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A premature delivery can be stressful and unsettling. Entering into parenthood in such a situation makes it difficult to stick to the prenatal plans for cord blood preservation. However, it’s especially important to prioritise a premature baby’s health and well-being. Here’s what new parents need to know about collecting their baby’s cord blood when the baby arrives early. Cord blood collected from a preterm baby may contain higher concentrations of certain primitive stem cell populations.
Cord Blood Banking: Reviving Hope
Parents may choose to save cord blood even during the challenges of a premature birth because of its unique biological properties. Umbilical cord blood is the blood left in the umbilical cord and placenta after a baby is born.
It is one of the richest, most readily available sources of Haematopoietic Stem Cells (HSCs), the primitive master cells of the human blood and immune systems, with the ability to mature into RBCs, WBCs, and platelets.
Umbilical cord blood stem cells have the potential to treat many life-threatening medical conditions, including:
- Blood Cancers: leukaemias, lymphomas
- Bone marrow failure syndromes: severe aplastic anaemia
- Inherited metabolic disorders
- Haemoglobinopathies: sickle cell disease and thalassaemia
- Immunodeficiency disorders
Amazing Preterm Cord Blood Quality
Many prospective parents show concern about cord blood collection from premature babies. Surprisingly, studies indicate that cord blood collected from preterm infants is of remarkably high quality.
In early foetal life, the haematopoietic stem cells actively migrate and circulate between the foetal liver, spleen, and developing bone marrow. Because premature babies are still in a phase of rapid cell growth, their cord blood may contain more primitive CD34+ stem cells per millilitre than cord blood from full-term babies. In lab tests, this early stem cell population in most preterm samples shows excellent colony-forming ability and rapid proliferation. [7] [8]
How is Preterm Cord Blood Collected?
Despite its obvious biological merit, collection of preterm cord blood involves a slew of questions regarding clinical safety. Collecting preterm birth cord blood is no different from that of full-term babies:
Maternal Health
A complicated delivery may often be associated with acute scenarios, such as placental abruption, severe maternal haemorrhage, or cord prolapse. The physicians focus on the health of the mother and the baby. Cord blood banking for premature babies in these cases would be “downgraded”, postponed, or cancelled entirely.
Neonatal Stabilisation
Neonates born early in gestation are physiologically vulnerable from the moment they are born. They are born with undeveloped lungs, body temperature drops precipitously, and they require rapid resuscitation and stabilisation. Neonatal Intensive Care Units (NICUs) are present at preterm deliveries to optimise these interventions.
Elective Activities
Parents can take comfort in knowing that a healthcare team’s decision to forego collection is always rooted in protecting the immediate well-being of mother and child.
Collection vs. Delayed Cord Clamping
The main concern with cord blood collection after preterm delivery is whether to delay cord clamping (DCC).
Major pediatric groups, including the American College of Obstetricians and Gynaecologists (ACOG), the American Academy of Paediatrics (AAP) and the World Health Organisation (WHO), recommend delayed cord clamping for eligible preterm infants, although the recommended duration varies by guideline and clinical circumstances. For the premature baby having some blood drawn immediately into their circulation is a “gift” of health benefits:
- Increased Blood Volume: A natural transfusion of the placental blood into the premature baby’s circulation can increase blood volume and haemoglobin levels.
- Reduced Transfusion Requirements: Delayed cord clamping may reduce the need for donor blood transfusions in the NICU.
- Decreased Risk of Necrotising Enterocolitis (NEC) and Intraventricular Haemorrhage (IVH): Significantly decreased risk of developing those two devastating conditions.
The Effect on Cord Blood Volume
When clamping is delayed, placental blood flows directly into the premature infant, leaving less in the cord and placental circulation to be collected. Literature suggests that a 60-second delay can leave 50% to 80% less blood behind for collection.
Preterm Collection Methods:
When clinical circumstances permit, the delivery team may use collection methods adapted to preterm deliveries.
- In Utero Collection: In this traditional method, cord blood is collected after the umbilical cord has been clamped and cut, while the placenta remains attached to the uterine wall.
Although this method is commonly used during full-term vaginal deliveries, space constraints within the sterile field may make collection challenging during an unplanned preterm delivery.
- Ex Utero Collection: Many obstetricians and maternal-fetal medicine specialists prefer to harvest UCB through an Ex Utero collection from a preterm delivery. If possible, following birth and delayed clamping:
- Doctors deliver the baby and take them directly to the pediatric or NICU team.
- During the third stage of labour, the obstetrician delivers the placenta.
- The placenta and attached cord are transferred to a sterile utility table, separate from the mother and child.
- A trained clinician or technician can collect the remaining cord blood from the umbilical vein using an appropriate sterile collection technique.
Ex utero collection lets healthcare professionals collect cord blood separately from emergency care for the newborn.
Additional Resources for Expectant Parents
- Most banks recommend ordering kits at 28-30 weeks. However, if preparing for a preterm birth, notify the bank to provide a collection kit by 24-26 weeks.
- Store the collection kit according to the cord blood bank’s instructions and ensure it is available when travelling to the hospital for delivery.
- Inform the doctor, the maternal-foetal medicine specialist, and the delivery team about plans for premature baby cord blood banking, provided clinical circumstances permit.
- Review the cord blood bank’s policies regarding low-volume samples. Select a family bank that will refund a pre-processed cost of collection if storage does not occur due to a unit being unsuitable for storage, due to medical conditions or an insufficient amount of blood.
Conclusion
During a premature birth, the primary focus of parents and healthcare providers is ensuring the health and safety of the baby. True health care balances cord blood collection after premature birth against the baby’s health. Early planning, open communication with healthcare providers, and a clear understanding of the process can help parents prepare for cord blood preservation while keeping their baby’s immediate health needs the priority.