the exposure. The study included
460 children between 1 and 60 months of age in whom urinalysis was required
for investigation of routine pediatric complaints. Anonymously and without
informed consent, an aliquot of urine was screened for cocaine metabolite
(benzoylecgonine) and 11- or delta-9-tetrahydrocannabinol-9 carboxylic acid
with the enzyme multiplied immunoassay technique. Positive specimens were
rescreened with a radioimmunoassay and confirmed with gas
chromatography/mass spectrometry, if a sufficient quantity of urine was
available. Benzoylecgonine was identified in 25 patients (5.4%) by both
screening techniques. Enough urine was available for confirmatory testing
in eight patients, and all eight urine specimens contained benzoylecgonine.
Neither 11- nor delta-9-tetrahydrocannabinol-9 carboxylic acid was detected
in any patient. We documented the magnitude of the problem of occult
passive cocaine exposure in young children living in an urban environment.
Such exposure has serious implications for the assessment of outcomes in
postnatal follow-up studies of prenatally exposed children as well as
potential risks to children living in household environments where occult
cocaine exposure occurs.
