OCCULT COCAINE AND OPIATE EXPOSURE IN CHILDREN AND ASSOCIATED PHYSICAL FINDINGS

We determined the prevalence of cocaine and opiate exposure and the as sociation of exposure with objective physical findings in children pre senting to an urban pediatric emergency department. The study included 942 children between one and 60 months of age who required urinalysis for investigation of their chief complaint, Anonymously and without i nformed consent, urine was screened for benzoylecgonine (BE) and opiat es, using an enzyme multiplied immunoassay technique (EMIT) with sensi tivity of 50 ng/ml, EMIT-positive samples were rescreened using a fluo rescence polarization immunoassay (FPIA), Specimens positive by both E MIT and FPIA were confirmed by gas chromatography/mass spectrometry (G C/MS) if sufficient quantity of urine was available. BE was identified in 41 (4.4%) and opiates in 46 (4.9%) patients by both EMIT and FPIA, The presence of BE or opiate was confirmed by GC/MS in all 34 cases w here sufficient urine was available, The age- and sex-adjusted systoli c and diastolic blood pressure percentiles were greater, and head circ umference and weight percentiles were lower in BE-positive patients co mpared to those with negative drug screens, There were no associations between opiate exposure and any of these variables. We conclude that occult postnatal cocaine exposure is associated with measurable physic al and physiologic differences.