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    Should I Bank Cord Blood?

    Stem cell transplantation has become an exceedingly hot topic of research in modern medicine. Ever since the first successful isolation of stem cell from umbilical cord blood, banking cord blood is becoming increasingly popular in many countries around the world. The issue of whether to bank or not to bank has also been hotly debated. According to many private cord blood banks, cord blood is a form of “insurance” if your newborn child ever gets sick in the future, and that it's a once-in-a-lifetime opportunity you should take advantage of. I have to admit, it sounds very compelling, so much so that it will make you feel slightly guilty if you chose not to bank the blood. Like most parents, I was faced with the same dilemma of whether to bank the cord blood. After tons of research, I eventually decided not to bank. The reason behind my decision? Let me explain in the rest of this article.



    【Stem cell transplantation in brief】


    Stem cells are a class of cells in our body that are able to differentiate into many other different cell types. They have this remarkable potential to develop into tissue- or organ-specific cells when given the necessary stimulation. Theoretically, they can be used to repair damaged tissues or organs, and cure many life-threatening diseases. Clinically, stem cell transplantation has been used to cure many hematologic and immunologic disorders such as leukemia, multiple myeloma, and aplastic anemia. The type of stem cell used to cure these diseases are called hematopoietic stem cell or HSCs.

    The main source of HSCs is the bone marrow, and this source can be further divided into two: autologous (coming from yourself) or allogeneic (coming from your siblings, twin, or an unrelated stranger). If autologous stem cells are not available or cannot be used, then only allogeneic stem cells can be used. Before an allogeneic source can be used for transplant, it must first go through a genetic test called HLA matching to test its compatibility with the recipient’s cell. The closer the match, the higher chance of successful transplantation, and minimal risk of transplant rejection as well as the potentially fatal graft-vs-host-diseases. Unfortunately, there is only a 25% chance for identifying a perfect HLA match in a sibling donor, and an even lower probability (~ 0.001%) for identifying a matched unrelated donor.



    【HSCs in cord blood】


    Umbilical cord blood also contains a rich source of HSCs and can be used as an alternative donor source to treat diseases. Unlike bone marrow, it is relatively easier to obtain a good allogeneic cord blood donor source because you don’t always need a perfect HLA-match in order for the transplant to work, a “close enough” match is all you need. Studies have shown that when compared with similarly mismatched bone marrow HSCs, the cord blood is transplantable with a lower risk of graft-versus-host disease. Therefore, cord blood transplant therapy has a greater advantage clinical applications.



    【Things that private banks didn’t tell you】

    Umbilical cord blood, once considered a human waste, has become a valuable resource after the discovery of stem cell transplantation. Many private banks encourages parents to bank their newborn’s cord blood as a type of “biological insurance” for their beloved child. They will tell you that the cord blood can be used to cure more than 50 diseases, and that it has the potential to cure organ diseases like heart or liver failure if ever there was complications in the near future. You will not have to worry about transplant rejection at all because it is coming from your child’s own body. These claims make cord blood sounds like a magical elixir that cures almost everything, but can we really trust their claims?


    There are some things that private bank didn’t tell you:


    1. The use of cord blood is exaggerated.

    Private banks advertise that cord blood is able to cure organ diseases such heart and liver failure. However, there are no data to support the claim that cord blood can be a tissue source for regenerative medical purposes. Therefore, the use of cord blood in novel treatments are, at this point, merely assumptions. Though it is possible in the future, but we are still uncertain about when it will come true. There also is no successful case of using autologous cord blood transplant for the treatment of Malignant neoplasms. Many private banks, however, still made these unverified claims that malignant can be treated with autologous cord blood. So beware of the advertisement private banks made because a lot of the times they are exaggerating the actual usefulness of cord blood.


    1. Autologous transplantation does not work for congenital disease.

    Some diseases can be congenital, means that the child is born with the disease. Examples are leukemia. In some rare cases the fetus will develop acute leukemia even before she is born. This kind of leukemia are caused by natural gene abnormality. As a result, it is highly possible that the cord blood HSCs of the infant also contains the same genetic defect and therefore cannot be used as a autologous source. Abnormal cells have also been detected in the cord blood of children who were not diagnosed with acute leukemia until later in life. Thus, the strategy for children receiving their own cord blood for the treatment of leukemia might even be contraindicated.



