Background: Neonates with congenital anomalies frequently require perioperative allogeneic red blood cell (RBC) transfusion. Whole cord blood for autologous transfusion to neonates may provide an alternative RBC source, but whether sufficient volumes can be collected after delayed cord clamping to reduce allogeneic RBC requirements is unknown.Study Design and Methods: Inclusion criteria were mothers delivering a viable infant >34 weeks' gestation. Sterile cord blood collection from the umbilical cord was performed at delivery as per routine obstetric indications. During storage at 4°C, we performed weekly blood gases. Blood culture, complete blood count, and hemolysis tests were performed at baseline and day 21. We compared the whole cord blood volume collected with each infant's allogeneic transfusion requirements.Results: 54 collection attempts yielded 49 collections with a mean volume of 54.1 mL (±20.3) after median delayed cord clamping of 46 seconds (IQR 12.0, 60.0). Among 39 blood cultures obtained, 3 grew organisms after vaginal delivery (3/27, 11.0% vs. 0/12, 0% cesarean delivery, p = .54). Hemolysis was stable during storage (baseline vs. day 21, median [IQR], 0.7% [0.4%–0.9%] vs. 0.7% [0.6%–1.1%], p = .08).Conclusions: Whole cord blood collection following delayed cord clamping was feasible, with volumes equal to 16.7 mL/kg, or one transfusion. Hemolysis was low, and although potassium increased during storage, it was consistent with patterns observed with adult donor stored whole blood. There were no positive blood cultures from collections during cesarean deliveries. Studies are needed to determine whether whole cord blood transfusions improve patient outcomes.

Fetal surgery is an expanding domain in which the developing fetus receives therapeutic interventions aimed at reducing mortality and/or morbidity. It presents unique challenges to the anesthesiologist, as it involves managing two simultaneous patients and necessitates the integration of both obstetric and pediatric anesthesia. Fetal therapies range from minimally invasive techniques to open mid-gestation procedures to near-term procedures performed with the fetus partially delivered while on placental circulation. In this overview, we delineate the indications for fetal surgery, review the principles for administering anesthesia in these cases, and outline the anesthetic strategies for minimally invasive, open mid-gestation, and ex utero intrapartum treatment (EXIT) procedures.