Ml Of Cord Blood Research Articles

Determining the Correlation between Cord Blood Lipid Profile and Birth Weight among Term Babies

Aims: This study aimed to examine the association between cord blood lipid levels and neonatal birth weight.
 Study Design: Hospital based prospective cross-sectional study.
 Place and Duration of Study: Study was conducted in Government medical College Nagpur, a tertiary care hospital that provides maternal and child health services between June 2011 to March 2013
 Methodology: We enrolled 200 healthy pregnant women who attended antenatal clinics in our hospital. We collected 5 mL of cord blood from the umbilical vein and measured the serum levels of total cholesterol, triglycerides, HDL cholesterol, and LDL cholesterol using spectrophotometric methods. We calculated LDL cholesterol using Friedewald’s formula, and we measured anthropometric parameters using standard methods.
 Results: Neonates with SGA had significantly lower birth weight (2.24 ± 0.3 vs 2.83 ± 0.4; P < 0.01), head circumference (31.5 ± 1.5 vs 33.4 ± 1.8; P < 0.04), recumbent length (51.2 ± 0.3 vs 53.6 ± 0.2; P < 0.04), and Ponderal Index (2.24 ± 0.5 vs 2.35 ± 0.2; P < 0.03) than AGA babies. The cord blood lipid profile levels were also significantly lower (P < 0.001) in AGA than SGA babies. There was a positive correlation between birth weight and total cholesterol (r = 0.31; P < 0.001) and triglycerides (r = 0.46; P < 0.001), and a small positive correlation between birth weight and HDL cholesterol (r = 0.157; P = 0.013).
 Conclusion: SGA babies had significantly higher cord blood lipid profile levels than AGA babies. The lipid profile of umbilical cord blood is related to the fetal nutritional status and growth and development. This may have implications for the prevention and management of low birth weight and its associated complications

Comparison Between Maternal Blood Glucose and Fetal Cord Insulin Level Among Gestational Diabetes Mellitus Women

Introduction: Offspring of gestational diabetes mellitus (GDM) mothers are at high risk of developing insulin resistance, type 2 diabetes mellitus (T2 DM), and cardiovascular complications later in life. So, screening maternal blood glucose during pregnancy and identifying high-risk infants immediately after birth is necessary to prevent the potential long-term implications. Aim: To correlate the maternal fasting and post-prandial blood glucose withfetal insulin level. Materials and methods:A case-control study, was conducted at Chettinad Hospital and Research Institute, India, between May 2019 to May 2020. A 75-gram OGTT was performed among pregnant women between 24 to 28 weeks of pregnancy for diagnosing GDM according to American Diabetes Association (ADA) guidelines. 94 GDM mothers and Non-GDM mothers and theirnew-bornswere taken up for this study. 2.5ml of maternal venous blood was collected in a vacutainer containing sodium fluoride and EDTA as an anticoagulant for FBS and PPBS estimation. Some mothers on induction of labor were posted for emergency LSCS (for failed induction and non - progression of labor) and some had normal vaginal deliveries. Plasma FBS and PPBS estimation in the mother’s blood sample was assayed by the Hexokinase method in Siemen'sDimension RxLMachine immediately after centrifugation. 2.5ml of umbilical cord blood was collected in a vacutainer without an anticoagulant after the 2nd stage of labor. 0.5 ml of cord blood serum was separated and stored at -80°C in an eppendorf for later estimation of insulin by CLIA method in Beckman Coulter – Access 2 Immunoassay System. Independent students’ t-tests and Pearson’s correlation were used as statistical methods. p-value <0.05 is considered significant. Results: There is a positive correlation and significant difference between maternal FBS, PPBS, and fetal insulin levels in the GDM group (p-value 0.008, r-value 0.272 and p-value 0.005, r-value 0.286) compared to the Non-GDM group (p-value -0.087, r-value 0.243 and p-value 0.018, r-value 0.212). Conclusion: Significant hyperinsulinemia was noted in the offspring of the GDM group compared to the NON-GDM group.Those hyper-insulinemic babies are at very high risk of developing obesity, metabolic syndrome, and type 2 DM in the future and possess a threat to society.