    1. The usability of one’s own cord blood sample is unknown

    Typically, the amount of cord blood obtained from a newborn is about 40 to 100 mL. The amount of effective stem cells that can be extracted from a specific sample is even smaller, only enough for the transplant for a small children. In order for a transplant to be successful, the cell dose per weight of recipient is very important. The heavier the weight, the more stem cells you need. Most hematologic diseases won’t show until the child grows older or enters adulthood. At that time, the number of stem cells needed for transplant will be far greater than a single cord blood sample could provide. Cord blood banking is also a relatively new technology. We are uncertain whether or not the freeze-stored cells will remain its viability after decades of storage. This means the “life insurance” has an expiry that is not as long as the advertised 25 years. You might be spending a huge money on the storage for years but only to find out that it is not usable at all. As technology constantly improves, ex vivo cell expansion techniques (which means multiplication of cells outside of a body) may be able to solve this problem. However, at this point, this is only a distant vision.


    1. The chance of using your own umbilical cord blood is small

    Statistically, the odds that privately banked cord blood will ever be used is very small. It might be a good idea to bank the newborn cord blood privately if a full sibling has already been diagnosed with a medical condition that could potentially benefit from cord blood transplantation. However, parents should keep in mind that, even for siblings, the chance of a good HLA-match is only 25% and the blood sample may not even be enough if the sick sibling is a lot older. Therefore, I do not recommend private cord blood banking for healthy families with no history of genetic disorders. If you are thinking about banking cord blood privately, consult a professional first before making the final decision.

     

    1. The collection, transportation, and storage of cord blood samples are very delicate procedures.

    To ensure the sterility and viability cord blood stem cells, complex procedures must be followed from sample collection to storage. In order to do so, highly trained professionals and hardware that meet set standards are required. If you decide to bank umbilical cord blood, be sure to verify the qualification, make sure their labs, storage environment, and procedures all meet standards before committing to sign a contract.


    【It makes more sense to donate】

    Base on the current development of biomedical science, AAP discourage saving umbilical cord blood as a “life insurance”, because there are no scientific data as of now to support the use of autologous cord blood transplant. Though theoretically possible, we are uncertain whether the theory will become practice at all, or when exactly will this technology be adopted. Most private banks prey on the parent’s fear of the unknown future, knowing how vulnerable the parents are to the emotional effects of the marketing of cord blood banking. They advertise the many possibility as a reality despite there being a lot of uncertainties still.

    Contrarily, there are many successful cases of allogeneic cord blood transplantation. In such cases, the stem cells transplanted are from other individuals. Majority of these stem cell transplants have been done using samples from public banks because a perfect match is not required for cord blood transplantation. This also shows why public donations of cord blood are so important. Donating cord blood increases the amount of samples available for people who are actually in need of it. Although the chance of matching pair between strangers are low, given a large enough sample to choose from, the chance of finding a good sample can still be promising. Donating cord blood maximizes the chance for a patient to find a good matched sample, avoid the life-saving cells going to waste. In addition, by donating the cord blood publicly, we are providing scientists with more research resources.


    【Conclusion】

    Due to small possibility of being used and limitation of autologous usage, cord bloods saved in private banks are mostly wasted. On the other hand, donating cord blood makes it available for free to anyone who needs it. Though I do recommend donating over private banking, the decision is totally up to you. Banking cord blood definitely has its value. You can choose to bank the cord blood privately as a biological insurance for future cell therapy if you are comfortable with the cost, but you shouldn’t feel guilty, irresponsible or even ashamed if you decided not to do so. The key is for parents to be given the accurate information by doctors as well as cord blood banks, so they can make rational choice rather than being pushed into making a decision by false advertisement.



     

    Reference:
    American Academy of Pediatrics Section on Hematology/Oncology. (2007). Cord blood banking for potential future transplantation. Pediatrics, 119(1), 165.
    Kurtzberg, J., Cairo, M. S., Fraser, J. K., Baxter‐Lowe, L., Cohen, G., Carter, S. L., & Kernan, N. A. (2005). Results of the cord blood transplantation (COBLT) study unrelated donor banking program. Transfusion, 45(6), 842-855.
    Sullivan, M. J. (2008). Banking on cord blood stem cells. Nature Reviews Cancer, 8(7), 555-563.

