Correspondence

Correction of X-Linked Lymphoproliferative Disease by Stem-Cell Transplantation

N Engl J Med 1994; 330:1159April 21, 1994

Article

To the Editor:

On reading the article by Vowels et al. (Nov. 25 issue)1 on the use of cord-blood stem cells to correct X-linked lymphoproliferative disease, we were troubled by the authors' cavalier attitude concerning clamping of the umbilical cord of the newborn donor. They state that early clamping is safe but offer no data to substantiate this claim. There is evidence in the literature that early clamping of the umbilical cord increases the incidence of intraventricular hemorrhage in the neonate2,3.

Mark Ende, M.D.
Frederick I. Ende, M.D.
121 S. Market St., Petersburg, VA 23803

3 References

1. 1

   Vowels MR, Lam-Po-Tang R, Berdoukas V, et al. Correction of X-linked lymphoproliferative disease by transplantation of cord-blood stem cells. N Engl J Med 1993;329:1623-1625
   Full Text | Web of Science | Medline

2. 2

   Hofmeyr GJ, Bex PJM, Skapinker R, Delahunt T. Hasty clamping of the umbilical cord may initiate neonatal intraventricular hemorrhage. Med Hypotheses 1989;29:5-6
   CrossRef | Web of Science | Medline

3. 3

   Hofmeyr GJ, Bolton KD, Bowen DC, Govan JJ. Periventricular/intraventricular haemorrhage and umbilical cord clamping: findings and hypothesis. S Afr Med J 1988;73:104-106
   Medline

Author/Editor Response

The authors reply:

To the Editor: We performed transplantations using cord blood collected after early (less than 60 seconds) clamping of the cord in a neonate with a gestational age of 39 weeks who was delivered after a normal pregnancy. There were no postnatal complications. Cord blood has usually been collected from full-term infants, as in our report, and neonates are excluded from consideration if any of the following are present: maternal membrane rupture more than 12 hours before cord-blood collection,1,2 maternal fever, fetal distress, or meconium-stained amniotic fluid2,3. In these studies, the normal practice of midwives with respect to clamping of the cord was not changed, and 199 samples of cord blood were collected with no adverse effects in the neonates or the mothers1,2. In our institution, we have collected 80 cord-blood samples, with no neonatal or maternal complications.

Ende and Ende raise questions about the risks to the neonate of early cord clamping. The study they cite3 to substantiate the risks was performed in 35 premature infants of less than 35 weeks' gestation. The intraventricular hemorrhages in the group that underwent early clamping were all grade 2 or less. There has been no study of full-term infants that indicates a negative outcome associated with early clamping of the cord4. Indeed, according to Hows et al.,1 this is standard practice in many obstetrical units and does not appear to be associated with any increased risk of hemorrhage in the newborn baby.

Marcus R. Vowels, M.D.
Barry Duffy, M.D.
Reg Lam-Po-Tang, M.D.
David Ford, M.Appl.Sc.
Prince of Wales Children's Hospital, Randwick, NSW 2031, Australia

4 References

1. 1

   Hows J, Bradley B, Joyce D, Thierry D, Gluckman E. Umbilical cord blood for transplantation. Lancet 1992;340:921-922
   CrossRef | Web of Science | Medline

2. 2

   Thierry D, Hervatin F, Traineau R, et al. Hematopoietic progenitors cells in cord blood. Bone Marrow Transplant 1992;9:Suppl 1:101-104
   Web of Science | Medline

3. 3

   Hofmeyr GJ, Bolton KD, Bowen DC, Govan JJ. Periventricular/intraventricular haemorrhage and umbilical cord clamping: findings and hypothesis. S Afr Med J 1988;73:104-106
   Medline

4. 4

   Tyson JE. Immediate care of the newborn infant. In: Sinclair JC, Bracken MB, eds. Effective care of the newborn infant. Oxford, England: Oxford University Press, 1992:22-34.