Banking Your Newborn's Cord Blood

On the day you deliver your baby, you'll probably be overcome with visions of your future with your child - first smiles and steps, birthday parties and sports events, and holidays and life milestones. Your little one ever becoming seriously ill will probably be the last thing on your mind.

But some parents do consider the possibility that a serious illness might someday affect their child - and they make a choice on the day their baby is born that might impact the future health of that child or even their other children. They're deciding to bank their newborn's cord blood.

So, what is cord-blood banking, and is it right for you?
Cord-Blood Banking

After a baby is delivered, the mother's body releases the placenta, the temporary organ that transferred oxygen and nutrients to the baby while in the mother's uterus. Until recently, in most cases the umbilical cord and placenta were discarded after birth without a second thought. But during the 1970s, researchers discovered that umbilical cord blood could supply the same kinds of blood-forming (hematopoietic) stem cells as a bone marrow donor. And so, umbilical cord blood began to be collected and stored.

What are blood-forming stem cells? These are primitive (early) cells found primarily in the bone marrow that are capable of developing into the three types of mature blood cells present in our blood - red blood cells, white blood cells, and platelets. Cord-blood stem cells may also have the potential to give rise to other cell types in the body.

Some serious illnesses (such as certain childhood cancers, blood diseases, and immune system disorders) require radiation and chemotherapy treatments to kill diseased cells in the body. Unfortunately, these treatments also kill many "good" cells along with the bad, including healthy stem cells that live in the bone marrow.

Depending on the type of disease and treatment needed, some children need a bone marrow transplant (from a donor whose marrow cells closely match their own). Blood-forming stem cells from the donor are transplanted into the child who is ill, and those cells go on to manufacture new, healthy blood cells and enhance the child's blood-producing and immune system capability.

Collection of the cord blood takes place shortly after birth in both vaginal and cesarean (c-section) deliveries. It's done using a specific kit that parents must order ahead of time from their chosen cord-blood bank.

After a vaginal delivery, the umbilical cord is clamped on both sides and cut. In most cases, an experienced obstetrician or nurse collects the cord blood before the placenta is delivered. One side of the umbilical cord is unclamped, and a small tube is passed into the umbilical vein to collect the blood. After blood has been collected from the cord, needles are placed on the side of the surface of the placenta that was connected to the fetus to collect more blood and cells from the large blood vessels that fed the fetus.

During cesarean births, cord-blood collection is more complicated because the obstetrician's primary focus in the operating room is tending to the surgical concerns of the mother. After the baby has been safely delivered and the mother's uterus has been sutured, the cord blood can be collected. However, less cord blood is usually collected when delivery is by c-section. The amount collected is critical because the more blood collected, the more stem cells collected. If using the stem cells ever becomes necessary, having more to implant increases the chances of engraftment (successful transplantation).

After cord-blood collection has taken place, the blood is placed into bags or syringes and is usually taken by courier to the cord-blood bank. Once there, the sample is given an identifying number. Then the stem cells are separated from the rest of the blood and are stored cryogenically (frozen in liquid nitrogen) in a collection facility, also known as a cord-blood bank. Then, if needed, blood-forming stem cells can be thawed and used in either autologous procedures (when a person receives his or her own umbilical cord blood in a transplant) or allogeneic procedures (when a person receives umbilical cord blood donated from someone else - a sibling, close relative, or anonymous donor).

How long can blood-forming stem cells last when properly stored? Theoretically, stem cells should last forever, but cord-blood research has only been ongoing since the 1970s, so the maximum time for storage and potential usage are still being determined. Blood-forming stem cells that have been stored up to 14 years have been used successfully in transplants.
Pros and Cons

Cord-blood banking isn't routine in hospital or home deliveries - it's a procedure you have to choose and plan for beforehand, so be sure to consider your decision carefully before delivery day.

The primary reason that parents consider banking their newborn's cord blood is because they have a child or close relative with or a family medical history of diseases that can be treated with bone marrow transplants. Some diseases that more commonly involve bone marrow transplants include certain kinds of leukemia or lymphoma, aplastic anemia, severe sickle cell anemia, and severe combined immune deficiency.

The odds that the average baby without risk factors will ever use his or her own banked cord blood is considered low; however, no accurate estimates exist at this time.

