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Extremely preterm infants who received red blood cells (RBCs) derived from umbilical cord blood had a smaller drop in foetal haemoglobin levels than those who received RBCs from adult donor blood, and this approach was feasible within a regional blood bank model; no transfusion-related adverse events were observed.
METHODOLOGY
- This prospective single-centre study assessed the feasibility and safety of cord blood-derived RBC transfusion and its association with foetal haemoglobin levels in extremely preterm infants.
- The researchers included 39 infants (median gestational age, 26 weeks; median birth weight, 755 g; 56% boys) born before 28 weeks of gestation at a tertiary NICU in Spain between September 2023 and July 2025; of these, 20 needed transfusions, and 19 did not.
- Among the infants who needed transfusion, 10 received only cord blood-derived RBCs, seven received only adult donor blood-derived RBCs, and three received both.
- Infants received compatible umbilical cord blood-derived RBCs first, with adult donor blood-derived RBCs being used only when compatible cord blood-derived RBCs were unavailable. Transfusions were given at 15-20 mL/kg; cord blood-derived RBCs were harvested from the umbilical cord blood of healthy group O donors after term deliveries.
- The researchers judged feasibility based on unit availability and delivery within 6 hours and safety based on clinical monitoring and acid-base and electrolyte measurements within 24 hours of transfusion. They measured foetal haemoglobin levels in dried blood spots before and within 24 hours after the first transfusion. Follow-up continued until death, discharge, or a postmenstrual age of 36 weeks.
TAKEAWAY
- Compatible cord blood-derived RBCs were available for 22 of 28 eligible requests (78.6%). All supplied units arrived within 6 hours, and the median request-to-arrival time was longer for cord blood-derived RBCs than for adult donor blood-derived RBCs (3.2 vs 2.0 hours).
- After the first transfusion, the median foetal haemoglobin level fell by 3.6 percentage points among infants who received cord blood-derived RBCs and by 30.2 percentage points among those who received adult donor blood-derived RBCs (between-group difference, 26.3 percentage points; 95% CI, 22.1-44.0).
- No transfusion-related adverse events were observed after transfusions with either cord blood-derived or adult donor blood-derived RBCs.
IN PRACTICE
"These findings provide a foundation for multicentre randomised trials to determine whether preservation of HbF [foetal haemoglobin] through UCB-RBC [umbilical cord blood-derived RBC] transfusion translates into improved clinical outcomes in this vulnerable population," the authors of the study wrote.
SOURCE
The study was led by Elsa García González, Hospital Clínic de Barcelona, Barcelona, Spain. It was published online on October 23, 2026, in Archives of Disease in Childhood: Fetal & Neonatal.
LIMITATIONS
The study did not estimate treatment effects, and its non-randomised design precluded causal inference. The small sample size and low number of severe neonatal outcomes limited the assessment of potential benefits on retinopathy of prematurity, bronchopulmonary dysplasia, and other morbidities. Follow-up data were limited by deaths and interhospital transfers.
DISCLOSURES
The study was funded by the Instituto de Salud Carlos III and co-funded by the European Union. One author reported receiving a grant from the Royal Netherlands Academy of Arts and Sciences to support a research stay at Hospital Clínic Barcelona.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
