Use of Autologous Umbilical Cord Blood in Neonatal Cardiac Surgery: A European Survey of Current Practices and Perceptions

Use of Autologous Umbilical Cord Blood in Neonatal Cardiac Surgery: A European Survey of Current Practices and Perceptions | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL Pediatric Blood & Cancer This is a preprint and has not been peer reviewed. Data may be preliminary. 28 July 2025 V1 Latest version Share on Use of Autologous Umbilical Cord Blood in Neonatal Cardiac Surgery: A European Survey of Current Practices and Perceptions Authors : Sonia Garcés-Sánchez , Álvaro Solaz-García , José Luis López-Guillén , Laura Torrejón-Rodríguez , Nerea Valles-Murcia , Alba Cayuela Hernández , Alejandro Pinilla-Gonzalez , Pilar Argente Navarro , and Marta Aguar-Carrascosa 0000-0003-1553-4833 [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.175370406.66126259/v1 Published Pediatric Blood & Cancer Version of record Peer review timeline 253 views 153 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Objective : To evaluate current clinical practices, identify perceived barriers, and explore healthcare professionals’ perspectives on the use of autologous umbilical cord blood (AUCB) in neonatal cardiac surgery across Europe. Methods : A descriptive, cross-sectional online survey was distributed to healthcare professionals involved in neonatal cardiac surgery. The questionnaire, developed ad hoc by a multidisciplinary expert team, assessed institutional AUCB use, perceived benefits and barriers, and professionals’ interest in further information. The survey was disseminated through European scientific societies and professional social media platforms. Data were collected anonymously and analyzed using descriptive statistics. Results : A total of 42 responses were analyzed. The majority of respondents were neonatologists (50%), followed by perfusionists and neonatal nurses; 78% were based in Spain. Only 10% of participants reported institutional use of AUCB, primarily for selected patients in the postoperative setting. Reported benefits included reduced transfusion requirements and decreased exposure to allogeneic blood products. Among non-users, key barriers included logistical challenges (18%), insufficient scientific evidence (15%), and limited training (10%). The most frequently cited overall obstacle was lack of education and training (78%), followed by regulatory restrictions. Only 8% considered the current evidence sufficient to support routine AUCB use. Despite limited implementation, overall interest was high (mean rating 4.6/5), with many respondents expressing interest in future collaboration. Conclusions : AUCB use in neonatal cardiac surgery remains limited and institution-dependent across Europe. Significant barriers—including insufficient training, logistical challenges, and perceived evidence gaps—hinder broader adoption. These findings highlight the need for standardized protocols, targeted educational strategies, and further clinical evidence to facilitate safe and effective integration of AUCB into neonatal cardiac care. Use of Autologous Umbilical Cord Blood in Neonatal Cardiac Surgery: A European Survey of Current Practices and Perceptions Sonia Garcés-Sánchez 1,2 , Álvaro Solaz-García 2 , José Luis López-Guillén 3 Laura Torrejón-Rodríguez 2,4 , Nerea Valles-Murcia 2 , Alba Cayuela Hernández 2,4 , Alejandro Pinilla Gonzalez 2,4 , Pilar Argente Navarro 1 , Marta Aguar-Carrascosa 2,4 * 1 Anesthesiology and resuscitation department. University and Polytechnics Hospital La Fe, Valencia, Spain. 2 Neonatal Research Unit, Health Research Institute La Fe, University and Polytechnics Hospital La Fe, Valencia, Spain. 3 Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada. 4 Division of neonatology, University and Polytechnics Hospital La Fe, Valencia, Spain. **Sonia Garcés-Sánchez and Álvaro Solaz-García have had the same contribution. *Corresponding Author Marta Aguar-Carrascosa [email protected] Neonatal Research Unit, Health Research Institute La Fe. University and Polytechnics Hospital La Fe, Valencia, Spain. Avda. Fernando Abril Martorell, 106 Valencia - Spain Abstract Objective : To evaluate current clinical practices, identify perceived barriers, and explore healthcare professionals’ perspectives on the use of autologous umbilical cord blood (AUCB) in neonatal cardiac surgery across Europe. Methods : A descriptive, cross-sectional online survey was distributed to healthcare professionals involved in neonatal cardiac surgery. The questionnaire, developed ad hoc by a multidisciplinary expert team, assessed institutional AUCB use, perceived benefits and barriers, and professionals’ interest in further information. The survey was disseminated through European scientific societies and professional social media platforms. Data were collected anonymously and analyzed using descriptive statistics. Results : A total of 42 responses were analyzed. The majority of respondents were neonatologists (50%), followed by perfusionists and neonatal nurses; 78% were based in Spain. Only 10% of participants reported