The expense of collecting and storing the cord blood can be a deciding factor for many families. At a commercial cord-blood bank, you'll pay approximately $1,500 to store a sample of cord blood, in addition to a $100 yearly maintenance fee. You might also pay an additional fee of several hundred dollars for the cord-blood collection kit, courier service to the cord-blood bank, and initial processing.

In most cases, stem cell transplants are performed only on children or young adults. The larger the size of the person, the more blood-forming stem cells that are needed for a successful transplant. Umbilical cord blood stem cells aren't adequate in quantity to complete an adult's transplant.

In addition, it's not known whether stem cells taken from a relative offer more success than those taken from an unrelated donor. Stem cells from cord blood from both related and unrelated donors have been successful in many transplants. That's because blood-forming stem cells taken from cord blood are naive (a medical term for early cells that are still highly adaptable and are less likely to be rejected by the recipient's immune system). Therefore, donor cord-blood stem cells do not need to be a perfect match to create a successful bone marrow transplant.

There has been little experience with transplanting self-donated cells. Some experts are concerned that an ill baby who receives his or her own stem cells during a transplant would be prone to a repeat of the same disease. Most of the bone marrow transplants that use blood-forming stem cells have been performed on relatives of the donating child, not on the donating child.

The risks to the health of the mother and baby at the time of collection are low, but they do exist. Clamping the umbilical cord too soon after birth may increase the amount of collected blood, but it could cause the baby to have a lower blood volume and possible anemia soon after birth.
Is It Right for You?

As parents evaluate their reasons for banking their newborn's cord blood and begin to research cord-blood bank facilities, there are many considerations and cautions to keep in mind.

Some doctors and organizations, such as the American Academy of Pediatrics (AAP), have expressed concern that cord-blood banks may capitalize on the fears of vulnerable new parents by providing misleading information about the statistics of bone marrow transplants. Parents of children of ethnic or racial minorities, adopted children, or children conceived through in vitro fertilization may be especially encouraged to bank cord blood because it's statistically harder to find a match in these cases.

The AAP doesn't recommend cord-blood banking for families who don't have a history of disease. That's because research has not yet determined the likelihood that a child would ever need his or her own stem cells, nor has it confirmed that transplantation using self-donated cells rather than cells from a relative or stranger is safer or more effective. According to the AAP, "private storage of cord blood as 'biological insurance' is unwise. However, banking should be considered if there is a family member with a current or potential need to undergo a stem cell transplantation."

Other doctors and researchers support saving umbilical cord blood as a source of blood-forming stem cells in every delivery - mainly because of the promise that stem-cell research holds for the future. Most people would have little use for stem cells now, but research into the use of stem cells for treatment of disease is ongoing - and the future looks promising.

If you do decide to bank your newborn's cord blood, be sure to discuss your options with your obstetrician. Here are a few questions to consider before choosing a cord-blood bank:

* How financially stable is the cord-blood bank? (Financial stability means a reduced chance that you will have to transfer your sample if the facility closes.)
* How many samples are processed in the facility? (A larger number of samples usually means that there are more collection and handling procedures in place.)
* Do I have the option of switching to another facility if I choose?
* What happens to my sample if the facility goes out of business?
* What are the yearly fees and maintenance costs involved? Will these fees increase, or are they fixed?

Like community or hospital blood banks, cord-blood banks are regulated by the U.S. Food and Drug Administration (FDA), which has developed standards regulating future cord-blood collection and storage.
Donating Your Baby's Cord Blood

You may decide that instead of banking your newborn's cord blood, you'd like to donate it to a nonprofit cord-blood bank for research or to save the life of another child. By choosing this option, the cord blood will still be collected after your child's birth, but it will be anonymously marked and sent to a public bank. However, if your child or a family member later develops a disease that requires a bone marrow transplant for treatment, you won't be able to obtain the donation you made to the bank.

If you'd like to donate your child's umbilical cord blood, contact your local chapter of the American Red Cross or a local university hospital, or check the National Marrow Donor Program's list of registered cord-blood facilities that accept donations. You'll need to give proper written consent before you donate your child's umbilical cord blood, but there's no cost and the process is confidential.