Analysis of influencing factors for the cord blood collection volume in newborns with congenital heart disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

PENG Zirui ¹ , LIU Yanli ¹ , MENG Qingqing ^1,2 , LIU Yumei ^1,2 , ZHANG Pushan ¹ , LOU Qi ¹ , LIU Xiaobing ^1,2 ,  WEN Shusheng ^1,2 ,  YUAN Haiyun ^1,2

1. Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, P. R. China;
2. Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, 510080, P. R. China;

Corresponding?author：

WEN Shusheng, Email: yhy_yun@163.com; YUAN Haiyun, Email: doctorwen@139.com

Keywords：

Congenital heart disease; newborns; umbilical cord blood; blood collection volume; umbilical cord length; influencing factors

DOI：

10.7507/1007-4848.202601090

Video：

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Objective To investigate the influencing factors of umbilical cord blood collection volume in newborns with congenital heart disease (CHD), so as to provide a scientific basis for promoting the development of umbilical cord blood reinfusion technology. Methods A retrospective study was conducted on CHD newborns who were delivered in the Department of Obstetrics, Guangdong Provincial People's Hospital and underwent umbilical cord blood collection from August 2024 to January 2026. Clinical data related to pregnant women, newborns, placentas and umbilical cords were collected. Results A total of 144 CHD newborns were enrolled, including 50 in the simple CHD group and 94 in the complex CHD group. The mean maternal age was (31.0±5.0) years. Among the CHD newborns, 96 (66.7%) were male and 48 (33.3%) were female. Umbilical cord blood collection volume was significantly positively correlated with maternal weight, placental weight, umbilical cord length, neonatal body length, neonatal head circumference and birth weight, among which neonatal head circumference (r=0.315, P<0.001) and birth weight (r=0.327, P<0.001) showed the strongest correlations. Multiple linear regression analysis revealed that after adjusting for neonatal birth weight, placental weight, umbilical cord length and maternal weight, only umbilical cord length was an independent influencing factor for umbilical cord blood collection volume (B=0.488, β=0.262, P=0.007). Conclusion The volume of umbilical cord blood collected from CHD newborns is affected by multiple factors, among which umbilical cord length is the most dominant one.

