If you are expecting a baby you have undoubtedly thought about the nursery, the pram and the seemingly never ending list of things that you and your baby will need. But have you thought about what to do with your baby's umbilical cord?

Umbilical cord blood is the blood that remains in your baby's umbilical cord and placenta after the birth of the baby and the umbilical cord has been cut. The cord blood contains a potent mixture of cells, including stem cells, which are the 'building blocks' of all cells in the body. These include specialised stem cells such as haematopoietic stem cells (HSCs), which have the unique ability to develop into all of the different blood cell types, as well as other types of stem cells.

Cord blood is also a source of unique populations of immune cells, called regulatory T-cells. These are important in controlling the immune system and may have therapeutic potential in the treatment of immune disorders.

Collecting the umbilical cord blood is not harmful to the baby or mother and ensures that these cells are immediately available if ever needed. If you don’t choose to store your baby's cord blood, it would normally be discarded as medical waste after the birth.

Cord blood stem cells may be used in two areas of disease and injury treatment: Transplant Medicine and Regenerative Medicine.

• Transplant Medicine
  Currently in Australia, cord blood stem cells are used in a variety of medical treatments to regenerate healthy blood and immune cells after a patient's own blood cells have been destroyed by chemotherapy and/or irradiation and currently play an important role in the treatment of blood and immune system related diseases, cancers and blood disorders. Infused directly into the patient's blood stream, they migrate to the bone marrow where they begin differentiating into the three blood cell types - red blood cells, white blood cells and platelets. This initiates the regeneration of the patient's blood and immune system.
  
• Regenerative Medicine
  Cord blood is also being used overseas in an emerging field called regenerative medicine. This field of medical research is exploring how cord blood stem cells may be used to repair or regenerate cells and tissue damaged by illness or accident. Among the primary applications are autoimmune diseases, such as type 1 diabetes and rheumatoid arthritis where the body's immune system turns to destroying body tissues. Other experimental approaches are looking at the potential of cord blood stem cells to treat conditions like brain injury.
  

Medical Developments
Regenerative medicine is one of the most active areas of research in the world. Currently, in the cord blood area alone, approved major clinical trials in experimental therapies to treat cerebral palsy, brain injury and juvenile diabetes are underway in the USA and Europe.

• More than 250 children diagnosed with cerebral palsy have already been treated with their own cord blood stem cells at Duke University in the US. Anecdotal reports show promising results. Parents, therapists and researchers are observing some dramatic improvements in the motor and speech skills of the children, in some cases within a few days of being treated. Trials at the Medical College of Georgia, Duke University and in Germany are currently being conducted on infants diagnosed with cerebral palsy.
• The University of Florida is conducting the first approved clinical trial to evaluate using cord blood in the treatment of Type 1 Diabetes. Preliminary results suggest that this treatment is able to stop progression of the diabetes leading to reduced insulin dependency.

Australia is also looking to play an important part in the development of these treatments with trials planned:

• Monash Medical Centre (VIC), with the support of Cell Care, Australia's largest private cord blood bank, is working to establish a clinical trial for the use of autologous cord blood to treat cerebral palsy. The study will be similar to that being undertaken at Duke University.
• Subject to securing the necessary funding, a Cell Care study is looking at the development of a protocol for a trial of cord blood use in Type 1 Diabetes. A grant application to support this trial is currently under review.

In other areas of cord blood research, two umbilical cord blood "stem cell expansion" technologies are in, or are about to commence, Phase 3 trials (www.mesoblast.com, www.gamida-cell.com). If these prove successful then cord blood will be a potential source of stem cells for life, not just during childhood.

With so much work going on, an increasing number of parents worldwide are making the decision to "bank" their baby's cord blood stem cells as insurance for their baby's future health. Whilst the probability of your child ever needing to use the cells is low, the reassurance of knowing that they are stored and readily available to their child gives parents enormous peace of mind.

Banking Options in Australia
Currently in Australia cord blood can be collected and stored in two ways:

1. As a public donation to a government funded, non-profit, public cord blood bank for use by anyone needing a transplant; and
2. Privately stored for possible future personal use. This service is only offered by private cord blood banks.
   Australian parents deciding to store cord blood are able to choose between public or private cord blood banking. It is very important to understand the differences between the two types of bank in order to make a completely informed decision.

Public Banking
A public cord blood bank is much like a standard blood bank. Public donation allows families to offer their baby's cord blood stem cells to the public network at no cost. The donation is intended to increase the national supply of cord blood and once donated, is made available to any patient worldwide, who is in need of a cord blood transplant.

AusCord is the Australian national network of umbilical cord blood banks and cord blood collection centres. The network collects and banks cord blood from voluntary donors for anonymous use by patients needing a stem cell transplant. Only hospitals associated with the public cord blood banks that are licensed by the Therapeutic Goods Administration and accredited by the Foundation for Accreditation of Cellular Therapy are able to collect cord blood and stringent acceptance criteria apply so not every sample collected is banked. AusCord currently employs specially trained Collection Personnel to collect cord blood from a limited number of hospitals in NSW, VIC, QLD and NT. Currently there are no collection facilities in Western Australia, South Australia or Tasmania.

There are no costs charged to the parents who consent to the donation of their baby's cord blood or the Australian patient who receives this life saving treatment. The network is funded by the Government.

Private Banking
Storing in a private bank is much like holding something in a safe. The parents retain ownership and control the destiny of their baby's cord blood, but there is a fee associated with the collection and storage. Families choose to store their baby's cord blood privately for many reasons, including a) having a family history of disease, b) having a baby of an ethnic minority or mixed ethnicity, where there may be a greater difficulty finding a matched donor through the public banks c) for future regenerative medicine therapies, where the child's own stem cells will be required and d) as insurance for their child's future health. Cord blood stem cells represent a perfect match for the baby that they were collected from so the risks of rejection are eliminated.

Private cord blood collections can take place at any time and in most hospitals Australia-wide with a network of trained obstetricians, midwives and healthcare professionals available to perform the collection.

Although it is difficult to estimate the likelihood of using stem cells, some published studies have estimated the chance of needing a stem cell transplant from any source (i.e. cord blood, bone marrow) to be:

• The chance of a child (ages 0 to 21) needing a therapy using his or her own stem cells are currently about 1 in 2,700.(reference 2)
• The chance of an individual needing stem cells (either their own or from someone else) for transplantation over the course of their lifetime, is estimated to be about 1 in 217 (ages 0-70). (reference 3)

These estimates do not include future therapies that may be developed. 

While the probability of a child needing a transplant (eg for leukaemia) in early childhood is low, the emerging regenerative medicine technologies and clinical trials taking place with autologous cord blood support parents researching their options for the future.

Ultimately the choice between public and private banking belongs to the parents. If you are interested in collecting your baby's cord blood, talk to your obstetrician, GP or midwife to discuss your options.

Find our where you can donate cord blood

References:
1. Australian Bone Marrow Transplant Recipient Registry Annual Data Summary 2006
2. Johnson F. Placental blood transplantation and autologous banking-caveat emptor. J Pediatr Hematol Oncol. 1997;19(3):183-6.
3. Nietfeld JJ, Pasquini MC, Logan BR, Verter F, Horowitz MM. Lifetime probabilities of hematopoietic stem cell transplantation in the U.S. Biol Blood Marrow Transplant. Mar 2008;14(3):316-322.

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