An Indian perspective for umbilical cord blood haematological parameters reference interval

BackgroundThe Haematological Reference Intervals (RIs) are prone to vary on the basis of various factors such as altitude, age, sex, socioeconomic status, etc. These values play a major role in laboratory data interpretation and determine the necessary clinical treatment. Currently, India has no well–established RI for cord blood haematological parameters of newborns. This study aims to establish these intervals from Mumbai, India.MethodA cross sectional study was conducted in a tertiary care hospital of India from October 2022 to December 2022 on healthy and term neonates having normal birth weight and born to healthy pregnant mothers. About 2 – 3 mL of cord blood was collected from the clamped cord into EDTA tubes from 127 term neonates. The samples were analysed in the haematology laboratory of the institute and the data was analysed. The upper and lower limits were determined using non-parametric method. The Mann–Whitney U test was used to compare the distribution of the parameters between sex of infant, modes of deliveries, maternal age and obstetric history. P value less than 0.05 was considered to declare statistical significance.ResultThe median values and 95% RI for umbilical cord blood haematological parameters of newborns were as follows: WBC = 12.35 [2.56–21.19] × 109/L, RBC = 4.34 [2.45–6.27] × 1012/L, HGB = 14.7 [8.08–21.44] g/dL, HCT = 48 [29–67]%, MCV = 109.6 [59.04–159.1] fL, MCH = 34.5 [30.54–37.79] pg, MCHC = 31.3 [29.87–32.75] %, PLT = 249 [16.97–479.46] × 109/L,LYM = 38 [17–62] %, NEU = 50 [26–74] %, EOS = 2.3 [0.1–4.8] %, MON = 7.3 [3.1–11.4], BAS = 0 [0–1]. This study found no statistically significant difference between sex of infants, except MCHC, and obstetric history. A significant difference was observed in WBC, EOS% and absolute NEU, LYM, MON and BAS by delivery type. A higher platelet count and absolute LYM was observed in the cord blood compared to venous blood.ConclusionsFor the first time, haematological reference intervals in cord blood were established for newborns in Mumbai, India. The values are applicable for newborns from this area. Larger study throughout the country is required.

A cross-sectional study of reticulocyte count and hemoglobin content of umbilical cord blood with relation to maternal factors in newborns of Sikkim

Background: The hematological values of the new born is amenable to certain changes under the influence of fetal, maternal, and environmental factors. Aims and Objectives: The aims of this study was to study the effect of maternal factors on hemoglobin content and reticulocyte count in umbilical cord blood of newborns of Sikkim. Materials and Methods: A total of 150 cord blood samples from newborns delivered at CRH Hospital and STNM Govt. Hospital, Gangtok, Sikkim were analyzed. Two ml of cord blood was taken in an ethylene diamine tetra acetic acid tube under aseptic condition and within 6 h: Hemoglobin estimation and Reticulocyte count was done. Results: The mean reticulocyte count was 2.48 ± 0.87% in normal vaginal delivery (NVD) and in C/S was 3.06 ± 0.97%. The mean hemoglobin content was 13.9 ± 2.6 g/dL in NVD and in C/S was 16.1 ± 3.4 g/dL. P < 0.05 for cord hemoglobin and reticulocytes in relation to mode of delivery was found to be highly significant. The mean reticulocyte count was 2.85 ± 1.0% in normal pregnancy and in complication of pregnancy was 2.9 ± 0.70%. The mean hemoglobin content was 15.36 ± 3.31 g/dL in normal pregnancy and in complication of pregnancy was 16.1 ± 3.4 g/dL. The reticulocyte count was found to be statistically significant in relation to complication of pregnancy. The mean mother’s hemoglobin was 11.16 ± 1.27 when cord hemoglobin content was <14 g/dL and was 11.88 ± 1.24 g/dL when cord hemoglobin content was >14 g/dL. There was statistical significance between the cord hemoglobin content and the hemoglobin content of the mother. Conclusion: Maternal anemia leads to lower circulating hemoglobin in new born. Cord blood screening is a useful means for identification of anemia in neonatal period. High reticulocyte count in neonates denotes active erythropoiesis which might help to defer transfusion unless there were other special reasons for proceeding.