1.	Yao AC, Moinian M, Lind J. Distribution of blood between infant and placenta after birth. Lancet, 1969, 2(7626): 871-873.
2.	彭梓睿, 袁海云, 孟擎擎, 等. 自體臍帶血預充CPB管路在新生兒先天性心臟病外科手術中的應用. 中華胸心血管外科雜志, 2025, 41(10): 589-598.Peng ZR, Yuan HY, Meng QQ, et al. Study on the application of autologous umbilical cord blood priming of CPB circuit in cardiac surgery for congenital heart disease. Chin J Thorac Cardiovasc Surg, 2025, 41(10): 589-598.
3.	梁潤哲, 張志濤, 呂遠, 等. 臍帶血自體回輸在產時手術及新生兒外科手術中應用的可行性探討. 中國實用婦科與產科雜志, 2019, 35(5): 589-592.Liang RZ, Zhang ZT, Lyu Y, et al. Feasibility of application of umbilical cord blood autologous transfusion in intrapartum and neonatal surgery. Chin J Pract Gynecol Obstet, 2019, 35(5): 589-592.
4.	袁海云, 彭梓睿, 孟擎擎, 等. 臍帶血自體回輸在先心病產前產后一體化診療中的操作管理規范. 中國心血管病研究, 2026, 24(1): 5-9.Yuan HY, Peng ZR, Meng QQ, et al. Standard operating procedures for the application of umbilical cord blood autotransfusion in the integrated prenatal diagnosis and postpartum treatment management program for congenital heart disease. Chin J Cardiovasc Res, 2026, 24(1): 5-9.
5.	Darwish A, Bassiouny MR, Mansour AK, et al. Neonatal factors impacting umbilical cord blood unit characteristics. Sci Rep, 2025, 15(1): 16776.
6.	Hung TH, Chuang YC, Huang L. The association between placental residual blood volume and two placental transfusion methods after delivery at term. Front Pediatr, 2021, 9: 768075.
7.	Samarkanova D, Codinach M, Montemurro T, et al. Multi-component cord blood banking: a proof-of-concept international exercise. Blood Transfus, 2023, 21(6): 526-537.
8.	Chaowawanit W, Koovimon P, Soongsatitanon A. The residual blood from segmental umbilical cord milking in preterm delivery. J Obstet Gynaecol, 2020, 40(2): 205-210.
9.	McAdams RM, Fay E, Delaney S. Whole blood volumes associated with milking intact and cut umbilical cords in term newborns. J Perinatol, 2018, 38(3): 245-250.
10.	Jones J, Stevens CE, Rubinstein P, et al. Obstetric predictors of placental/umbilical cord blood volume for transplantation. Am J Obstet Gynecol, 2003, 188(2): 503-509.
11.	Flo K, Kulseng CPS, Peterson HF, et al. Placental size and umbilical vein volume blood flow. Acta Obstet Gynecol Scand, 2025, 104(6): 1135-1142.
12.	Mercer JS, Erickson-Owens DA, Collins J, et al. Effects of delayed cord clamping on residual placental blood volume, hemoglobin and bilirubin levels in term infants: a randomized controlled trial. J Perinatol, 2017, 37(3): 260-264.
13.	Ruangkit C, Bumrungphuet S, Panburana P, et al. A randomized controlled trial of immediate versus delayed umbilical cord clamping in multiple-birth infants born preterm. Neonatology, 2019, 115(2): 156-163.
14.	Qian Y, Ying X, Wang P, et al. Early versus delayed umbilical cord clamping on maternal and neonatal outcomes. Arch Gynecol Obstet, 2019, 300(3): 531-543.
15.	Ali N, Donofrio MT. Delivery room and early postnatal management of neonates with congenital heart disease. Prenat Diagn, 2024, 44(8): 915-924.
16.	Backes CH, Huang H, Cua CL, et al. Early versus delayed umbilical cord clamping in infants with congenital heart disease: a pilot, randomized, controlled trial. J Perinatol, 2015, 35(10): 826-831.
17.	Marzec L, Zettler E, Cua CL, et al. Timing of umbilical cord clamping among infants with congenital heart disease. Prog Pediatr Cardiol, 2020, 59: 101318.
18.	Pellegrino C, Papacci P, Beccia F, et al. Differences in cerebral tissue oxygenation in preterm neonates receiving adult or cord blood red blood cell transfusions. JAMA Netw Open, 2023, 6(11): e2341643.
19.	Teofili L, Papacci P, Pellegrino C, et al. Cord red blood cell transfusions for severe retinopathy in preterm neonates in Italy: a multicenter randomized controlled trial. EClinicalMedicine, 2025, 87: 103426.
20.	Hassall OW, Thitiri J, Fegan G, et al. Safety and efficacy of allogeneic umbilical cord red blood cell transfusion for children with severe anaemia in a Kenyan hospital: an open-label single-arm trial. Lancet Haematol, 2015, 2(3): e101-e107.
21.	Dang D, Gu X, Jiang S, et al. RBC transfusion and necrotizing enterocolitis in very preterm infants: a multicenter observational study. Sci Rep, 2024, 14(1): 14345.
22.	Teofili L, Papacci P, Giannantonio C, et al. Allogenic cord blood transfusion in preterm infants. Clin Perinatol, 2023, 50(4): 881-893.
23.	Bianchi M, Papacci P, Valentini CG, et al. Umbilical cord blood as a source for red-blood-cell transfusion in neonatology: a systematic review. Vox Sang, 2018, 113(8): 713-725.
24.	Teofili L, Papacci P, Orlando N, et al. Allogeneic cord blood transfusions prevent fetal haemoglobin depletion in preterm neonates. Results of the CB-TrIP study. Br J Haematol, 2020, 191(2): 263-268.
25.	Maslen CL. Recent advances in placenta-heart interactions. Front Physiol, 2018, 9: 735.
26.	Josowitz R, Woyciechowski S, Jadhav T, et al. Placental malperfusion is associated with adverse outcomes in congenital heart disease and with genetic variants in placental developmental pathways. J Am Coll Cardiol, 2025, 86(19): 1704-1720.
27.	Jacobwitz M, Kapse K, Ngwa J, et al. Placental and fetal in utero growth among fetuses with congenital heart disease. JAMA Netw Open, 2025, 8(4): e257217.
28.	Sathasivam R, Selliah P, Sivalingarajah R, et al. Placental weight and its relationship with the birth weight of term infants and body mass index of the mothers. J Int Med Res, 2023, 51(5): 3000605231172895.
29.	Fumarola S, Lucarini A, Lucchetti G, et al. Predictors of cord blood unit cell content in a volume unrestricted large series collections: a chance for a fast and cheap multiparameter selection model. Stem Cell Res Ther, 2022, 13(1): 246.
30.	Zdanowicz JA, von Dach S, Justen AK, et al. Placental weight in pregnancies complicated by fetal congenital heart defects. Placenta, 2025, 167: 166-174.
31.	Leon RL, Sharma K, Mir IN, et al. Placental vascular malperfusion lesions in fetal congenital heart disease. Am J Obstet Gynecol, 2022, 227(4): 620. e621-620. e628.
32.	Nijman M, van der Meeren LE, Nikkels PGJ, et al. Placental pathology contributes to impaired volumetric brain development in neonates with congenital heart disease. J Am Heart Assoc, 2024, 13(5): e033189.