institutional use of AUCB, primarily for selected patients in the postoperative setting. Reported benefits included reduced transfusion requirements and decreased exposure to allogeneic blood products. Among non-users, key barriers included logistical challenges (18%), insufficient scientific evidence (15%), and limited training (10%). The most frequently cited overall obstacle was lack of education and training (78%), followed by regulatory restrictions. Only 8% considered the current evidence sufficient to support routine AUCB use. Despite limited implementation, overall interest was high (mean rating 4.6/5), with many respondents expressing interest in future collaboration. Conclusions : AUCB use in neonatal cardiac surgery remains limited and institution-dependent across Europe. Significant barriers—including insufficient training, logistical challenges, and perceived evidence gaps—hinder broader adoption. These findings highlight the need for standardized protocols, targeted educational strategies, and further clinical evidence to facilitate safe and effective integration of AUCB into neonatal cardiac care. Keywords: autologous umbilical cord blood, neonatal cardiac surgery, survey. What is Known: Neonatal cardiac surgery often requires substantial blood transfusion, which is associated with increased morbidity and mortality. Autologous umbilical cord blood (AUCB) provides immunological and physiological advantages over allogeneic transfusion, including reduced risk of immune-mediated complications and improved oxygen delivery. Isolated clinical studies have demonstrated the feasibility and safety of AUCB use in selected neonatal cardiac surgical procedures. What is New: This is the first European survey assessing current clinical practices and healthcare professionals’ perspectives on AUCB use in neonatal cardiac surgery. AUCB utilization remains rare, inconsistent, and highly institution-dependent, with major barriers including lack of professional training, logistical complexity, and perceived insufficient scientific evidence. Strong interest exists among clinicians to expand knowledge, engage in collaborative research, and support the development of standardized protocols to facilitate broader AUCB integration into routine neonatal cardiac care. Introduction Neonatal cardiac surgery requiring cardiopulmonary bypass (CPB) remains one of the most transfusion-intensive scenarios in perioperative medicine. While allogeneic blood transfusion remains a cornerstone in the management in this population, increasing evidence has linked transfusions with heightened morbidity and mortality in the neonatal patient (1). Allogeneic transfusion carries risks of immunomodulation, infectious disease transmission, inflammatory response activation and alloimmunization, collectively described under the concept of transfusion-related immunomodulation (TRIM). To mitigate these risks, multiple blood conservation strategies have been introduced, with varying degrees of success. Miniaturized CPB circuits, modified ultrafiltration, intraoperative cell salvage systems, and institution-wide patient blood management (PBM) programs have all contributed to reducing donor blood exposure. However, achieving transfusion-free neonatal cardiac surgery remains a major challenge, largely due the small circulating blood volume of neonates, combined with the disproportionately large priming volume of the CPB circuit relative to body weight (2). In this context, autologous umbilical cord blood (AUCB) transfusion has emerged as a promising strategy to further reduce or eliminate donor exposure in neonatal cardiac surgery. AUCB offers several biological advantages as eliminating risks of alloimmunization and infectious transmission. It contains high levels of fetal hemoglobin, whose higher oxygen affinity may optimize tissue oxygen delivery during critical periods and it includes anti-inflammatory cytokines, which may attenuate perioperative inflammatory responses. Furthermore, AUCB has favorable rheological properties that support microcirculatory perfusion and oxygenation — critical factors in neonates with limited physiologic reserve (3). Early investigations have confirmed the feasibility of collecting and using AUCB in neonates with prenatally diagnosed congenital anomalies (4). More recent studies have extended its application to neonatal cardiac surgery (5). Fernández and Chasovskyi (1) reviewed its physiological compatibility during hypothermic CPB, highlighting its potential role in reducing donor exposure while enhancing intraoperative oxygen delivery through the properties of fetal hemoglobin. In this regard, Torrejón et al. demonstrated that lower levels of fetal hemoglobin in preterm infants were significantly associated with increased biomarkers of oxidative stress, including malondialdehyde and reduced antioxidant enzyme activity, suggesting a potential protective role of fetal hemoglobin in neonatal redox balance (6). Choi et al. (2) demonstrated that AUCB can effectively replace homologous blood for CPB priming in most neonatal procedures, while Chasovskyi