Potential misclassification of a case of SIDS: Maternal and neonatal hair analysis for cocaine and heroin

Verification of illicit drug use by the mother during pregnancy is crucial when an attempt is made to correlate such exposure with fetal outcome. However, maternal report has been shown to be very inaccurate, and urine and blood testing for illicit drugs are positive only during the few days after their use [1]. Meconium testing is a very sensitive tool to detect in utero exposure to drugs; however, it has to be performed during the first days of life [2]. We have recently reported the sensitivity and specificity of hair analysis for intrauterine cocaine exposure; accumulation of cocaine in the hair is maintained for the life of neonatal hair [3]. We describe a case in which analysis of maternal and neonatal hair yielded important information about drug history, which was not elicited from the mother.