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  1. Can I Delay Cord Clamping and Bank Umbilical Cord Blood?

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    Delayed cord clamping has been linked to health benefits for both mother and baby. But what does this mean for umbilical cord blood collection and transplantation?

    Is it possible to enjoy the best of both worlds?

    Stem Cell Scientists from Biovault and University College London, as well as the Parents’ Guide to Cord Blood Foundation, believe that it is. Here they review the challenge and offer their expert insights into optimum umbilical cord blood storage with minimal compromise.

    Delayed umbilical cord clamping: definition

    Delayed umbilical cord clamping is defined as the “interruption of the blood supply between cord and infant after more than one minute postpartum” by Lindsey Parker et al in their paper published this week by BioInsights.¹ This follows The World Health Organisation (WHO) who recommend delayed clamping, “not earlier than 1 min after birth… for improved maternal and infant health and nutrition outcomes.”²

    Benefits of delayed cord clamping for full-term babies

    Delayed clamping allows blood to flow between the placenta and the newborn baby after birth for a period of 1-3 minutes. This prolonged access to blood from the placenta and umbilical cord may increase the baby’s iron stores for up to six months, reducing the risk of iron deficiency anaemia.

    In randomised controlled trials:

    • scientists found no difference in mortality or admission to intensive care between those with delayed or early umbilical cord clamping (1675 full-term infants)
    • studies of 954 infants found no significant difference between the rates of anaemia in full-term babies at  3-6 months of age with delayed or early clamping
    • a higher incidence of iron-deficiency was associated with early clamping in studies of 1152 infants at 3-6 months

    WHO notes that these findings are particularly relevant for “infants living in low-resource settings with reduced access to iron-rich foods.”²

    Benefits of delayed cord clamping for pre-term babies

    In studies of 668 pre-term babies, no difference was found in the risk of infant mortality. However, babies born pre-term benefitted most from delayed clamping, with a 39% reduction in the need for blood transfusion for anaemia or low blood pressure.²

    Maternal benefits of delayed cord clamping

    In a recently updated review of over 2000 women, no significant differences were found in the rates of severe postpartum haemorrhage ( >100ml) or postpartum haemorrhage (>500ml) between groups with early or delayed clamping times.²

    Umbilical cord blood banking: the benefits

    Umbilical cord blood is a source of haematopoietic stem cells (HSCs). The transplantation of HSCs is an established treatment for leukaemias, lymphomas, multiple sclerosis, metabolic diseases and numerous disorders of blood cell proliferation, including sickle cell disease and Fanconi’s anaemia.

    Umbilical cord blood can be stored and used to treat the donor child or any other compatible patient. In the case of privately stored blood, HSCs may be used to treat a sibling or other family member with a blood cancer or disorder.

    Umbilical cord blood HSCs offer an alternative to peripheral blood and bone marrow stem cells and have advantages over both. The collection of cord blood is quick, non-invasive and painless, and the HSCs are generally healthier and in higher numbers than those sourced from older donors. Since the first transplant of umbilical cord blood HSCs in 1988, it is estimated that over 35,000 umbilical cord blood transplants have been performed worldwide.

    What we think here at Biovault Family

    Yes, you can still do delayed cord clamping with Biovault Family. The WHO guidelines for Delayed Umbilical Cord Clamping have a number of recommendations for different indications, but in summary “Delayed umbilical cord clamping (not earlier than 1 min after birth) is recommended for improved maternal and infant health and nutrition outcomes”, and that “Late cord clamping (performed approximately 1–3 min after birth) is recommended for all births”.

    NICE (National Institute for Health and Care Excellence) whose role in the UK “is to improve outcomes for people using the NHS and other public health and social care services” by “producing evidence-based guidance and advice for health, public health and social care practitioners”. NICE’s statement on DCC is that “Women do not have the cord clamped earlier than 1 minute after the birth unless there is concern about cord integrity or the baby’s heartbeat”.

    With this in mind, Biovault recommend DCC of an absolute minimum of 1 minute. Please note, that internal data suggests a correlation between increasing delay between birth and collection, and lower collected volumes of cord blood for banking.

    ¹ EXPERT INSIGHT: Advances and challenges in umbilical cord blood and tissue bioprocessing: procurement and storage, Lindsey Parker, Shaun Mansfield, Kate Sneddon, Ben Charles and Qasim A. Rafiq (August 2017)

    ² Guideline: Delayed umbilical cord clamping for improved maternal and infant health and nutrition outcomes, World Health Organisation.

    stem cell preservation

    BSc (Hons) Microbiology

    Chief Executive Officer | Biovault Family

    Biovault Family CEO, Kate Sneddon, joined Biovault in July 2009 and became Chief Executive Officer in 2016. As health industry professional her experience includes working as a microbiologist and leader at GSK for over 10 years. Her expertise in cord blood banking has been recognised in her awards, features in Parliamentary Review and Parents Guide to Cord Blood, as well as contributions to research with UCL and others.