Cord Blood Test Could Predict Which Babies at Risk of Severe Lung Disease, Study Reports

A simple test with cord blood could predict which babies are at risk of developing a severe lung disease called bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH), according to a study.

If scientists can validate the test’s predictive ability, doctors could intervene to try to prevent the disease immediately after a baby is born.

The study, “Cord Blood Biomarkers of Placental Maternal Vascular Underperfusion Predict Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension,” was published in The Journal of Pediatrics.

“We have many promising interventions, and it would be exciting to start them at birth in babies at risk, before they become extremely sick,” Karen Mestan, MD, a neonatologist at Ann & Robert H. Lurie Children’s Hospital of Chicago, said in a news release. “Currently we do not use cord blood for prediction of disease, but our study shows that it has tremendous potential to save lives,” added Mestan, who is also an associate professor at Northwestern University’s Feinberg School of Medicine.

BPD-PH is a life-threatening disease that causes the vessels that carry blood from the heart to the lungs to narrow, preventing enough oxygen from getting to the lungs.

Mestan and her colleagues wanted to see if cord blood biomarkers of insufficient blood flow between a mother and her fetus could predict BPD-PH in babies. The biomarkers are associated with lesions in the placenta that cause the blood flow problem, which is known as placental maternal vascular underperfusion.

The team analyzed 15 biomarkers in cord blood and placental tissue.

They discovered that two factors — granulocyte colony-stimulating factor (G-CSF) and placental growth factor (PlGF) — were lower than they should have been in women with placental lesions. They also found very low levels of the factors in premature infants who later developed BPD-PH, compared with babies who did not develop the condition.

The researchers validated the findings in 39 premature babies — children born at 28 weeks of gestation, or less.

While the findings did not constitute a cause-and-effect link between the growth factors and BPD-PH, the team used a robust statistical method to determine that decreased levels of G-CSF and PlGF can predict the disease.

“Our findings also have implications for what we do during pregnancy,” Mestan said. “The growth factors we identified potentially could be measured in the mom’s blood, and if they are low, that would signal lesions in the placenta that place the baby at risk for severe lung disease. Better understanding about fetal origins of disease, which is still a mystery, would help us find new ways to improve outcomes even before the child is born.

“There are many undifferentiated stem cells in cord blood and these growth factors might help mobilize them to get assigned to specific immune functions involved in the healing process,” she added. “Preemies who are deficient in G-CSF and PlGF might not be able to fight off the development of lung damage. But what if we could replenish these babies with healthier stem cells or even replenish the growth factors? We could then regenerate lung tissue. This is a thrilling area of research that could have huge impact.”

Larger studies are necessary to validate the results before doctors can use the growth factors to identify premature infants at risk of BPD-PH, and start interventions, the team said.