Is it necessary for me to store my baby's cord blood?

Umbilical cord blood

Up to 180mL of blood from a newborn baby that is returned to the neonatal circulation if the umbilical cord is not prematurely clamped. In some obstetric and midwifery practices, physiological extended-delayed cord clamping protocol, as well as water birth, allows for the cord blood to pulse into the neonate for 5-20 minutes after delivery. If the umbilical cord is not clamped, a physiological clamping occurs upon interaction with cold air, when the internal gelatinous substance, called Wharton's jelly, swells around the umbilical artery and veins.

Cord blood harvesting

A cord blood bank may be a private commercial enterprise, or a public medical resource.

Cord blood banking is controversial in the medical and parenting community. Blood collected this way takes up to 180mL from the neonate (sometimes up to half of the total blood volume) which is a highly controversial subject in perinatal medicine. Cord blood is rich in hematopoietic stem cells, however, The American Academy of Pediatrics 2007 Policy Statement on Cord Blood Banking states that:

"Physicians should be aware of the unsubstantiated claims of private cord blood banks made to future parents that promise to insure infants or family members against serious illnesses in the future by use of the stem cells contained in cord blood;"

Cord blood is stored by both public and private cord blood banks. Public cord blood banks store cord blood for the benefit of the general public, and most U.S. banks coordinate matching cord blood to patients through the National Marrow Donor Program (NMDP). Private cord blood banks are for-profit organizations which store cord blood for the exclusive use of the donor or donor's relatives.

Public cord blood banking is supported by the medical community. However, private cord blood banking is generally not recommended unless there is a family history of specific genetic diseases. Private banking is unlawful in France and Italy, and opposed by the European Group on Ethics in Science and New Technologies.

New parents have the option of storing their newborn's cord blood at a private cord blood bank or donating it to a public cord blood bank. The cost of private cord blood banking is approximately $2000 for collection and approximately $125 per year for storage, as of 2007. Donation to a public cord blood bank is not possible everywhere, but availability is increasing. Several local cord blood banks across the United States are now accepting donations from within their own states. The cord blood bank will not charge the donor for the donation; the OB/GYN may still charge a collection fee, although many OB/GYNs choose to donate their time.

After the first sibling-donor cord blood transplant was performed in 1988, the National Institute of Health (NIH) awarded a grant to Dr. Pablo Rubinstein to develop the world's first cord blood program at the New York Blood Center(NYBC), in order to establish the inventory of non embryonal stem cell units necessary to provide unrelated, matched grafts for patients.

In 2005, University of Toronto researcher Peter Zandstra developed a method to increase the yield of cord blood stem cells to enable their use in treating adults as well as children.

Controversy

While there is general support in the medical community for public banking of cord blood, the question of private banking has raised objections from many governments and nonprofit organizations. The controversy centers on varying assessments of the current and future likelihood of successful uses of the stored blood. In March 2008, a paper was published by Nietfeld et al. in the journal Biology of Blood and Marrow Transplantation which computed the lifetime probability (up to age 70) that an individual in the US would undergo a stem cell transplant. The likelihood of an autologous transplant using your own stem cells is 1 in 435, the likelihood of an allogeneic transplant from a matched donor (such as a sibling) is 1 in 400, and the net likelihood of any type of stem cell transplant is 1 in 217.

The National Marrow Donor Program estimates that by the year 2015, there will be 10,000 cord blood transplants world-wide per year using publicly banked cord blood. It is therefore vitally important to build public repositories of cord blood donations throughout the world. In the United States, the Health Resources and Services Administration (HRSA) of the US Dept. of Health and Human Services is responsible for funding national programs to register marrow donors and bank cord blood donations:

The European Union Group on Ethics (EGE) has issued Opinion No.19 titled Ethical Aspects of Umbilical Cord Blood Banking. The EGE concluded that "[t]he legitimacy of commercial cord blood banks for autologous use should be questioned as they sell a service, which has presently, no real use regarding therapeutic options. Thus they promise more than they can deliver. The activities of such banks raise serious ethical criticisms." However, in the final section 1.27 of their Opinion, the EGE admits that: "if in the future regenerative medicine developed in such a way that using autologous stem cells became possible, then the fact to have one's own cord blood being stored at birth could increase the chance of having access to new therapies."

In May 2006, The World Marrow Donor Association (WMDA) Policy Statement for the Utility of Autologous or Family Cord Blood Unit Storage stated that:

1. The use of autologous cord blood cells for the treatment of childhood leukemia is contra-indicated because pre-leukemic cells are present at birth. Autologous cord blood carries the same genetic defects as the donor and should not be used to treat genetic diseases.
2. There is at present no known protocol where autologous cord blood stem cells are used in therapy.
3. If autologous stem cell therapies should become reality in the future, these protocols will probably rely on easily accessible stem cells.