Relationship between Maternal and Cord Blood Iron Status in Women and their New Born Pairs

Maintaining iron homeostasis is of great importance to the growing fetus and neonates. There is no consensus as to whether the neonates iron status is determined by fetal demands or by maternal iron status. There is no conclusive data confirming the likelihood of neonates born to anemic mothers suffering from compromised iron status. Therefore the aim of our study was to evaluate the relationship of iron indices between maternal and cord blood collected from mother and infant pairs and explore the association of maternal anemia on the iron status indicators of the cord blood. This prospective study included 60 mother and newborn pairs. The study population was subdivided as anemic and non-anemic groups based on hemoglobin (Hb) levels. The maternal venous blood samples were collected 1.5 h ± 20 min before the delivery. 5 ml of cord blood was collected soon after child birth. Samples were analyzed for hemoglobin (Hb), serum ferritin and iron. Significantly lower values of Hb, Ferritin, iron (p < 0.05) was observed in neonates born to anemic mothers when compared to the indices of neonates born to non-anemic mothers. On multivariate linear regression analysis , maternal Hb showed positive linear correlation with cord Hb and ferritin (r =0.87, p<0.05). However, correlation between maternal Hb and cord iron was not significant. Maternal anemia can effect neonatal iron stores. Lowered concentration of iron status indicators in cord blood of neonates born to anemic mothers indicates that fetal iron transfer may be dependent on that of the iron stores of the mothers. However, this process may involve complex factors.

The prevalence of Vitamin D deficiency in pregnancy and neonatal outcomes

Introduction: Vitamin D is an essential fat-soluble vitamin and has multiple functions. It affects calcium metabolism, modulates the immune system, cell proliferation, and differentiation. Objective: To study the prevalence of vitamin D deficiency in pregnant women and neonatal outcome in a tertiary care hospital, to study the association between maternal vitamin D and medical disorders, and to correlate maternal vitamin D deficiency with neonatal vitamin D levels and neonatal outcomes. Materials and Methods: This cross-sectional and observational study was conducted over a period of one year on 355 antenatal women admitted for safe confinement. 4 ML of whole blood was collected from median ante-cubital fossa and vitamin D levels were assessed using ELFA [Enzyme Linked Fluorescent Assay] following delivery, and 2ml of cord blood was also collected and sent for Vitamin D levels. R esults: Out of the total study population, 12.96% (46) had adequate levels of vitamin D, the majority - 74.65% (265) had insufficient vitamin D levels, and 12.39% (44) had severe vitamin D deficiency. The overall deficiency among neonates was 95.22%. No significant association was found between vitamin D deficiency and maternal complications, except for the mode of delivery which was statistically significant with a P-value of 0.04. Conclusion: This study reaffirms that vitamin D deficiency is on the increase and therefore needs intervention by biochemical screening and corrective measures during pregnancy.

Gestational impaired glucose tolerance (GIGT)-induced suppression of fetal thyroid secretion: effect on fetal outcome

Introduction: Gestational impaired glucose tolerance (GIGT) is a milder form of gestational diabetes mellitus (GDM), which is often poorly managed. Although, GDM is known to be associated with increased incidence of thyroid dysfunction, no study has been done to study the effect of GIGT on thyroid status and its effect on fetal outcome. Here, we carried out a study to assess thyroid function and glycemic status in both maternal and cord blood of the subjects with GIGT, and to find their association with the fetal outcome.Materials and methods: Women who came to the hospital for safe confinement during 37–40th weeks of gestation were recruited in the study. Based on the 2 hours post prandial blood glucose levels with 75 grams OGTT, done at 24–28 weeks of gestation, all the subjects were stratified into two groups: (1) Cases or GIGT group – women with blood glucose levels between 120 and 140 mg/dl and (2) Controls – women with blood glucose levels of less than 120 mg/dl. Three milliliters of venous blood was collected from mothers and 3 ml of cord blood was collected during delivery. New-borns were assessed for birth weight, head circumference, abdominal circumference, thigh circumference, and crown-heel length. Glycated hemoglobin was carried out using immunoturbidimetry (DiaSys Diagnostic Systems GmbH, Holzheim, Germany) and fructosamine was estimated using dye binding method (Biosystems, Spain). Estimation of total T3 (TT3), free T3 (FT3), total T4 (TT4), free T4 (FT4), and TSH was done by chemiluminescence in Siemens Advia Centaur CP using competitive immunoassay.Results: Although within the normal reference range, GIGT mothers had higher concentration of free and total T4 than controls. Cord fructosamine levels were significantly higher in babies of GIGT mothers than controls, indicating the reflection of maternal hyperglycemia. There was a positive correlation between the maternal glycated hemoglobin and cord blood fructosamine in the GIGT group. Statistically significant lower levels of total T3 and T4 with high TSH levels were found in babies with GIGT mothers, indicating the suppressive effect of maternal hyperglycemia on fetal thyroid function. Birth weight, head circumference, and thigh circumference were significantly higher in babies born to mothers with GIGT, which may be a combined effect of maternal hyperglycemia and fetal thyroid suppression.Conclusions: Maternal hyperglycemia, even in milder form of GIGT may cause suppression of fetal thyroid function. Both these factors may predispose to change in fetal anthropometry, leading to a large baby. Therefore, it is recommended to evaluate maternal and cord thyroid function for timely management strategies.

