Feasibility of umbilical cord blood (UCB) collection in neonates at high risk of brain damage

Background:

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.

Study design:

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.

Preliminary Results:

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.

Conclusions:

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.