The study was conducted by Anup Katheria, M.D., of the Sharp Mary Birch Hospital for Women and Newborns in San Diego, and colleagues at institutions in the United States, Canada and Poland.
A team of researchers has demonstrated that some childhood leukemias originate during embryonic development, although they do not manifest after a few months after birth.
The team includes researchers from the Institute of Oncology of the University of Oviedo (IUOPA), the Josep Carreras Leukemia Research Institute, the University of Barcelona and the Center for Biomedical Research in Cancer Network (CIBERONC).The study is published in the journal Leukemia.
Acute myeloid leukemia is the second most common type of acute leukemia in childhood and can be diagnosed within a few months of life. The early onset of the disease had led to the suspicion that the tumor could have a prenatal origin. However, proving this theory has been challenging due to the lack of prenatal or birth samples.
Standard practice for non-vigorous infants is to immediately clamp and cut the umbilical cord so that the infant can rapidly be resuscitated. Many researchers are concerned, however, that this could deprive them of needed blood and worsen their outcome. Non-vigorous infants are at risk for complications such as low oxygen levels in the brain, cerebral palsy and stroke. In the current study, authors sought to determine if cord milking for non-vigorous infants could provide similar benefits to delayed cord clamping in less time
The current recommendation for vigorous, full-term infants is to delay clamping and cutting the umbilical cord for at least 30 to 60 seconds after birth. This allows blood from the cord to enter the newborn’s circulation. Compared to infants undergoing immediate cord clamping, term infants undergoing delayed clamping have higher hemoglobin and iron levels. Preterm infants undergoing delayed cord clamping have less need for blood transfusion, are less likely to have a hemorrhage inside the brain, and are less likely to have necrotizing enterocolitis, a life-threatening deterioration of the intestine.
Non-vigorous infants in the study were assigned at random to undergo either cord milking or immediate clamping. For the cord milking, attending providers milked 20 centimeters of cord for two seconds, then repeated this procedure three times. Of more than 16,000 infants born after 35 to 42 weeks of pregnancy and screened at 10 institutions, 1,730 were included in the analysis.
For the study’s primary outcome—admission to a newborn intensive care unit—the researchers found no significant difference between the two groups. However, the researchers found several significant differences between the two groups for the study’s secondary outcomes. On average, the cord milking group had a higher hemoglobin level than the immediate clamping group. Of the milking group, 61% required heart and respiratory support, compared to 71% for the clamping group. Moderate to severe hypoxic ischemic encephalopathy—low blood oxygen levels in the brain—occurred in 1.5% of the milking group, compared to 3% of the clamping group.
Elwell said the ABRC wanted to take an ethnographic approach to understanding why donations among American Indian parents were particularly low, so they contacted NAU to conduct the study, which included Elwell, Emery Eaves, an assistant research professor in Department of Anthropology and a CHER affiliate, Julie Baldwin, CHER director and Regents’ Professor, Katharine Sanderson, senior program coordinator with CHER, and Robert T. Trotter II, Regents’ Professor in the Department of Anthropology. Elwell and Eaves were co-principal investigators on the study.
According to the Arizona Public Cord Blood Program, umbilical cord blood remains in the blood vessels of the placenta and the umbilical cord after the baby is born and the cord has been clamped and cut. It contains blood-forming stem cells and has been proven to be a viable method for treating a variety of diseases.
Cord blood is one of the several places in the body that contain stem cells, others being the brain, heart, skin, teeth, gut, liver, skeletal muscle, testis, bone marrow and more, according to the Arizona Public Cord Blood Program.
“If we can encourage more American Indians to donate cord blood, it will provide more opportunities for patients to get stem cell transplants,” Elwell said.
The primary goal of the two-year study was to better understand underlying beliefs, attitudes and cultural practices of American Indian community members that influence views and attitudes toward cord blood donation. Another goal of the study was to assess professionals, such as obstetricians, nurses and nurse-midwives, as potential sources of information for cord blood donors.
“The study was important because beliefs about cord blood donation are not well understood, and without a good understanding of what people know and think about donation, it is difficult for consenters, providers or home health workers to explain the implications of donation to American Indian parents,” Eaves said. “It is important that all parents have the information they need to make an informed decision that makes sense for them and that they understand what the program is about when they’re approached in the hospital.”
The researchers interviewed health care providers including obstetricians, gynecologists, midwives, labor and delivery nurses, childbirth educators, cord blood program consenters, members of American Indian tribes and pre- and post-delivery mothers.
Study recommendations
The researchers provided the ABRC with a list of recommendations:
Consult with tribal leadership
Work with hospitals that serve a large percentage of American Indian patients but do not currently have a cord blood program
Offer training for community health representatives and other health care providers who work directly with American Indian parents