Antioxidant Levels in Cord Blood of Term Neonates and Its Association with Birth Weight.

Due to excessive production of free radicals and antioxidants evolved mechanisms against oxidative stress, infants are very vulnerable. As there was a significant relation between antioxidant levels and birth weight, we aimed verify this relationship. In this descriptive analytical study we evaluated the antioxidant status of 40 healthy term newborns (gestation age 38-42 wk) with weight >2500 g (AGA) and 40 healthy term newborns (gestation age 38-42 wk) with LBW babies (weight < 2500 g) (SGA) in Ardabil Buali Hospital, Ardabil, northwest Iran in 2014. About 15 Ml of cord blood was collected after the second stage of labor. The levels of vitamin A, E, and C, catalase, glutathione peroxidase (GPX), bilirubin and serum uric acid were measured by standard methods. Informed consent was obtained from newborn mothers and study protocol was approved by university Ethics Committee. Data were analyzed using SPSS.19. The mean levels of bilirubin, vitamin C, E, catalase and GPX in AGA group were significantly higher than SGA group but the mean of serum uric acid in SGA group was more than AGA. In addition, the mean of vitamin A was similar in two groups. There was a significant relation between antioxidant levels and birth weight in term newborns. In line with other studies the amounts of antioxidant levels except serum uric acid in AGA group was significantly more than SGA group.

Plasma-depleted versus red cell-reduced umbilical cord blood.

Umbilical cord blood banks use two methods to store frozen umbilical cord blood (UCB): red cell reduction (RCR) or plasma depletion (PD). The RCR method centrifuges cord blood in hetastarch or albumin to isolate 21 ml of cord blood containing mostly white blood cells, adds 4 ml of 50% dimethyl sulfoxide (DMSO), and then freezes the resulting 25 ml of cell suspension. The PD method removes plasma, saves all the cells, and freezes the cells in 10% DMSO. PD UCB units are cheaper to process but more expensive to store and somewhat more troublesome to thaw. However, when properly thawed and washed, PD UCB units have as many or more total nucleated cells (TNCs), CD34(+) cells, and colony-forming units (CFU) than RCR units. Two studies suggest that PD units have 20-25% more TNCs, MNCs, and CD34(+) cells, as well as two to three times more CFU than RCR units. Higher TNC, CD34(+), and CFU counts predict engraftment rate with faster neutrophil and platelet recovery. PD units have high engraftment rates with low mortality and high disease-free survival, comparable with clinical results of treatments with RCR units. One recent series of studies suggests that PD units are more effective for treating thalassemia with 2-year survival rates of 88%, disease-free survival rates of 74%, and 100% cure rate for children under age 7, compared to only 61% overall survival and 23% disease-free survival rate in thalassemic children treated with RCR units. These findings suggest that PD units not only have more TNCs, CD34(+) cells, and CFU than RCR units but also have high engraftment rates and may be more effective for treating certain conditions such as β-thalassemia.

