Tuesday, 17 January 2017

Let's cut the chord then, or shall we not?

Very recently I was asked by a relative for my opinion on how valuable and realistic it is the collecting of chord blood and placenta stem cells for therapeutic purposes. I've done it twice with a company named Future Health Biobank, with headquarters set in Nottingham (UK), if I'm not wrong. I did it for my first child and now again a few weeks back for my daughter. Now the person asking my opinion is going to have a child soon and after my advice started looking for information on what realistically is offered by the advances made in stem cell-based therapies.

There is plenty of information on the web, made available with minimum complication and with a straight forward verbatim. However, after visiting several web pages designed for the purpose, I realised that not many, if any at all, wastes any time providing specific, accurate, up-to-date research references on the specific medical utilisation of stem cell therapies for fixing health issues.

When I decided for the stem cell collection, I myself was vaguely instructed on how effective these therapies present themselves to patients, numbers and science involved in it. Because it is one thing to mention that "Stem cells found in the chord blood have been used for blood related illnesses since 1988 and are now commonly used to treat over 85 diseases, including leukaemia, anaemia and thalassemia". This is too generalist, this is almost common knowledge these days. Another thing is to read the chapter entitled "Advances in Stem Cell therapy" that is part of the series "Stem Cell Biology and Regenerative Medicine". This chapter provides an article that I wasn't able to read entirely but if you'd like to, the chapter is priced at £19.95 and the whole ebook at £112. The abstract gives evidence that there is very saucy information for those who want more than just a mere "this can be useful", and are actually looking for a "how is that useful?". If you'd like to purchase the book, access here for more information.

Now, my relatives were given a few articles a nurse passed them, and these contain information that was expected to clarify many of the aspects that were still a gray area. In the nurse's opinion "stem cell therapy wasn't that good because it could only fix blood-related problems", "and the collection has got to be immediate otherwise there is no point". Well, who am I to judge information coming from a nurse who's dealing with births on a daily basis. But as a science writer, former researcher, current medical information officer, educated person, scientifically prepared individual, I can provide my perspective on how people mess up when they say stuff so blunt and vague as that. Sure, she knows she's talking to parents who probably know little about such a specific research realm, but the simple fact that you reduce, say, a possible treatment for leukaemia, to something like "could only fix blood-related problems" reveals a bit of a boisterous simplification of what could mean the possibility of saving your children from a horrific death. For me personally, and trying not to point my fingers so coldly, I don't cherish such approach. In my humble opinion if she wanted to say something like that she could go with "it might fix blood-related problems". See the difference in providing a positive perspective from reducing it to a prior judgmental reduction of its inherent potential capacity to fix a serious health issue?

The articles provided by the nurse (pretty much everything was from web pages) were about delayed chord clamping improving the child's future mental abilities. And also criticising early chord clamping, having it as a possible cause of infant brain damage.

Well, you know me, I don't like to talk about stuff I don't know, but I was asked for an opinion. And I had to read these articles to actually base my opinion on the literature they were given. So what did I find in these pieces of text my relatives were offered?

"Early chord clamping (within the first three minutes of birth) -> reduces the risk of excess bleeding for mums but increases the risk of hypoxia and incidence of autism in children.

If the chord is not clamped -> Children will eventually start breathing on their own gaining an adequate homeostasis by themselves -> The chord vessels clamp themselves and the oxygen flow is not interrupted until the child got stable.

Chord clamping in premature babies can be devastating".

Chord clamping is responsible for:


And might also be related to:


OK, so all this came from a commercial page. Biased? Very Possibly! There is no known link, to the best of my knowledge, between early chord clamping and increase in autism as it is reported by Russel et al in their article "A qualitative analysis of lay beliefs about the aetiology and prevelance of  autistic spectrum disorders (2010)". But when one takes a look at the remaining articles one is confronted with some scientific evidence that is not offered in the shape of a direct scientific reference... however, for a trained mind, it is easy to find these in proper databases. Here is what I could compile for you that is mainly based on research by Ola Andersson et al:

- Delayed chord clamping did not affect iron levels or neuronal development at age 1 year old in a sample of 347 babies assessed [2] but showed improvements in reducing prevalence of neonatal anaemia [4], therefore naturally associated to future impaired development; 

- Delayed chord clamping for a period of 180 seconds after delivery resulted in similar overall neuronal development among 4-year old children when compared to clamped ones, but the first showed better pro-social indicators [3];

- Delaying chord blood clamping for over 1 minute after the actual exit of the baby's shoulders is likely to increase the risk of phototherapy for jaundice and increase the levels of haemoglobin in the first 2 days of life, but no difference is observed at 3 to 6 months of age [5].

And among all the numerous articles one can find in this topic, I guess the ultimate summary line is that for a technique that has no additional costs and no associated side-effects or reported adverse events, if there is a minimal advantage in reducing the risks of anaemia for these children, then why not doing it and applying it as a common practice? However, there are some recent indications that delayed chord clamping might be associated to increased bilirubin levels in neonatals, but I'd rather prefer jaundice than a short supply of antibodies, white and red blood cells for adequate iron levels and immune responses. On the other hand, collecting those necessary 150-ish milliliters of blood soup where stem cells 'proliferate' might represent risks some will be willing to take if it is for tackling tougher problems in the future. Whatever anyone might say, the choice is not only yours but also of scientists in looking into this matter further, urgently.

[1] Are doctors causing infant brain damage by clamping  the umbilical chord prematurely?, Kencap Medical solutions, [http://m.kenyon.webnode.com/umbilical-cord-articles/], last visited on the 17th of January 2017, last update unknown.

[2] Andersson, O., Domellof, M., Andersson, D., Hellstrom-Westas, L. (2014). "Effect of delayed vs early umbilical cord clamping on iron status and neurodevelopment at age 12 months - A randomized clinical trial". JAMA Pediatrics, 168(6), pp. 547-554.

[3] Andersson, O., Lindquist, B., Lindgren, M., Domellof, M., Hellstrom-Westas, L. (2015). "Effect of delayed on neurodevelopment at 4 years of age". JAMA Pediatrics, 169(7), pp. 631-638.

[4] Andersson, O., Hellstrom-Westas, L., Andersson, D., Domellof, M. (2011). "Effect of delayed vs early umbilical cord clamping on iron status and neurodevelopment at age 12 months - A randomized clinical trial". BMJ, 343, pp. 1-12.

[5] Boehmer, S. and Armando, Q. (2016). "Among healthy term infants , is delayed cord clamping superior to usual practice for preventing clinically significant anemia at 6 months of age?". Helpdesk Answers, Evidence-Based Practice, 19(1), pp. 10-11.

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