As of spring 2008, there are several known instances where autologous use of cord blood is indicated:

1. Whereas the WMDA cautioned against autologous transplant for diseases with a genetic signature, there are pediatric cancers (ex: neuroblastoma) and acquired conditions (ex: aplastic anemia) which can be treated by autologous transplant. There has even been one autologous transplant for leukemia
2. Type 1 Diabetes, also known as Juvenile Diabetes, has been shown to improve if treated shortly after onset with an infusion of autologous cord blood. The American Diabetes Association reports that 1 in 7000 children is diagnosed each year with Type 1 diabetes, and 1 in 600 children are living with it.
3. Cerebral Palsy and other forms of pediatric brain injury have responded well to infusions of autologous cord blood in a clinical trial conducted at Duke University. The Brain Injury Association of America estimates that the prevalence of Cerebral Palsy is about 1 in 300 among children up to age 10.

All about Kawasaki disease

Kawasaki disease is an illness that involves the skin, mouth, and lymph nodes, and most often affects kids under age 5. The cause is unknown, but if the symptoms are recognized early, kids with Kawasaki disease can fully recover within a few days. Untreated, it can lead to serious complications that can affect the heart.

Kawasaki disease occurs in 19 out of every 100,000 kids in the United States. It is most common among children of Japanese and Korean descent, but can affect all ethnic groups.
Signs and Symptoms

Kawasaki disease can't be prevented, but usually has telltale symptoms and signs that appear in phases.

The first phase, which can last for up to 2 weeks, usually involves a persistent fever higher than 104° Fahrenheit (39° Celsius) and lasts for at least 5 days.


Other symptoms that typically develop include:

* severe redness in the eyes
* a rash on the stomach, chest, and genitals
* red, dry, cracked lips
* swollen tongue with a white coating and big red bumps
* sore, irritated throat
* swollen palms of the hands and soles of the feet with a purple-red color
* swollen lymph nodes

During the second phase, which usually begins within 2 weeks of when the fever started, the skin on the hands and feet may begin to peel in large pieces. The child also may experience joint pain, diarrhea, vomiting, or abdominal pain. If your child shows any of these symptoms, call your doctor.
Complications

Doctors can manage the symptoms of Kawasaki disease if they catch it early. Symptoms often disappear within just 2 days of the start of treatment. If Kawasaki disease is treated within 10 days of the onset of symptoms, heart problems usually do not develop.

Cases that go untreated can lead to more serious complications, such as vasculitis, an inflammation of the blood vessels. This can be particularly dangerous because it can affect the coronary arteries, which supply blood to the heart.

In addition to the coronary arteries, the heart muscle, lining, valves, and the outer membrane that surrounds the heart can become inflamed. Arrhythmias (changes in the normal pattern of the heartbeat) or abnormal functioning of some heart valves also can occur.
Diagnosis

No one test can detect Kawasaki disease, so doctors usually diagnose it by evaluating the symptoms and ruling out other conditions.

Most kids diagnosed with Kawasaki disease will have a fever lasting 5 or more days and at least four of these symptoms:

* redness in both eyes
* changes around the lips, tongue, or mouth
* changes in the fingers and toes, such as swelling, discoloration, or peeling
* a rash in the trunk or genital area
* a large swollen lymph node in the neck
* red, swollen palms of hands and soles of feet

If Kawasaki disease is suspected, the doctor may order tests to monitor heart function (such as an echocardiogram) and might take blood and urine samples to rule out other conditions, such as scarlet fever, measles, Rocky Mountain spotted fever, juvenile rheumatoid arthritis, or an allergic drug reaction.
Treatment

Treatment should begin as soon as possible, ideally within 10 days of when the fever begins. Usually, a child is treated with intravenous doses of gamma globulin (purified antibodies), an ingredient of blood that helps the body fight infection. The child also might be given a high dose of aspirin to reduce the risk of heart problems.

Do Allergies Cause Asthma?

Although allergies and asthma are separate conditions, they are related. People who have allergies — particularly those that affect the nose and eyes — are more likely to have asthma. If you have allergies or asthma, your child is more likely to have it, too, because the tendency to develop these conditions is often inherited.
But not everyone who has allergies has asthma, and not all cases of asthma are related to allergies. About 75% of kids who have asthma also have an allergy to something. And many people who have asthma find their symptoms get worse when they're exposed to specific allergens (things that can cause allergic reactions in some people).

With any kind of allergy, the immune system overreacts to normally harmless substances such as pollen or dust mites. As part of this overreaction, the body produces an antibody of the immunoglobulin E (IgE) type, which specifically recognizes and attaches to the allergen when the body is exposed to it.

When that happens, it sets a process in motion that results in the release of certain substances in the body. One of them is histamine, which causes allergic symptoms that can affect the eyes, nose, throat, skin, gastrointestinal tract, or lungs. When the airways in the lungs are affected, symptoms of asthma can occur.

Future exposure to the same allergens can cause the reaction to happen again. So if your child has asthma, it's wise to explore whether allergies may be triggering some of the symptoms. Talk with your doctor about how to identify possible triggers, which can be things other than allergens, such as cold air, pets, or tobacco smoke. Your doctor might also recommend visiting an allergist for allergy tests. If your child is allergic to something, that substance may be causing or contributing to asthma symptoms (coughing, wheezing, and trouble breathing).

If it does look like allergens are an important trigger for the asthma symptoms, do what you can to help your child avoid exposure to the allergens involved. If this doesn't control the asthma symptoms adequately, the doctor may also prescribe medications or allergy shots.