Transfuse Neonates with Cord Blood-Derived Red Blood Cells: A Feasibility Study to Assess Allogeneic Cord Blood Unit Fractionation and Validation

AbstractAbstract 275Newborns are currently transfused with RBCs from adults, which mainly contain adult hemoglobin (HbA). HbA has a lower affinity for oxygen than fetal hemoglobin: therefore adult red cell transfusion could be responsible for increased oxygen increasing the risk of the “oxygen radicals disease of the newborn”. Autologous umbilical cord blood has been suggested as the only alternative source of blood for newborn transfusions. Previous studies, however, demonstrated that autologous cord blood transfusions in newborns are not sufficient to entirely cover the early neonatal blood requests. We reported the preliminary results of our study carried out to assess the feasibility of an allogeneic cord blood (ACB) transfusion program for prematures in terms of preparation and yield of valid ACB red blood cell (RBC) units. ACB units collected at the Cord Blood Bank but not suitable for processing and storage for allogeneic transplant cord blood were evaluated. Eligible criteria for cord blood collection were: more than 37 weeks of gestation, absence of mother’s infection or fever 24 hours before the delivery, no stain of the amniotic fluid. ACB units eligible for our study contained more than 60 mL of cord blood, with no clots or hemolysis. We prepared buffy coat–depleted ACB RC units by automated separation (Compomat G4®, Fresenius HemoCare, Germany) in a processing set (Compoflex®). Suspension in SAG-mannitol and post-storage filtration was performed to obtain a leukocyte-depleted red cell unit. Resuspended units were stored for fourteen days after manipulation (2–6°C). Cultures for bacterial contamination were performed immediately after manipulation and after 14 days; biochemical determination (LDH, glucose, lactate, potassium, chloride, sodium, pH and pO2) were performed the day of fractionation (=0) and after 7 and 14 days of storage. Biochemical data were also compared to the same parameters obtained from adult red blood cell concentrates. We collected 76 ACB units. Thirty-three were discharged for insufficient volume or clots. The median collection volume of the 43 remaining units was 92.3 (± 18.3) ml. After fractionation, 43 ACB RC units were obtained with a median volume of 31.2 (± 8.2) ml and a median hematocrit of 59 ± 2%. Microbial contamination was absent in all units after manipulation and after 14 days; viral tests carried out on mother’s blood at the time of cord blood collection were negative. Biochemical parameters maintained rather well up to 14 days of storage, but less resistant than adult red cells. Our data highlight that ACB is a promising source of RBC for transfusion in preterm infants. Besides the reduction of waste of not validated ACB units collected in the Cord Blood Bank, transfusional utilization of ACB RBC can overcome several problems of autologous cord blood transfusion: insufficient volumes is less frequent in ACB from term newborns and the incidence of clots, which is one of the more frequent cause of ineligibility of cord blood units, is substantially reduced when collection is performed by trained staff, in term neonates and using adequate blood shakers. Microbial contamination is prevented by adopting the strict eligibility criteria and the adequate aseptic collection technique adopted in the Cord Blood Bank. In conclusion, the preparation of transfusionally valid RCs from ACB is possible and convenient. Clinical studies are needed to evaluate the efficacy and safety of this new transfusion practice. Disclosures:No relevant conflicts of interest to declare.

Determination of reference ranges for full blood count parameters in neonatal cord plasma in Hilla, Babil, Iraq

BackgroundThe health of an individual is known to vary in different countries, in the same country at different times, and in the same individuals at different ages. This means that the condition of individuals must be related to or compared with reference data. Determination of a reference range for the healthy term newborn is clinically important in terms of various complete blood count parameters. The purpose of this study was to establish a local reference range for full blood count parameters in neonatal cord plasma in Hilla, Babil, Iraq.MethodsA total of 220 mothers and their neonates were enrolled in this cross-sectional study from February 2011 to January 2012. Maternal inclusion criteria were age 15–45 years, an uneventful pregnancy, and hemoglobin ≥ 10 g. Neonatal inclusion criteria were full term (37–42 weeks) and normal birth weight. The umbilical cord was immediately clamped after delivery of the baby; 3 mL of cord blood was then taken from the umbilical vein and collected in a tube containing ethylenediamine tetra-acetic acid, its plasma was analyzed for full blood count parameters by standard Coulter gram, and the differential leukocyte count was done manually.ResultsMean neonatal hemoglobin was 13.88 ± 1.34 (range 11–17.3) g/dL and mean white cell count was 10.12 ± 2.8 (range 3.1–21.6) × 109/L. Mean platelet count was 267.63 ± 60.62 (range 152–472) × 109/L. No significant differences in red cell, white cell, or platelet counts were found between males and females, except for neutrophil count. The current study shows lower levels of hemoglobin, white cells, and red cells compared with other studies, and there is agreement with some studies and disagreement with others concerning platelet count.ConclusionMost results in the current study were within the reference range. The hematological reference values for Iraqi neonatal cord plasma need to be confirmed by larger numbers of blood samples and by collecting samples from different areas in Iraq.

