Umbilical Cord Blood Use for Admission Blood Tests of VLBW Preterm Neonates: A Randomized Control Trial

Abstract

Objective Umbilical cord blood (UCB) for admission laboratories is an approach to decrease anemia risk in very low birth weight (VLBW) neonates. We hypothesized that UCB use results in higher hemoglobin concentration [HgB] around 24 hours of life. Study Design A randomized control trial among VLBW infants whose admission laboratories were drawn from UCB (n = 39) or the infant (n = 41) in three U.S. military NICUs (clinicaltrials.gov#NCT02103296). Results No demographic differences were observed between groups. UCB infants had higher [HgB] at 12 to 24 hours of life (15.5 vs. 14.0 g/dL, p = 0.02). The median time to first transfusion was 17 days longer in the experimental group (p = 0.04), and at discharge, their number of donor exposures was lower (1.1 vs. 1.8, p = 0.04). Conclusion In the first 24 hours of life that is a period of higher risk for hemodynamic instability, UCB utilization for admission bloodwork in VLBW infants results in higher [HgB]. Key Points

Race and Ethnicity of Infants Enrolled in Neonatal Clinical Trials

“…We assessed reporting by NIH funding: of the 52 studies funded by the NIH, 35 studies (67%) included race and ethnicity data. Among 68 studies not funded by the NIH, 40 studies (58%) reported race and ethnicity data; the difference between NIH-funded and non-NIH–funded studies was not statistically significant by Pearson χ 2 .…”

“…We identified 120 studies that were entered into Cochrane CENTRAL 2017 to 2021 and met our inclusion criteria (eFigure 1 in Supplement 1). There was a range in the articles’ availability via electronic publication (2016-2021) and publication year (2017-2023).…”

“…There were 75 studies (62.5%) that included participant race and ethnicity data of any kind (eTable in Supplement 1). Most studies reported race and ethnicity as a single combined variable (eg, non-Hispanic White), while some reported them as separate variables (eg, non-Hispanic and White).…”

“…Among the 75 studies that reported race and ethnicity, there was a pooled sample of 10 650 participants. This pooled sample was classified as 1.2% Asian participants, 33.0% Black participants, 11.2% Hispanic participants, 0.2% Indigenous, 0.8% participants identifying as multiple races, 49.3% White participants, and 10.3% participants identifying as other race or ethnicity (eFigure 2 in Supplement 1).…”

“…A few studies specified the source of race and ethnicity information: 8 studies reported that it was from parental report and 1 study reported that it was from the medical record; the other 66 studies did not specify. Of studies that specified whose race was reported, 31 studies reported the infant’s information, 13 studies reported the mother’s information (using the label mother specifically), and 1 study reported the mother’s, father’s (using the label father specifically), and infant’s information.…”