    Those Myths that Raised Us

    Traditional parenting beliefs will sometimes contradict modern parenting and it doesn’t matter where you’re from.  You will often hear:”this is how you were raised!”, usually, this line carries a lot of influence, but are these myths that raised us always right?


    Not necessarily.


    Science and technology have drastically improved over the years and many of the traditional parenting concepts have been proven inefficient, or to even have negative effects! We summarized some of these outdated parenting concepts so when the grandparents try to correct you with their experience, remember to let them know that they might not be right anymore!


    About Newborns

    X Newborns sneeze because they’re cold.

    Newborns often sneeze, but it doesn’t always mean that they’re cold or sick. They have narrow nasal cavities so their nose are easily clogged with dust or mucus, and sneezing is how the body naturally clears up the nasal passages. The capillaries in their nasal cavities are also extremely sensitive, so if the air is too dry or contains stimulants (such as smoke, or perfume) it may also lead to sneezing. Try to make sure the room is well ventilated and if the air gets too dry, try using a humidifier.


    X Newborn Jaundice curable with glucose water.

    Jaundice occurs when there is a high level of bilirubin in the blood, most newborns will have some yellowing of the skin but it’s perfectly normal and will not require special treatments. Feeding the baby often (8 to 12 times a day) to encourage frequent bowel movements is usually enough to help reduce the level of bilirubin. The best treatment is plenty of fluids with breastmilk or formula. Water (glucose or regular) will not help with recovery because it does not encourage bowel movement as much as breastmilk or formula does. Infact, it might make the symptoms worse because it would lower their appetite and allow for the bilirubin to build up. The symptoms will usually go away within 2 weeks. If a newborn is suffering from severe jaundice or still showing symptoms after a long period of time, please consult with your doctors.


    X Newborns should be woken up during the day so they can fall asleep at night.

    A newborn’s sleep cycle shouldn’t be disturbed. They need a lot of sleep in order to grow, typically around 15 to 18 hours a day. The development of the brain and central nervous system are most active when they’re asleep. With this in mind, parents shouldn’t keep their baby awake during the day just to prevent them from waking up in the middle of the night. Their sleeping cycle should be established gradually, and their circadian rhythm should be set naturally. Create an appropriate environment for their brain to naturally adjust. Pull up the curtains during the day and speak with your natural volume; at night, keep the lights dim and keeping all noise level to a minimal.


    X Excessive eye mucus are caused by eye infections.

    Excessive eye mucus are not always caused by eye infections, it’s usually because of a clogged tear duct. When the tear duct gets clogged it may lead to a mild inflammation which can cause the eye to secrete more mucus. It’s a very common symptom for newborns because their tear ducts are a lot narrower. The problem tends to go away as they grow older and their tear ducts finish developing. Parents can try to gently massage the area between the corner of the eyes and the bridge of the nose to try to help clear the clogged ducts. Do not give your baby eye drops without a doctor’s instruction.


    X Newborns needs to sleep on a pillow to get a beautiful head shape.

    It’s actually very dangerous for newborns to sleep on pillows. The risk of SIDS (Sudden Infant Death Syndrome) increases with the use of pillows and it actually doesn’t help to shape the head. If you want your baby to have a beautiful head shape, have more “Tummy Times” with them instead.

     

    About Breast Feeding

    X The mother can’t breastfeed when they’re sick.

    It’s a popular misconception that the mother shouldn’t breastfeed if they’re sick. It doesn’t matter whether you have a cold, flu, stomach-ache or fever, you should continue to breastfeed. By the time the symptoms shows up and you realized you were sick, your child would have already come in contact with the virus. Breastfeeding will not only not transmit the illness to your baby, but it actually contains antibodies to protect them from it.


    X Lacking breast milk for newborns? Just use formula instead.