750 Determining the Mean Cord Blood Immature Platelet Fraction (IPF) of Healthy Newborns

Thrombocytopenia is the most common hematologic abnormality in newborn infants Immature platelet fraction (IPF) shows megakaryopoetic activity. The purpose of this study is to provide non-invasive new approach to thrombocytopenic...

Preimplantation genetic diagnosis for HLA typing in a case of X‐linked chronic granulomatous disease

Bone marrow transplantation may be life saving in cases of hematopoietic disease, severe congenital immunodeficiency or malignancy. An HLA-matching sibling often gives the best success, but this may not be an option, nor may an HLA-matching unrelated donor be found. Preimplantation genetic diagnosis with HLA-matching embryos may then be a solution. We report the first Danish child born after such diagnosis with identification of healthy embryos and HLA matching for a sibling with chronic granulomatous disease. Our patient had 13 in vitro fertilization (IVF) cycles; 286 oocytes were collected and 74 embryos analysed. Sixteen of these (22%) were either healthy or carriers. Five embryos were transferred in four stimulated fresh IVF cycles. Four embryos were frozen, and two were later transferred. Two successive clinical pregnancies ensued. In the first, prenatal diagnosis revealed trisomy 21, and the fetus was aborted. In the second pregnancy, chorionic villus sampling revealed a normal karyotype, the diagnosis was confirmed, and the pregnancy was normal. At delivery, 82 mL of cord blood was collected for later transplantation to the diseased sibling.

Efficient Reprogramming of Human Cord Blood CD34+ Cells Into Induced Pluripotent Stem Cells With OCT4 and SOX2 Alone

The reprogramming of cord blood (CB) cells into induced pluripotent stem cells (iPSCs) has potential applications in regenerative medicine by converting CB banks into iPSC banks for allogeneic cell replacement therapy. Therefore, further investigation into novel approaches for efficient reprogramming is necessary. Here, we show that the lentiviral expression of OCT4 together with SOX2 (OS) driven by a strong spleen focus-forming virus (SFFV) promoter in a single vector can convert 2% of CB CD34(+) cells into iPSCs without additional reprogramming factors. Reprogramming efficiency was found to be critically dependent upon expression levels of OS. To generate transgene-free iPSCs, we developed an improved episomal vector with a woodchuck post-transcriptional regulatory element (Wpre) that increases transgene expression by 50%. With this vector, we successfully generated transgene-free iPSCs using OS alone. In conclusion, high-level expression of OS alone is sufficient for efficient reprogramming of CB CD34(+) cells into iPSCs. This report is the first to describe the generation of transgene-free iPSCs with the use of OCT4 and SOX2 alone. These findings have important implications for the clinical applications of iPSCs.

497 Role of Cord Stress Hormone Levels for Developing Transient Tachypnea of Newborn in Cesarean Delivered Late Preterm and Term Infants

Background and aims: Failure of adequate and timely clearance of fetal lung fluid results in transient tachypnea of newborn (TTN). Of the several factors that have been proposed to effect sodium reabsorption some have been investigated including glucocorticoids, oxygen, catecholamines, thyroid hormones, surfactant. The aim of this study was to investigate the role of cord stress hormones; ACTH, cortisol, adrenalin, sT3, sT4, TSH in the development of TTN in CS delivered late preterm and term infants. Methods: Study was designed as a prospective and sectional study. The information about all of the deliveries taking place in our center between September 2008-July 2009 were recorded. Study group consisted of 37 CS delivered late preterm and term infants with the diagnosis of TTN. Thirty three gestational age matched CS delivered consecutive infants without the diagnosis of TTN delivered after each study case constitutes the control group. At birth 10 ml of cord blood were collected from all CS deliveries of late preterm and term infants for analysis of serum cortisol, ACTH, sT3, sT4, TSH and adrenalin levels. Results: Though there was no significant demographic difference between our patient and control groups, cord ACTH, cortisol, sT3 were significantly low and adrenalin was high in the study group (p< 0.05). Conclusions: Lower cord cortisol, ACTH, sT3 in patients with TTN indicate the possible role of these hormones in fetal lung fluid clearance and postnatal pulmonary adaptation through their modulatory effect on ENaC and NaK ATPase.

