Subscribe to RSS
DOI: 10.1055/s-0041-1733781
Umbilical Cord Blood Use for Admission Blood Tests of VLBW Preterm Neonates: A Randomized Control Trial
Funding None.![](https://www.thieme-connect.de/media/ajp/202310/lookinside/thumbnails/10-1055-s-0041-1733781_210425-1.jpg)
Abstract
Objective Umbilical cord blood (UCB) for admission laboratories is an approach to decrease anemia risk in very low birth weight (VLBW) neonates. We hypothesized that UCB use results in higher hemoglobin concentration [HgB] around 24 hours of life.
Study Design A randomized control trial among VLBW infants whose admission laboratories were drawn from UCB (n = 39) or the infant (n = 41) in three U.S. military NICUs (clinicaltrials.gov#NCT02103296).
Results No demographic differences were observed between groups. UCB infants had higher [HgB] at 12 to 24 hours of life (15.5 vs. 14.0 g/dL, p = 0.02). The median time to first transfusion was 17 days longer in the experimental group (p = 0.04), and at discharge, their number of donor exposures was lower (1.1 vs. 1.8, p = 0.04).
Conclusion In the first 24 hours of life that is a period of higher risk for hemodynamic instability, UCB utilization for admission bloodwork in VLBW infants results in higher [HgB].
Key Points
-
Umbilical cord blood laboratory work in preterm infants is feasible.
-
Cord blood use for admission laboratories results in increased hemoglobin in the first 24 hours of life.
-
Cord blood use for admission laboratories delays time to first transfusion in preterm infants.
Keywords
umbilical cord blood - preterm infant - anemia of prematurity - hemoglobin - blood transfusionAuthors' Contributions
T.S.M. and A.C.P. conceptualized and designed the study and coordinated multisite recruitment. T.S.M., A.C.P., G.D.H., and J.B.S. participated in study enrollment. All authors participated in data analysis and interpretation as well as drafting, revisions, and approval of the manuscript.
Note
All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author. The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, Tripler Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Air Force and Army, Department of Defense or the U.S. Government.
Publication History
Received: 01 June 2021
Accepted: 23 June 2021
Article published online:
18 August 2021
© 2021. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Bishara N, Ohls RK. Current controversies in the management of the anemia of prematurity. Semin Perinatol 2009; 33 (01) 29-34
- 2 Lin JC, Strauss RG, Kulhavy JC. et al. Phlebotomy overdraw in the neonatal intensive care nursery. Pediatrics 2000; 106 (02) E19
- 3 Carroll PD, Widness JA. Nonpharmacological, blood conservation techniques for preventing neonatal anemia–effective and promising strategies for reducing transfusion. Semin Perinatol 2012; 36 (04) 232-243
- 4 Jansen M, Brand A, von Lindern JS, Scherjon S, Walther FJ. Potential use of autologous umbilical cord blood red blood cells for early transfusion needs of premature infants. Transfusion 2006; 46 (06) 1049-1056
- 5 Wong EC, Punzalan RC. Neonatal and pediatric transfusion practice. In: Fung M. ed. American Association of Blood Banks Technical Manual. Bethesda: AABB; 2017: 613-640
- 6 Ohls RK, Christensen RD, Kamath-Rayne BD. et al. A randomized, masked, placebo-controlled study of darbepoetin alfa in preterm infants. Pediatrics 2013; 132 (01) e119-e127
- 7 Christensen RD, Lambert DK, Baer VL. et al. Postponing or eliminating red blood cell transfusions of very low birth weight neonates by obtaining all baseline laboratory blood tests from otherwise discarded fetal blood in the placenta. Transfusion 2011; 51 (02) 253-258
- 8 Beeram MR, Loughran C, Cipriani C, Govande V. Utilization of umbilical cord blood for the evaluation of group B streptococcal sepsis screening. Clin Pediatr (Phila) 2012; 51 (05) 447-453
- 9 Carroll PD, Nankervis CA, Iams J, Kelleher K. Umbilical cord blood as a replacement source for admission complete blood count in premature infants. J Perinatol 2012; 32 (02) 97-102
- 10 Greer R, Safarulla A, Koeppel R, Aslam M, Bany-Mohammed FM. Can fetal umbilical venous blood be reliable source for admission complete blood count and culture in NICU patients?. Neonatology 2019; 115 (01) 49-58
- 11 Hansen A, Forbes P, Buck R. Potential substitution of cord blood for infant blood in the neonatal sepsis evaluation. Biol Neonate 2005; 88 (01) 12-18
- 12 Baer VL, Lambert DK, Carroll PD, Gerday E, Christensen RD. Using umbilical cord blood for the initial blood tests of VLBW neonates results in higher hemoglobin and fewer RBC transfusions. J Perinatol 2013; 33 (05) 363-365
- 13 Balasubramanian H, Malpani P, Sindhur M, Kabra NS, Ahmed J, Srinivasan L. Effect of umbilical cord blood sampling versus admission blood sampling on requirement of blood transfusion in extremely preterm infants: a randomized control trial. J Pediatr 2019; 211: 39-45.e2
- 14 La Gamma EF, Blau J. Transfusion-related acute gut injury: feeding, flora, flow, and barrier defense. Semin Perinatol 2012; 36 (04) 294-305
- 15 Patel RM, Kandefer S, Walsh MC. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Causes and timing of death in extremely premature infants from 2000 through 2011. N Engl J Med 2015; 372 (04) 331-340
- 16 Deputy NP, Kim SY, Conrey EJ, Bullard KM. Prevalence and changes in preexisting diabetes and gestational diabetes among women who had a live birth – United States 2012–2016. MMWR Morb Mortal Wkly Rep 2018; 67 (43) 1201-1207
- 17 Stevens W, Shih T, Incerti D. et al. Short-term costs of preeclampsia to the United States health care system. Am J Obstet Gynecol 2017; 217 (03) 237-248.e16
- 18 Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008; 371 (9606): 75-84