The Importance of Cord Blood Gases Levels in Umbilical Cord Preservation

Cord blood gases can be incredibly important, especially in lawsuits against physicians. If infants have a particularly low APGAR score–3 or less on a scale of 1-10 within 5 minutes of delivery–then a cord blood gas level should automatically be drawn. The reason for this is that the doctor was not negligent in allowing the infant to have an anoxic episode at birth, which can cause a range of brain injuries including cerebral palsy or other neurological deficits. The cord blood gases can help determine if brain injuries occurred before, during or after delivery–thus, potentially freeing the doctor from litigation in up to 80% of cases (according to PubMed.com).

What cord blood gas levels mean

001109b42f730b60e1b10eCord blood is the stem cell-rich blood that is drawn directly from the cord leading to the placenta after delivery of a newborn. There are two arteries that wrap around a large vein leading up to the placenta, and this is where the cord blood is drawn from. Freshly oxygenated blood comes directly from the umbilical cord and umbilical vein from the mother to the infant. The baby’s veins dump unoxygenated blood directly into the umbilical artery, where the blood then travels back to the mom’s heart and lungs–picking up oxygen along the way. Since this blood is the most likely to provide solid information about the baby’s birth blood oxygenation levels, this is where cord blood gases should be drawn from. This process is called, drawing a Cord Blood Arterial Gas (CABG) and is utilized as an indicator of child health immediately before birth.

Nurses and physicians are looking for several things when they draw a CABG: signs of anaerobic metabolism; unbalanced acid bases or pH level and abnormal levels of lactic acid. The presence of any of these in the CABG may indicate that the infant was in distress, but pH is the best and most important indicator that health care professional utilize to make this determination.

The information gathering during this sampling process of CABG is useful both as a medical indicator of health as well as a medicolegal perspective as it may be a good indicator of fetal health immediately intrapartum. Cord acid-base analysis at birth (or pH levels) is something that respiratory therapists and OB nurses alike dread–because it means there is a high possibility that the newborn has suffered a trauma or some sort of distress that may or may not cause long-term brain damage or damage to other major systems.

Drawing cord blood gases may in some instances prove that neurological deficits that develop years down the road were caused before birth, resolving the delivering physician and nurses of liability. If the pH analysis shows a CABG over 7.10, then there is a relatively solid indication that the infant did not suffer from a hypoxic episode during delivery. Premature babies are at a much greater risk of suffering episodes such as intracranial hemorrhage or developing cerebral palsy down the road. Most normal infants would never have this type of difficulty.

Umbilical cord storage

Similar to the stem cells found in cord blood, umbilical cords contain a completely different type of stem cells–a type that could be proven to provide a multipotent form of stem cells that would help support a different variety of genetic diseases and ailments. The cord tissue cells are called Mesenchymal Stem Cells (MSCs), and they can turn into a very wide variety of different cell types including organ and muscle tissues, skin, bone, cartilage and fat cells. Some of the diseases which can potentially be treated by this highly differentiated type of cells include Alzheimer’s Disease, spinal cord injuries, and even Type 1 Diabetes. There are currently over 50 clinical trials ongoing to identify opportunities for using cord tissue in helping individuals overcome this wide variety of medical issues and diseases.

Stem cell preservation

13139111_31nAfter cord blood and tissue has been collected, it is generally couriered to a cord-blood bank for blood storage. The samples are then given an identifying number and stem cells are separated from the rest of the blood. Then, the stem cells are placed into a cryogenic storage facility, which includes exposing the cells to liquid nitrogen to flash-freeze them. when properly stored, stem cells can last in cryogenic storage indefinitely. Since storage of cord-blood only began in the 1970’s, we aren’t sure yet exactly how long they will last when properly stored and still be viable for transplantation. We do know that cells that were stored in liquid nitrogen have been used successfully in transplants after being stored for more than ten years.

Public cord blood and tissue banks are free to store these important biological materials, but there may be a small fee charged by the midwife or doctor for blood collection. Private cord blood and tissue storage can be very expensive, with costs exceeding $3,000 or more for long-term storage as well as additional fees for collection kits, courier services and processing fees.

The American Academy of Pediatrics (AAP) has made a recommendation that public cord banking be used instead of private cord and tissue banking whenever possible. The exception would be when you, a child, or a close family member has a future or potential transplant need for stem cells. Most healthy individuals will never need stem cell treatment, so private banking may be an unnecessary expense and may also keep someone who desperately needs the transplant from receiving the needed treatment–and your family may never use the stem cells. Additionally, there is no confirmed research that cord blood stem cells from someone other than a family member will be unconditionally rejected as the cells are so highly adaptable by nature. There is no requirement that cord blood stem cells are not required to be a perfect match in order to ensure that stem cell transplantation is successful.

While getting your own cord blood or tissue stem cells self-donated seems like it would be the most logical choice for success and the least chance that the cells will be rejected, experts now consider the fact that your stem cells may contain the same blood abnormalities that were causing the disease in the first place. In this case, a cord blood or tissue transplant is not going to be successful in solving the core disease.

Some experts and organizations have expressed caution when considering private cord blood and umbilical cord preservation, for the simple reason that there is a potential that these organizations may be preying on the fears of new parents of keeping their child’s safety in mind long-term. The possibility is greater for adopted children or ethnic or racial minorities, as finding a match can be even more difficult with those additional factors added in.

Similar to public blood banks, public cord blood banks accept donations from anyone; with donations that do not meet stringent quality standards discarded. Public cord blood and tissue banks also tend to use registries that are available nationwide in order to help doctors find a match as expediently as possible. It is common practice for cord blood stem cells to be combined in order to provide enough of the life-giving stem cells to generate renewed blood for an adult, as the amount banked by any one individual is likely to be too small to be useful for adults. This is only possible since an exact genetic match is not required, so samples from unrelated individuals can more easily be meshed together. However, the vast majority of public cord blood and cord tissue is discarded due to contamination during collection or shipping complications, or because the sample size was too small to collect enough stem cells to be viable for transplant therapy.

Public cord blood and cord tissue banking has been widely accepted by the medical community, partially because there’s the potential of a lower quality control and lower potential of match at a private cord blood bank facility, as well as the possibility of lower usefulness from a medical perspective of an individual using their own banked blood, which may be diseased. The high cost of public cord blood banks has prevented a large number of them from opening; most of the operating facilities are owned by medical centers that are large enough and prosperous enough to support the cost required to keep them running.

Cord blood and certainly cord tissue and umbilical cord banking are all still relatively new practices, with cord blood being the oldest and most well-known process. Many hospitals do not even offer the service of cord blood and tissue banking, making the question a moot point. Many doctors and health care facilities advocate banking cord blood and tissues not because of a current use for them, but because of the future potential for research and the ability to combat different diseases in the future. While parents must make a choice based on their individual needs and experiences, as well as, the health of their family, the future research into stem cell usage seems incredibly promising as a way to treat deadly diseases with a massive impact on quality of life for a broad range of individuals.

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