Comparison of maternal and cord blood nucleated red blood cell count between pre‐eclamptic and healthy women

The aim of this study was to evaluate the influence of pre-eclampsia on the cord and maternal nucleated red blood cell (NRBC) count. Immediately after delivery, 1 mL of maternal venous blood and 1 mL of cord blood from 50 pre-eclamptic and 150 healthy pregnant women were collected separately in tubes containing 1.5 mg ethylene diamine tetra-acetic acid. Blood smears were prepared and stained using the Giemsa method. The number of NRBC per 100 leukocytes in maternal and cord blood was counted and compared between the two groups using SPSS software package for Windows. Any correlation of the NRBC count in maternal and umbilical cord blood was also evaluated. P-values < 0.05 were considered significant. The mean (+/-SD) NRBC per 100 white blood cell (WBC) level in cord blood of newborns in the pre-eclamptic group (18.2 +/- 31.8, range 0-142) was significantly greater than in the control group (6.2 +/- 8.1, range 0-36). Low birth weight and intrauterine growth restriction showed a statistically significant relationship with abnormal NRBC count in pre-eclamptic patients. A significant correlation was found between the maternal and cord blood NRBC count in the pre-eclamptic group. Fetal response to utero-placental insufficiency in pre-eclampsia leads to elevated NRBC in the cord blood, particularly in the presence of low birth weight and intrauterine growth restriction. The positive correlation between maternal and cord blood NRBC counts in pre-eclamptic patients indicates that maybe the hypoperfused placenta plays a role in the correlated alteration of the maternal and fetal NRBC count.

A Single Center Experience with Allogeneic Sibling Umbilical-Cord-Blood Transplantation in Children with Malignant and Non-Malignant Disease.

To study the outcome of allogeneic sibling umbilical-cord-blood transplantation (CBT) in children in China, we studied the records of 38 recipients of cord blood from HLA-identical siblings from 1998 through 2004. The mean age at transplant was 10.3+/−5.5 years. Diseases of the patients were leukemia (28), neuroblastoma (3), severe aplastic anaemia (3) and inborn errors of metabolism (four). A volume of 76–208 ml of cord blood was collected from sibling infants soon after delivery. HLA antigens were identical in 32 and one to three antigens mismatched in six. The patients received busulphan and cyclophosphamide as conditioning, and antithymocyte globulin was given to prevent graft rejection. The median number of collected nucleated cells was 3.5 x 107/kg nucleated cells (range, 2.0 to 10.2). T-cell reconstitution was evaluated by using combined approaches of phenotyping analysis of lymphocytes and assessment of ex vivo thymic function by measuring T-cell receptor (TCR) rearrangement excision circles (TRECs). The overall survival is 89% at the median observation time of 72 months. The median time for neutrophil engraftment (absolute neutrophil count >500/mm3) was 16 days (range, 10 to 41days). The median time to become transfusion independent after CBT was 27 days for platelets (range, 15 to 54) and was 28 days for packed red blood cells (range, 19 to 128). Acute GVHD (aGVHD)was observed in 20/38 patients and involved only skin in 16 patients, skin and liver or gut in 2 patients and all 3 organs in another 2 patients. Seventeen of 20 patients had grade 1 to 2 aGVHD toxicity, whereas 3 patients experienced grade 3 to 4 aGVHD. Chronic GVHD (cGVHD) developed in 12 patients. Acute transplant related mortality was 5.5%. Cause of death was persisting non-engraftment till day +100 after transplant. Late mortality occurred in 2 patients: one cGVHD associated haemorrhage 22 months after CBT and one cGVHD associated septicaemia 4 years after CBT. Immunologic reconstitution demonstrated that CBT resulted in consistent and stable T-, B- and natural killer (NK) cell development. The kinetics of development was such that T-cell development occurred between 65 to 180 days. Initial T-cell engraftment consisted predominantly of CD45RO+, CD3+, and CD4+ T cells, and at 12 to 24 months changed to CD45RA+, CD3+, and CD4+ T cells, indicating de novo maturation of T cells. During the first 5 months after transplantation, TCR repertoires were highly abnormal and TREC values low. However, in a longer follow-up (one years or more after transplantation) TREC values and TCR diversity increased and became normal. This data confirms that CBT still should be the first treatment choice if an HLA-identical sibling is available.

