Is it an option cord blood collection in preterm infants?

Recommendations of cord blood collection in preterm infants according to Netcord-FACT standards are split in 2 categories, if the procedure is performed while placenta is still in uterus:

  • For public banking, the procedure may be performed only if the pregnancy has a minimum of 34 weeks of gestation
  • For related/family banking, the procedure may be performed at less than 34 weeks’ gestation only “based on an evaluation of infant donor safety by the licensed health care professional responsible for the delivery”

Why is this slight nuance of differentiation in the recommendations of cord blood collection in preterm infants?

The main goal of cord blood public banking currently is to provide cord blood units for patients in need for a blood forming (hematopoietic)stem cells transplant, having one of the diseases included in the standard indications.

The list of standard indications for allogeneic blood forming (hematopoietic) stem cells transplant contains more than 70 diseases included in the following main categories: hematological malignancies, marrow failure, immunodeficiencies, hemoglobinopathies and certain inherited metabolic diseases.

For a donated cord blood unit to be suitable for usage as source of blood forming stem cells transplant it has to fulfill certain qualification criteria.

Volume of cord blood and especially the concentration of stem cells and progenitors in the unit, called generic total nucleated cells (TNC) have to reach a minimum threshold. For instance:

  • TNC has to meet a minimum of 25 million cells per kg of patient’s body weight.
  • Volume of collected cord blood has to be minimum of 70 ml

For cord blood collection in preterm birth these minimum qualification criteria are not possible to be fulfilled, especially since delayed umbilical cord clamping has to be applied for this category of infants.

Thus, during the 30 - 60 seconds following delivery, the preterm newborn receives an additional amount of umbilical cord blood which is associated with significant neonatal benefits.

In comparison with public banking, the recommendation for family banking takes into considerations the potential usage of cord blood unit for own or related cord blood therapeutic applications.  

Preterm children belong to category of infants with an increased risk for developing a cerebral palsy or developmental disability. For instance prevalence of cerebral palsy ranges from 35 to 79.5 cases in 1000 babies born between 28 and 31 weeks of gestation.

Laboratory and clinical studies conducted in recent years have provided a new perspective on therapeutic use of own umbilical cord blood for acquired brain disorders. From this perspective, preterm infants may benefits from the emerging field of stem cell therapy.

According to the results of study conducted by Jessica Sun and Joanne Kurtzberg on 93 preterm deliveries

cord blood collection is applicable (feasible) and may results in doses of total nucleated cells which are well above those  utilized in recent brain injury trials.

Compared to full term birth, it has been shown that preterm cord blood contains a higher concentration of blood forming lineage-committed cells, suggesting that cells with intermediate maturational stages may be highly mobilized early in fetal gestation.

Cord blood potency assessed by cell viability and capability to form new cells was also proved to be increased in preterm.

As a result, the option of cord blood collection in preterm infants is an important aspect to be taken into consideration by licensed health care professional responsible for the baby delivery.

 “Across 184 countries, the rate of preterm birth ranges from 5% to 18% of babies born

Every year, an estimated 15 million babies are born preterm (before 37 completed weeks of gestation), and this number is rising.” according to WHO (World Health Organization) in 2016

Sources:

  • 6th edition NetCord-FACT International Standards for Cord Blood Collection, Banking, and Release for Administration
  • Jessica Sun & al. “Preterm umbilical cord blood is enriched for progenitor cells” American Journal of Obstetrics & Gynecology Supplement to JANUARY 2016

 

 

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