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Using umbilical cord blood for the initial blood tests of VLBW neonates results in higher hemoglobin and fewer RBC transfusions

Journal of Perinatology volume 33, pages 363–365 (2013)Cite this article

Subjects

Abstract

Objective:

We previously described a method for reducing early phlebotomy losses from very low birth weight (VLBW) neonates by obtaining the initial blood tests from otherwise discarded fetal blood from the placenta. In the present study we sought to; (1) measure the feasibility of performing this method in actual practice, (2) test the hypothesis that this method would result in higher hemoglobin concentrations and lower erythrocyte transfusion rates in the first week after birth.

Methods:

We conducted two studies in three Intermountain Healthcare NICUs. The first was a feasibility analysis involving 96 VLBW neonates, measuring the success of obtaining the NICU admission laboratory blood tests this way. The second study used case–control methodology to test the hypothesis that this method would result in a higher blood hemoglobin 12 to 24 h after birth, and a lower proportion receiving an erythrocyte transfusion in the first week.

Result:

In 91 of 96 VLBW neonates (95%) the initial blood tests were successfully obtained with this method. The success rate was not diminished by delayed cord clamping or cord milking, as it was successful in 35 of 36 (97%) such instances. Cases and controls were well matched on demographic and level of illness comparisons. Among cases the hemoglobin generally increased between birth and 12 to 24 h later, but among controls the hemoglobin generally decreased (P<0.05). In the week following birth fewer cases received vasopressors (P<0.01) and erythrocyte transfusions (P<0.001).

Conclusion:

We judge that it is feasible to collect the initial blood tests of VLBW neonates using otherwise discarded umbilical cord/placental blood, in that this can be accomplished in about 95% of VLBW deliveries. This method, which can be used in addition to either delayed clamping of the umbilical cord or cord milking, results in higher hemoglobin concentrations, less vasopressor use and fewer transfusions in the first week.

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Acknowledgements

We thank Sarah J Ilstrup, MD, Director of Clinical Pathology and Director of Transfusion Medicine, Intermountain Healthcare, and Sterling T Bennett, MD, Central Laboratory Medical Director, Intermountain Healthcare, for their encouragement, advice and assistance with these studies.

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Authors and Affiliations

  1. The Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA

    V L Baer, D K Lambert, P D Carroll, E Gerday & R D Christensen

  2. McKay-Dee Hospital Center, Ogden, UT, USA

    V L Baer, D K Lambert & R D Christensen

  3. Dixie Regional Medical Center, St George, UT, USA

    P D Carroll

  4. Utah Valley Regional Medical Center, Provo, UT, USA

    E Gerday

Authors
  1. V L Baer
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  2. D K Lambert
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  3. P D Carroll
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  4. E Gerday
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  5. R D Christensen
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Correspondence to R D Christensen.

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The authors declare no conflict of interest.

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Supplementary Information accompanies the paper on the Journal of Perinatology website

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Baer, V., Lambert, D., Carroll, P. et al. Using umbilical cord blood for the initial blood tests of VLBW neonates results in higher hemoglobin and fewer RBC transfusions. J Perinatol 33, 363–365 (2013). https://doi.org/10.1038/jp.2012.127

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