Efecto de la vitamina K oral e intramuscular sobre los factores II, VII, IX, X y PIVKA II en el recién nacidohasta los 60 días de edad: Relación con la alimentación

Neonates on exclusive breast feeding that do not receive vitamin K at birth are at higher risk hemorrhagic disease of the newborn. To compare the effect of oral or intramuscular administration of vitamin K1 (VK1), on clotting factors II, VII, IX, X and PIVKA II, in children until the 60 days of age with exclusive breast feeding or mixed feeding. Forty healthy full term infants, distributed in two groups, A: 20 with mixed feeding (formula-feeding and breast-feeding) and B: 20 with exclusive breast feeding, were studied. Nine infants of each group received 1 mg of VK1 intramuscularly and eleven 2 mg VK orally 5 ml of cord blood was collected initially from each infant. Venous blood samples were taken on 15, 30 and 60 days of age. All factors increased in a progressive form reaching levels over 50% at 60 days of age, in both groups. PIVKA II decreased significantly during the study period (p < 0.01). Factor II increased more in children with mixed feeding that received intramuscular vitamin K, than in the rest of study groups. No other differences between groups were observed. No infant had an abnormal bleeding during the study period. Oral administration of vitamin K is as effective as the intramuscular route in the prevention of the hemorrhagic disease of the newborn.

Pooled umbilical cord blood as a possible universal donor for marrow reconstitution and use in nuclear accidents

Human umbilical cord blood has been shown to be an effective source of stem cells for marrow reconstitution in pediatric patients. Unfortunately, the quantity of stem cells obtained from an individual donor can be quite limited in both the total volume and the numbers of stem cells per ml of cord blood. HLA matching further limits the availability, but recent publications indicate close matching may be unnecessary. Therefore, if cord blood from different donors can be combined, larger numbers of stem cells can be available for clinical use provided pooling does not produce a negative effect. Storage of single cord blood specimens at 4° C for 10–21 days in gas permeable bags produced an apparent increase in the percentage of immature cells (CD34, CD117, GPA) and mitotic activity (S+G2/M cells) over day 1. With similar storage of pooled specimens there was a further increase in the number of immature colonies cultured, CD34, CD117, GPA, S+G2/M cells. In addition, nucleated red blood cells increased over the mean values obtained from single cord blood samples. Our previous studies have indicated that large numbers of human mononuclear cells are necessary to reconstitute an irradiated animal model. By combining multiple samples of human cord blood, adequate numbers of stem cells could be pooled for use in adults and would provide cells for megadose therapy, including those patients that had accidentally received lethal irradiation.

Usefulness of cord-blood harvesting for autologous transfusion in surgical newborns with antenatal diagnosis of congenital anomalies

Background/Purpose: The risks of homologous transfusion and the effectiveness of predeposit autologous transfusion have been described. The authors examined the clinical usefulness of cord-blood harvesting for autologous transfusion in newborns who had congenital anomalies antenatally diagnosed that would require surgical intervention at or near the time of delivery. Methods: Of 112 cases of antenatal diagnosis of congenital anomalies, 50 mothers gave informed consent and enrolled in this study. Cord-blood was withdrawn immediately after clamping of the umbilical cord and was used for autologous transfusion in newborns within the first 3 days postpartum. Results: A mean of 72 ± 54 mL of cord-blood was harvested (27 ± 18 mL/kg). While preserving cord-blood for 3 days at 4°C, no signs of clot formation or hemolysis were observed. The harvested cord-blood included plasma-free Hb ranging from 1 to 68 (13 ± 18) mg/dL and thrombin-antithrombin III complex ranging from 2 to 273 (18 ± 50) ng/mL. Bacteriologic examination of the stored cord-blood showed negative cultures, except for samples from 3 newborns after vaginal delivery. A mean of 46 ± 34 mL of cord-blood was used in 26 patients for autologous transfusion. No significant complications related to cord-blood transfusion were recognized clinically. Conclusions: Autologous cord-blood transfusion has the potential to be a useful alternative to homologous transfusion in newborns requiring surgery. Adequate collection and storage techniques for cord-blood must be developed. J Pediatr Surg 36:851-854. Copyright © 2001 by W.B. Saunders Company.