596 - Evaluation of urine drug screens in siblings and household contacts of children testing positive for methamphetamine and fentanyl at a large tertiary children’s hospital

Poster Number: 596
Publication Number: 596.103

Natalie Laub, University of California, San Diego School of Medicine, San Diego, CA, United States; Sara Kruczek, University of California at San Diego, San Diego, CA, United States; Mario Bialostozky, Rady Children's Hospital San Diego/University of California, San Diego, San Diego, CA, United States; Andrew C. Richardson, Rady Children's Hospital San Diego, San Diego, CA, United States; Karen Yaphockun, Rady Children's Hospital San Diego, San Diego, CA, United States

Background: Use of illicit drugs such as fentanyl has increased among adults in the past 10 years. Drug overdoses are now the leading cause of death for adults aged 18-45. As the number of adults using drugs continues to rise, so does the number of children accidentally ingesting illicit drugs.  Prior research has focused on trends or case reports of children with illicit drug exposure. There are no studies looking at the prevalence and symptoms of child household contacts who test positive for illicit drugs when there is a known drug positive child in the home. We aim to address this gap in the literature by studying a cohort of drug endangered children and their household contacts.

Objective: To understand presentations of siblings and household contacts who subsequently test positive for methamphetamine and/or fentanyl when an index child is identified and positive for one of these drugs.

Design/Methods: This was a retrospective cross sectional study of children less than 10 years who had positive urine drug screen for methamphetamine and/or fentanyl within a children’s hospital network from 2012-June 2022. Cases were excluded when confirmatory
testing was unavailable or positive test results were from birth. Data collected included demographics, reason for visit,  symptoms, drug screen results, and sibling information. We used descriptive statistics to analyze our dataset.

Results: Fifty children were positive for fentanyl.  Of these, 56% were male, the mean age was 2.6 years and 53% were non-Hispanic White. Seventy-five percent of children who tested positive for fentanyl were brought to care as a household contact of a child who was confirmed positive. In this fentanyl cohort, 60% were asymptomatic. Of the children with respiratory or cardiac arrest 32% never received naloxone. Regarding methamphetamine, the confirmed positives was 154. Of these 59% were male, the mean age was 2.3 years and 51% identified as white-Hispanic. Fifty-six percent of children were brought to care because they were a household contact of a child who tested positive. Of this household contact cohort 90% were asymptomatic.

Conclusion(s): In our cohort of children, the majority who tested positive were household contacts of a known positive index child. Most of this cohort were asymptomatic. This highlights the importance of a rapid evaluation of all child household contacts when a child in
the home has tested positive, even in the absence of clinical symptoms. Continued education regarding naloxone administration in young children with sudden cardiac or respiratory arrest is important