Background Exposure to psychoactive substances during childhood can have serious consequences in terms of physical and mental health. Despite the potential for significant morbidity and mortality, the epidemiological studies available in the literature are limited in number and sometimes yield inconsistent results. One possible method of investigating this phenomenon is the analysis of keratin matrices (head hair) in children. Materials and methods A retrospective observational study was performed on the results of chemico-toxicological analysis on hair of children under one year of age in the period 2018-2022. Toxicological analyses were carried at the Unit of Legal Medicine and Toxicology, University of Padova. Chemical-toxicological analysis on hair was conducted by UPLC- MS/MS with limit of quantification of 0.001 ng/mg hair for all analytes. After pseudonymization, gender, date of birth, date of sampling, age, requesting ward, and related request were collected in an Excel spreadsheet for each case. Hair were tested for illicit substances (Cocaine, Cannabinoids, Opiates/Opioids, Methadone, Ketamine, Amphetamines) and their metabolites. The cases included in the study were then subdivided into two groups according to the presence (Group 1) or absence (Group 2) of a suspicious clinical picture. Results The study sample included 102 cases (59 males - 57.8% and 43 females - 42.2%), with a mean age of 52.10 days, a median of 6 days, and a standard deviation of 83.43 days. The request for toxicological analysis was sent in 38 cases (37.3% - Group 1) for the presence of clinical suspicion (neuropsychiatric symptoms, epilepsy and/or unspecified paroxysms, neonatal withdrawal syndrome, other organic symptoms), and in 64 cases (62.7% - Group 2) for other reasons (maternal history of substance abuse, other circumstantial evidence, suspected family maltreatment, and previous positive results in another sample and/or analyzed matrix). Hair analysis in Groups 1 and 2 showed the presence of an illicit psychoactive substance in 44.7% and 67.2% of cases, respectively (p = 0.026). Cocaine and Opiates were the most frequently detected substances. They were less frequently detected in cases investigated for suspected clinical symptoms (p < 0.05). Conclusions The study contributes to the epidemiological analysis of a rarely investigated phenomenon on an international scale and provides insights for discussion in interpreting the data, including in relation to the symptomatic conditions experienced by the child. Hair analysis provides important information in the management of children in whom drug exposure is suspected; however, it should be implemented by a clinical evaluation, including family history and assessment of the living environment, in order to achieve the proper care and management of the patient aimed at protecting the patient's health and safety.
Presupposti dello studio L’esposizione in età pediatrica a sostanze psicoattive può avere gravi conseguenze in termini di salute fisica e psichica. Pur a fronte di possibili gravi conseguenze in termini di morbidità e mortalità, gli studi epidemiologici presenti in Letteratura sono numericamente esigui e con risultati talvolta non univoci. Tra le possibili modalità di indagine del fenomeno vi è l’analisi delle matrici cheratiniche (capello) del bambino. Scopo dello studio Lo studio ha l'obiettivo di condurre un'indagine epidemiologica sull'esposizione a sostanze stupefacenti in bambini di età inferiore ad un anno e indagare eventuali quadri sindromici correlati all'esposizione. Materiali e metodi È stato condotto uno studio osservazionale retrospettivo sui risultati delle analisi tossicologiche su capello eseguite dal Laboratorio dell'Unità Operativa Complessa di Medicina Legale e Tossicologia dell'Università di Padova dal 2018 al 2022 in bambini di età inferiore ad un anno. L'analisi chimico-tossicologica è stata condotta con la metodica UPLC - MS/MS e con limite di quantificazione (LOQ) di 0,001 ng/mg per ciascuna sostanza analizzata. Per ciascun caso, dopo pseudoanonimizzazione, sono stati raccolti sesso, data di nascita, data del prelievo, età, reparto richiedente e relativa richiesta in un foglio Excel. Su ciascun campione è stata condotta la ricerca delle sostanze di seguito elencate e dei relativi metaboliti: Cocaina, Cannabinoidi, Oppiacei/Oppioidi, Metadone, Ketamina, Amfetamine. I casi inclusi nello studio sono stati poi suddivisi in due gruppi in base alla presenza (Gruppo 1) o all'assenza (Gruppo 2) di un quadro clinico sospetto per esposizione a sostanze psicoattive. Risultati Lo studio è condotto su un campione di 102 casi (59 maschi- 57,8% e 43 femmine- 42,2%), con