Potential use of autologous umbilical cord blood red blood cells for early transfusion needs of premature infants

BACKGROUND: This prospective study investigated whether the odds of receiving a red blood cell (RBC) transfusion in premature infants can be predicted at birth and for whom of these infants harvesting of umbilical cord blood (UCB) for autologous transfusion within 30 days after birth would be worthwhile. STUDY DESIGN AND METHODS: Characteristics were evaluated from 288 premature infants with a gestational age between 24 and 36 weeks and who were admitted to our neonatal center. In 144 (63%) of these infants UCB collection was attempted and the early transfusion needs could be compared with the amount of UCB available for transfusion. RESULTS: Sixty-nine of 114 (61%) inborn infants with a gestational age of less than 32 weeks received one or more RBC transfusions of 10 mL per kg within 30 days after birth. Apgar score at 1 minute of less than 6 and gestational age of less than 32 weeks were independently associated with the chance of receiving a transfusion in this group. In 31 of 69 (46%) infants, at least 15 mL of UCB per kg of birth weight was collected and in 28 of 69 (41%) this would have been sufficient to cover their early transfusion needs. CONCLUSION: The decision to collect UCB for postnatal transfusion can be made just after labor, based on Apgar score and gestational age. The collection of UCB is most effective and efficient for premature infants between 29 and 31 weeks of gestation. For infants less than 29 weeks of gestation, the technical aspects of UCB collection need improvement. This pilot study requires a prospective clinical study to evaluate the proportion of premature infants that can be fully or substantially supported with autologous UCB.