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Feasibility of umbilical cord blood (UCB) collection in neonates at high risk of brain damage
20 September 2018 (online)
Therapeutic options for perinatal brain damage are limited. A new therapeutic approach is treatment with UCB cells. Evidence for stem cells as a potential intervention for neurological diseases is emerging. Collection of UCB in this critical-risk-group is organisationally and technically challenging. In emergencies the collection cannot be planned. In pre-term infants late cord clamping and anatomic conditions reduce the availability of UCB.
UCB should be collected from all high-risk-group neonates born 12/2017 – 12/2018. Four high-risk-groups are included: neonates with symptomatic hypoxemia, gestational age ≤30+0 weeks, intrauterine growth restriction (IUGR) and multiples with twin-twin transfusion syndrome (TTTS). Feasibility of the collection (successful patient enrolment, technical realization, puncture number and localisation) and quality of obtained blood (volume, sterility, cell-vitality) are assessed.
Aim of the study:
The aim of the study is to assess feasibility of UCB-collection in this critical-risk-group and to determine whether treatment options with autologous UCB for these infants exist.
36 neonates were enrolled (hypoxemia n = 4, IUGR n = 16, pre-term infants n = 16). 11 cases were missed due to team-intern coordination difficulties, immediate maternal/foetal life-threatening conditions or anatomical limitations. Additional UCB was collected from 7 neonates in initially critical clinical condition (shoulder dystocia, placental abruption, terminal bradycardia) and later discarded for not meeting the inclusion criteria of hypoxemia.
Collection and preparation of UCB in neonates at high risk of brain damage is challenging but possible. Extensive preparation and detailed team-briefings are necessary. The collection of UCB in critical cases requires a multidisciplinary approach.