1. Yao AC, Moinian M, Lind J. Distribution of blood between infant and placenta after birth. Lancet, 1969, 2(7626): 871-873.
2. 彭梓睿, 袁海云, 孟擎擎, 等. 自體臍帶血預充CPB管路在新生兒先天性心臟病外科手術中的應用. 中華胸心血管外科雜志, 2025, 41(10): 589-598.Peng ZR, Yuan HY, Meng QQ, et al. Study on the application of autologous umbilical cord blood priming of CPB circuit in cardiac surgery for congenital heart disease. Chin J Thorac Cardiovasc Surg, 2025, 41(10): 589-598.
3. 梁潤哲, 張志濤, 呂遠, 等. 臍帶血自體回輸在產時手術及新生兒外科手術中應用的可行性探討. 中國實用婦科與產科雜志, 2019, 35(5): 589-592.Liang RZ, Zhang ZT, Lyu Y, et al. Feasibility of application of umbilical cord blood autologous transfusion in intrapartum and neonatal surgery. Chin J Pract Gynecol Obstet, 2019, 35(5): 589-592.
4. 袁海云, 彭梓睿, 孟擎擎, 等. 臍帶血自體回輸在先心病產前產后一體化診療中的操作管理規范. 中國心血管病研究, 2026, 24(1): 5-9.Yuan HY, Peng ZR, Meng QQ, et al. Standard operating procedures for the application of umbilical cord blood autotransfusion in the integrated prenatal diagnosis and postpartum treatment management program for congenital heart disease. Chin J Cardiovasc Res, 2026, 24(1): 5-9.
5. Darwish A, Bassiouny MR, Mansour AK, et al. Neonatal factors impacting umbilical cord blood unit characteristics. Sci Rep, 2025, 15(1): 16776.
6. Hung TH, Chuang YC, Huang L. The association between placental residual blood volume and two placental transfusion methods after delivery at term. Front Pediatr, 2021, 9: 768075.
7. Samarkanova D, Codinach M, Montemurro T, et al. Multi-component cord blood banking: a proof-of-concept international exercise. Blood Transfus, 2023, 21(6): 526-537.
8. Chaowawanit W, Koovimon P, Soongsatitanon A. The residual blood from segmental umbilical cord milking in preterm delivery. J Obstet Gynaecol, 2020, 40(2): 205-210.
9. McAdams RM, Fay E, Delaney S. Whole blood volumes associated with milking intact and cut umbilical cords in term newborns. J Perinatol, 2018, 38(3): 245-250.
10. Jones J, Stevens CE, Rubinstein P, et al. Obstetric predictors of placental/umbilical cord blood volume for transplantation. Am J Obstet Gynecol, 2003, 188(2): 503-509.
11. Flo K, Kulseng CPS, Peterson HF, et al. Placental size and umbilical vein volume blood flow. Acta Obstet Gynecol Scand, 2025, 104(6): 1135-1142.
12. Mercer JS, Erickson-Owens DA, Collins J, et al. Effects of delayed cord clamping on residual placental blood volume, hemoglobin and bilirubin levels in term infants: a randomized controlled trial. J Perinatol, 2017, 37(3): 260-264.
13. Ruangkit C, Bumrungphuet S, Panburana P, et al. A randomized controlled trial of immediate versus delayed umbilical cord clamping in multiple-birth infants born preterm. Neonatology, 2019, 115(2): 156-163.
14. Qian Y, Ying X, Wang P, et al. Early versus delayed umbilical cord clamping on maternal and neonatal outcomes. Arch Gynecol Obstet, 2019, 300(3): 531-543.
15. Ali N, Donofrio MT. Delivery room and early postnatal management of neonates with congenital heart disease. Prenat Diagn, 2024, 44(8): 915-924.
16. Backes CH, Huang H, Cua CL, et al. Early versus delayed umbilical cord clamping in infants with congenital heart disease: a pilot, randomized, controlled trial. J Perinatol, 2015, 35(10): 826-831.
