Results from a phase 2 clinical trial recently published in Transfusion showed that cord blood red blood cell transfusions appeared to improve outcomes in extremely preterm infants, although limited availability reduced their full impact in a major clinical trial.
The BORN trial evaluated whether cord blood–derived red blood cells could outperform standard adult donor red blood cells in fragile newborns. These findings may also have implications for immune-related conditions such as fetal and neonatal alloimmune thrombocytopenia (FNAIT).
Among 142 enrolled infants, 118 received 458 transfusions, including 107 cord blood-red blood cell units. However, for 67 transfusion requests, no compatible cord blood units were available, forcing clinicians to use adult blood instead. This shortage affected results, as more than 40% of infants in the intervention group received a mix of both products.
For patients and families, this matters because cord blood contains higher levels of fetal hemoglobin, which may better support oxygen delivery in premature infants. This could reduce complications such as severe retinopathy of prematurity or bronchopulmonary dysplasia. These potential benefits are especially relevant in conditions such as FNAIT, where neonatal blood and immune factors play a critical role in early outcomes.
Read more about the prognosis of FNAIT
The study showed that producing cord blood-red blood cells is feasible and consistent across centers. Of 451 units processed, 84.0% met target hematocrit levels of 50% to 70%, and more than 90% met safety standards for low hemolysis and minimal white blood cell contamination. Nearly all units achieved leukocyte levels below 1 × 10⁶, considered safe for neonatal transfusion and important for reducing infection risk.
Despite this, supply constraints were a major barrier. Only 8.4% of 5,467 collected cord blood units were processed into usable transfusions, often because they did not meet minimum volume thresholds of 67 mL. In addition, bacterial testing required 5 to 7 days, and mandatory irradiation further shortened the usable shelf life to about 7 to 9 days. These delays significantly limited availability at the bedside.
“[C]ollaborating with neonatologists and preterm neonate parents’ associations could prove instrumental in promoting the informed altruistic [cord blood] donation,” explained the authors of this study.
Researchers suggest that extending storage up to 21 days and improving collection methods could expand access. They also question whether routine irradiation is necessary, noting modern processing may already reduce risks like transfusion-associated graft-versus-host disease.
For patients, including those affected by disorders like FNAIT, these findings point to a promising but still evolving therapy. Wider availability of cord blood transfusions could improve outcomes in vulnerable newborns, but practical challenges must be addressed before this approach becomes standard care.
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