Comparing the volume of umbilical cord blood collection using different techniques

Umbilical cord blood (UCB) as a source for red blood cell (RBC) transfusions is a promising alternative to adult RBC transfusions in extremely preterm neonates, as UCB contains predominantly fetal haemoglobin (HbF). A limitation to clinical use is the low and variable yield of UCB collections. This study aimed to assess UCB collection volume and feasibility across three techniques in uncomplicated term pregnancies.

We conducted a prospective observational study in two centres in The Netherlands. We compared the volume of UCB units collected from uncomplicated term deliveries using three different techniques: in utero, ex utero with a funnel and ex utero with a plateau. A minimum target volume of 70 mL was deemed adequate for further processing.

Of 606 collection attempts, 570 (94%) were successful. The median UCB volume was 65 mL (interquartile range, IQR 49-84), with 242 (42.5%) collections ≥70 mL. Volumes differed significantly between the three techniques, with the ex utero plateau technique yielding the highest median volume (70 mL, IQR 55-88), followed by in utero (56 mL, IQR 45-71) and the funnel technique (36 mL, IQR 30-51) (p < 0.001). UCB volume correlated with birth weight (p < 0.001), but not with gestational age or sex. Volumes obtained with the plateau technique increased over time, suggesting a learning-curve effect.

Collected UCB volume was highest using the ex utero plateau technique and was associated with birth weight and operator experience. The observed learning curve underscores the importance of dedicated teams to maximize UCB collection efficiency for future transfusion use.