Abstract:
Background: Preterm neonates have a critically small circulating blood volume of 85–90 mL/kg. Early admission phlebotomy removes a significant proportion of this volume. Umbilical cord sampling (UCS) in place of admission phlebotomy is a practical blood-conservation strategy that preserves blood volume during neonatal transition. In premature and very low birth weight neonates, it has been associated with more stable blood pressure, a reduction in the use of vasopressors, fewer transfusions, and a reduced risk of intraventricular hemorrhage. UCS is supported by the American Academy of Pediatrics however is not yet widely practiced in the UK.
Aim: To evaluate whether implementing UCS for neonates born at less than 32 weeks gestation in a UK tertiary neonatal unit reduces transfusion rates in the first week of life.
Methods: Following staff training and the introduction of pre-prepared sampling packs at preterm deliveries, clinical data was prospectively collected over a 14-month period comparing neonates who had and did not have UCS and their respective number of transfusions in the first week of life. From 153 admissions, 69 infants were excluded due to ex-utero transfer, death, or transfer out within the first week of life, and eight due to sampling issues. The final cohort of 76 neonates were born between 23+0 and 31+6 weeks gestation, were 50% male and female and had birthweights ranging from 465g to 1970g.
Results: UCS reduced the transfusion rate in the first week of life by half, reducing it from 32% (no UCS) to 16% (with UCS). When analysing the impact of DCC (delayed cord clamping) and UCS:
- No intervention (No DCC or UCS): Highest transfusion rate at 63%.
- DCC alone: Transfusion rate of 27%.
- DCC and UCS: Transfusion rate of 17%.
- UCS alone (compromised delivery, no DCC): 0% transfusion rate within a small sample size.
Discussion: Our results support the use of UCS to reduce the transfusion burden in premature neonates in the first week of life. In our cohort the number of transfusions in the first week reduced by 10%, when compared proportionately. Our results suggest that where delivery is compromised and the benefit of DCC is missed, UCS may arguably be of even greater benefit to these babies. Further data collection and analysis is ongoing as with a much larger sample size we aim to demonstrate a statistically significant reduction in transfusion and benefit in preterm neonates.