    Breastmilk is the best source of nutrient for a newborn. While it’s fine for moms to supplement formula along with breastfeeding, some might feel pressured to using it. They feel they don’t produce enough breastmilk, but even if you only produce a little bit, you should always try to breastfeed anyways. Breastfeeding is the best way to increase lactation, so the less you breastfeed, the less milk you will end up producing.

     

    About Nutritional Supplement

    X Babies should sunbathe through a window for Vitamin D.

    Vitamin D is essential for the growth of a healthy baby, it helps their body absorb calcium so they can develop strong bones and teeths. However, sunbathing through a window will not actually help the body produce any Vitamin D. The window actually acts a lot like a sunscreen; although it allows almost 100% of the light rays to pass through, most of the UV rays (specifically UVB which is required to convert 7-Dehydrocholesterol in the skin to Vitamin D3) that helps to produce vitamin D are actually blocked by glass. If you did want to sunbathe, a few minutes under the sun outdoors are enough, but babies have tender skin and should avoid over-exposure to direct UV rays. Pediatricians have suggested the use of Vitamin D supplements instead (around 400IU per day).


    X You should give your baby water/juice to quench their thirst.

    Breast and formula milk already contains enough fluid that babies shouldn’t need any water to hydrate. Only when they start eating solid food should you feed them water.

     

    About Medical Issue

    X Have your baby take Tylenol as soon as they have a fever.

    When you find out your baby has a fever, it can be scary and daunting, but a fever by itself actually causes no harm and may actually be a good thing. Fevers are the way their immune system naturally fights against infections, and not all fevers need to be treated. Tylenol provides temporary pain relief, but it will not speed up the recovery. So if there are no signs of discomfort (loss of appetite, energy and dehydration), there is actually no need to take any medicine. However, if the fever persists for 3 days or more, then you should take them to see a doctor.


    X If your child has a fever: use cold baths, ice packs, or rubbing alcohol to lower body temperature / use blankets to “sweat out the fever”.

    There is no denying that ice packs and cold baths are extremely effective at lowering body temperature, and it does alleviate some of the discomforts from a fever. However, those methods tend to cause the body temperature to drop too drastically. It will actually fool the body into working harder to heat up, effectively making the fever worse! Rubbing alcohol, like the ice pack and cold bath, will cause body temperature to drop too drastically. On top of this alcohol poisoning is also a concern when using rubbing alcohol, as it can be absorbed through the skin (or inhaled because of the fumes). It’s a common belief that you should try to “sweat out a fever” to recover faster, but this belief is unfounded. When your baby has a fever, piling on more blankets will not make the recovery faster, it’ll just make them uncomfortable. If they’re shivering and cold then wrapping them in blankets is fine.

    The proper ways to reduce body temperature are with warm baths, and wiping the body with a warm towel. Also, removing extra pieces of clothing and proper room ventilation will help as well. Allowing the body to naturally dissipate excess heat is ideal.


    Daily Issues

    X The baby’s hands and feet are cold, they should wear another layer of clothing.

    The circulatory system is important in helping our body to maintain temperature. Blood flows all throughout the body, and transfers heat as it travels; that’s why if you were warm, your hands would be warm as well. A baby’s circulatory system are not fully developed yet, so you should not judge whether or not they feels cold based on their hands or feet.  If you want to know whether they are cold or not, the best method is to touch their chest or back.


    X Potty training should start at 1 year old.

    The American Academy of Pediatrics (AAP) suggests parents to start potty training when their baby is around 2 years old. Toddlers younger than 2 years old will have a hard time because their bladder and excretory system would not be fully developed.




     

    Reference:
    American Academy of Pediatrics. 2011. Reversing day-night reversal. Availale from: http://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/Reversing-Day-Night-Reversal.aspx
    American Academy of Pediatrics. 1998. Toilet Training. Guidelines for Parents. Elk Grove Village, Il: AAP
    Kaplan M, Wong RJ, Sibley E, Stevenson DK. Neonatal jaundice and liver diseases. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine Diseases of the Fetus and Infant. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 100.                                      
    La Leche League International. 2016. Can I breast feed my baby if I am sick? Available from :http://www.llli.org/faq/sick.html

    Are Infant Swimming Neck Floaties Safe?