17. Marzec L, Zettler E, Cua CL, et al. Timing of umbilical cord clamping among infants with congenital heart disease. Prog Pediatr Cardiol, 2020, 59: 101318.
18. Pellegrino C, Papacci P, Beccia F, et al. Differences in cerebral tissue oxygenation in preterm neonates receiving adult or cord blood red blood cell transfusions. JAMA Netw Open, 2023, 6(11): e2341643.
19. Teofili L, Papacci P, Pellegrino C, et al. Cord red blood cell transfusions for severe retinopathy in preterm neonates in Italy: a multicenter randomized controlled trial. EClinicalMedicine, 2025, 87: 103426.
20. Hassall OW, Thitiri J, Fegan G, et al. Safety and efficacy of allogeneic umbilical cord red blood cell transfusion for children with severe anaemia in a Kenyan hospital: an open-label single-arm trial. Lancet Haematol, 2015, 2(3): e101-e107.
21. Dang D, Gu X, Jiang S, et al. RBC transfusion and necrotizing enterocolitis in very preterm infants: a multicenter observational study. Sci Rep, 2024, 14(1): 14345.
22. Teofili L, Papacci P, Giannantonio C, et al. Allogenic cord blood transfusion in preterm infants. Clin Perinatol, 2023, 50(4): 881-893.
23. Bianchi M, Papacci P, Valentini CG, et al. Umbilical cord blood as a source for red-blood-cell transfusion in neonatology: a systematic review. Vox Sang, 2018, 113(8): 713-725.
24. Teofili L, Papacci P, Orlando N, et al. Allogeneic cord blood transfusions prevent fetal haemoglobin depletion in preterm neonates. Results of the CB-TrIP study. Br J Haematol, 2020, 191(2): 263-268.
25. Maslen CL. Recent advances in placenta-heart interactions. Front Physiol, 2018, 9: 735.
26. Josowitz R, Woyciechowski S, Jadhav T, et al. Placental malperfusion is associated with adverse outcomes in congenital heart disease and with genetic variants in placental developmental pathways. J Am Coll Cardiol, 2025, 86(19): 1704-1720.
27. Jacobwitz M, Kapse K, Ngwa J, et al. Placental and fetal in utero growth among fetuses with congenital heart disease. JAMA Netw Open, 2025, 8(4): e257217.
28. Sathasivam R, Selliah P, Sivalingarajah R, et al. Placental weight and its relationship with the birth weight of term infants and body mass index of the mothers. J Int Med Res, 2023, 51(5): 3000605231172895.
29. Fumarola S, Lucarini A, Lucchetti G, et al. Predictors of cord blood unit cell content in a volume unrestricted large series collections: a chance for a fast and cheap multiparameter selection model. Stem Cell Res Ther, 2022, 13(1): 246.
30. Zdanowicz JA, von Dach S, Justen AK, et al. Placental weight in pregnancies complicated by fetal congenital heart defects. Placenta, 2025, 167: 166-174.
31. Leon RL, Sharma K, Mir IN, et al. Placental vascular malperfusion lesions in fetal congenital heart disease. Am J Obstet Gynecol, 2022, 227(4): 620. e621-620. e628.
32. Nijman M, van der Meeren LE, Nikkels PGJ, et al. Placental pathology contributes to impaired volumetric brain development in neonates with congenital heart disease. J Am Heart Assoc, 2024, 13(5): e033189.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesAnalysis of influencing factors for the cord blood collection volume in newborns with congenital heart disease

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