età media di 52,10 giorni, mediana di 6 giorni e deviazione standard di 83,43 giorni. La richiesta di analisi tossicologica è stata avanzata in 38 casi (37,3% - Gruppo 1) per presenza di un sospetto clinico (sintomi neuropsichici, epilessia e/o parossismi non altrimenti specificati, sindrome da astinenza neonatale, sintomi organici di altra natura) e in 64 casi (62,7%- Gruppo 2) per altri motivi (storia materna di abuso di sostanze, altri dati circostanziali, sospetto maltrattamento familiare e precedente positività su altro campione e/o matrice analizzata). L'analisi dei capelli nei Gruppi 1 e 2 ha mostrato la presenza di una sostanza stupefacente rispettivamente nel 44,7% e nel 67,2% dei casi (p = 0,026). Cocaina e Oppiacei sono state le sostanze più frequentemente rilevate. Esse sono state rilevate meno frequentemente nei casi investigati per sintomi clinici sospetti (p < 0,05). Conclusione Lo studio contribuisce all’inquadramento epidemiologico di un fenomeno complesso raramente studiato a livello internazionale e offre spunti di discussione nell’interpretazione del dato, anche in rapporto ai quadri sintomatologici sofferti dal bambino. L’analisi della matrice cheratinica fornisce importanti informazioni per la gestione dei bambini in cui vi è sospetta esposizione a sostanze stupefacenti; tuttavia, anche in caso di dimostrata esposizione dovrebbe essere implementata da una valutazione clinica, comprendente anamnesi familiare e valutazione dell’ambiente di vita, al fine di una adeguata presa in carico e gestione del paziente volta alla tutela della salute e sicurezza di quest’ultimo.
Sostanze stupefacenti su capello in bambini di età inferiore ad un anno. Studio casistico retrospettivo
RUSSO, ALESSIA
2022/2023
Abstract
Background Exposure to psychoactive substances during childhood can have serious consequences in terms of physical and mental health. Despite the potential for significant morbidity and mortality, the epidemiological studies available in the literature are limited in number and sometimes yield inconsistent results. One possible method of investigating this phenomenon is the analysis of keratin matrices (head hair) in children. Materials and methods A retrospective observational study was performed on the results of chemico-toxicological analysis on hair of children under one year of age in the period 2018-2022. Toxicological analyses were carried at the Unit of Legal Medicine and Toxicology, University of Padova. Chemical-toxicological analysis on hair was conducted by UPLC- MS/MS with limit of quantification of 0.001 ng/mg hair for all analytes. After pseudonymization, gender, date of birth, date of sampling, age, requesting ward, and related request were collected in an Excel spreadsheet for each case. Hair were tested for illicit substances (Cocaine, Cannabinoids, Opiates/Opioids, Methadone, Ketamine, Amphetamines) and their metabolites. The cases included in the study were then subdivided into two groups according to the presence (Group 1) or absence (Group 2) of a suspicious clinical picture. Results The study sample included 102 cases (59 males - 57.8% and 43 females - 42.2%), with a mean age of 52.10 days, a median of 6 days, and a standard deviation of 83.43 days. The request for toxicological analysis was sent in 38 cases (37.3% - Group 1) for the presence of clinical suspicion (neuropsychiatric symptoms, epilepsy and/or unspecified paroxysms, neonatal withdrawal syndrome, other organic symptoms), and in 64 cases (62.7% - Group 2) for other reasons (maternal history of substance abuse, other circumstantial evidence, suspected family maltreatment, and previous positive results in another sample and/or analyzed matrix). Hair analysis in Groups 1 and 2 showed the presence of an illicit psychoactive substance in 44.7% and 67.2% of cases, respectively (p = 0.026). Cocaine and Opiates were the most frequently detected substances. They were less frequently detected in cases investigated for suspected clinical symptoms (p < 0.05). Conclusions The study contributes to the epidemiological analysis of a rarely investigated phenomenon on an international scale and provides insights for discussion in interpreting the data, including in relation to the symptomatic conditions experienced by the child. Hair analysis provides important information in the management of children in whom drug exposure is suspected; however, it should be implemented by a clinical evaluation, including family history and assessment of the living environment, in order to achieve the proper care and management of the patient aimed at protecting the patient's health and safety.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/47413