Cord blood collection: effects on newborns (medical-legal)

The letter by Bertolini et all is primarily addressed to three references. The first two references were two letters written to BLOOD in 1992 by myself and my colleague^.'^^ These letters written in 1992 were not written to draw attention to the loss of hemoglobin, but to draw attention to ethical, medical, and legal issues revolving around the deliberate taking of blood from a n e w b ~ r n . ~ . ~ Some of these issues are as follows. 1. Can someone deliberately take from a newborn (even 5 mL) that which for millennia has been the infant’s own blood? This advocacy of immediate clamping to obtain cord blood is only a relatively recent event.”’ Prior investigators have all taken a middle ground, with none advocating immediate clamping or prolonged delays.’”” 2. Immediate clamping has been reported to produce brain hemorrhage in premature infants.” These investigators postulated that the hemorrhage resulted from the sudden increase in arterial pressure caused by immediate clamping.’’ Unless the doctors of Bertolini’s group or others who have practiced immediate clamping of the umbilical cord have had careful neurologic follow-up for a considerable period of time and can reassure the mother there is absolutely no increased risk of brain damage, then this is obviously a most significant, ethical, medical, and definite legal issue in which informed consent is pra~ticed.’~ It should be noted that neurologic deficits at birth are particularly difficult to detect. Type I and type I1 periventricular hemorrhage have few clinical symptoms.I4 3. What is the long-term effect of deliberately removing 20% of the circulating stem cells?” Do these children have a greater tendency for leukemia or autoimmune disease? Are there any published studies on this matter? Our concern covers the first few moments of life, primarily the first 60 seconds of life outside of the womb, during which time the bulk of the blood returns to the child from the placenta.I6 The decrease and later recovery of the Hb as reported by the investigators would be expected. The rate of return is so great during this short period of time that the variability of the decrease in hemoglobin described in Bertolini et al’s letter could be readily explained by the return of blood to the infant over a 30-second period. Their conclusion, which “supports the safety of procedures for the collection of adequate numbers of hematopoietic progenitors,” is totally unwarranted both ethically and legally.13