    There is no denying that people love to share adorable baby photos. Occasionally, you might find someone posting cute pictures of their babies at a swimming pool or hot tub with neck floats on. This practice is said to “have the ability to increase the baby’s athleticism and coordination.” While that sounds great, the reality of it is that these neck floats are not safe for babies to use.


    So why are Neck Floats unsafe?


    First of all, the way these neck floats are designed to function is extremely unnatural. Just imagine yourself, being strapped with a neck float in the water. Your head and neck are being restricted, and your body can only stay vertical in the water. I’m sure most people will agree that this wouldn’t feel very comfortable. If something seems uncomfortable for even the adults to use, then it shouldn’t even be mentioned as use for babies!


    Asides from looking uncomfortable, these floats function by using water buoyancy to keep only the head afloat which can cause tremendous stress to the neck. For babies, whose bone and muscle aren’t fully developed yet; it becomes an even bigger issue! Their body weight ends up unnaturally supported by an upward pulling force around the head. Even with the natural buoyancy of water helping to lessen the body weight, there is still a very high chance of injury.


    Knowing how dangerous it is, would you still use it?


    The muscles that are most essential to a newborn’s development are usually the neck and the back. Most of the actions in the next development stage (such as sitting up and crawling) will rely majorily on those. There are certain swimming and parenting classes that might encourage the use of these neck floats, claiming that it will help develop coordination and muscle strength. However, with the neck floats in place, the head and neck are restrained. Floating vertically in the water like that does not efficiently develop the neck, shoulder and back muscles.


    Pediatricians have strongly recommended against the use of neck floats. There are a lot of different exercises suitable for young babies. Rather than having young babies involved in unsafe exercises, let them have more “Tummy Times” instead. Not only is it a lot safer, it’s also the perfect way to develop the muscles needed!


    In a safe and controlled environment, taking your baby to play with water or swim does benefit their sensory development. But before signing up your baby for a swimming class, you need to note the followings:


    1. The American Academy of Pediatrics does not suggest babies under 12 months old to learn to swim. What they mean by this is: Although many advertisements show that swimming offers babies a lot of benefits. There is no scientific study to show that these lessons are actually teaching them anything. Therefore, when signing up you baby to a “swimming” lesson, you should focus more on the entertainment and safety, and not the actual “swimming” as they are still too young to actually learn.

    1. Swimming classes should always be accompanied by parents as well.

    1. Parents can choose to instead enroll in programs run by reputable organizations like Red Cross. They will usually have strict pool and hygienic standards. They even regulate the water temperature to constantly be at around 32°C!

    1. The swimming instructors must have the proper qualification and experience! Ideally, there shouldn’t be too many people in a class as well. That way the instructor can pay more attention to make sure everyone is safe.

    If you’re not interested in enrolling into a class, and instead want to just take your baby to the public pool by yourself. Here are some things you need to be aware of:

     

    1. When you’re inside the pool, please make sure that your child is always within an arm’s reach, and always within your line of sight. Never leave your baby alone in the pool, not even for one second!

    1. Babies under 12 months old should not stay in the water for more than 30 minutes. They lose heat a lot faster than an adult.

    1. Water temperatures at the pool should ideally be around 32°C, any hotter or colder is not recommended for babies. If your child is starting to shiver inside the water, quickly take them out of a pool and warm up with a dry towel.

    1. Do not submerge your child in water. Humans are not fish. Swimming is a skill that needs to be learned as we grow up, it is not inherently a trait.

    1. Do not use random safety gears. For babies, the best protection is still the parent’s watchful eyes. If you want to take extra precautions, use a baby-sized life jacket instead. Once again, make sure to always keep your baby within an arm’s reach at the pool!

    So how old should a child be before actually learning how to swim?


    The American Academy of Pediatrics (AAP) suggests that:


    For the most part, children should be at least 4 years old before learning how to swim. By this age, their body will have developed enough to swim.


    As of now there is not enough research to show what kind of teaching method is best for children aged 1 to 4. Parents who wish to enroll their child to swimming classes need to be extra attentive. Remember that every child is different. Some will learn how to swim when they are extremely young, and some will end up never knowing how to swim but you should never compare your child to someone else’s!

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