Term umbilical cord blood, fully tested and processed, as the source of red blood cell transfusions for extremely-low-gestational age neonates.

ELGANs (Extremely-Low-Gestational-Age Neonates; those born before 28 weeks gestation) are at risk for developing significant morbidities including retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), and cognitive impairment. The pathogenesis of each of these morbidities is complex, but a growing literature suggests that repeated transfusions of adult donor red blood cells (RBC) conveys a propensity to develop these disorders. The biological rationale for the propensities might vary with each morbidity. For instance, hemoglobin A in adult red cells increases oxygen delivery to the developing retina, potentiating ROP, while a proinflammatory nature of adult donor RBC might potentiate BPD. It is possible that fetal RBC harvested from otherwise discarded umbilical cord blood after healthy term births would be a more physiologically appropriate transfusion product for anemic ELGANs. Such a product might result in a lower incidence or severity of the common morbidities. Herein we review our progress, and that of others, toward testing that theory.