et al. (7) reported successful arterial switch operations performed in the first hours of life using exclusively AUCB in neonates, with 95% of patients avoiding allogeneic transfusion altogether and associated reductions in hospitalization and healthcare costs. More recently, Nelson et al. (3) demonstrated that AUCB can be collected successfully even following delayed cord clamping, though collected volumes may be limited. Their study reported a mean collection volume of 54.1 mL, sufficient to provide at least one transfusion in most cases, with acceptable hematologic stability during storage, minimal hemolysis, and low incidence of bacterial contamination. These results further support the technical feasibility and biological safety of AUCB as an alternative to donor blood in neonates undergoing cardiac surgery. Despite the growing body of supportive evidence, the adoption of AUCB in neonatal cardiac surgery remains limited and inconsistent across European centers and no standardized protocols have been widely implemented. Clinical acceptance appears to vary substantially across institutions, likely reflecting differences in prenatal diagnostic infrastructure, logistical capacity for cord blood collection and processing, and institutional comfort with this still-emerging technique. To address these knowledge gaps and explore the current landscape of practice, we conducted a European multicenter survey to assess present clinical utilization of AUCB in neonatal cardiac surgery. Our study aimed to identify both perceived barriers and facilitators of implementation, to capture healthcare professionals’ perspectives, and to inform the development of future clinical guidelines. We hypothesize that this work may serve as a foundation for the safe, evidence-based incorporation of autologous transfusion strategies into routine neonatal cardiac surgical care. Materials and methods Study design and settings An observational, descriptive, cross-sectional study was conducted based on an international survey targeting healthcare professionals involved in neonatal cardiac surgery across Europe. The primary objective was to assess current clinical practices and perceptions regarding the use of AUCB. Data were collected over a six-month period, from October 2024 and March 2025. Participants and recruitment Eligible participants included neonatologists, pediatric cardiologists, congenital cardiac surgeons, perfusionists, and neonatal nurses actively engaged in neonatal cardiac surgery care. The survey was disseminated electronically through official communication channels of European scientific societies in neonatology, pediatric cardiology, and cardiovascular surgery to maximize geographic reach and professional diversity. Additional recruitment was achieved via targeted outreach through professional social media platforms. Ethical considerations The study protocol was reviewed and approved by La Fe Hospital Ethics Committee and was implemented in compliance with applicable regulations and the ethical principles outlined in the Declaration of Helsinki. Participation was entirely voluntary, anonymous, and non-remunerated. Electronic informed consent was implied upon survey submission. Survey development In the absence of pre-existing validated instruments specifically addressing AUCB utilization in neonatal cardiac surgery, an original questionnaire was developed through a structured consensus process by a multidisciplinary research team with clinical and academic expertise in the field. The questionnaire was created using Microsoft Forms® to ensure secure, accessible, and user-friendly online distribution. The survey was structured into four sections: (1) respondent demographics and institutional characteristics; (2) current use of AUCB in neonatal cardiac surgery, including institutional practices and clinical indications; (3) perceived barriers and perceptions regarding its implementation; and (4) final remarks on interest in further information and membership in related professional scientific societies. The questionnaire employed a combination of multiple-choice, Likert-scale, and open-ended questions, as appropriate. All questions were mandatory to ensure data completeness of responses and consistency of the dataset. Dissemination Strategy Survey distribution followed the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guidelines to ensure methodological rigor in online survey implementation. An open dissemination approach was adopted, leveraging both official scientific society communications and professional networks. No financial incentives were offered to participants. Statistical Analysis All collected data were analyzed using Microsoft Excel®. Descriptive statistics were applied to summarize the full dataset. Categorical variables were reported as absolute frequencies and percentages. Due to the exploratory nature of the study, no inferential statistical analyses or subgroup comparisons were performed, given the limited sample size and uneven geographical representation. The intent of the analysis was to provide an initial descriptive framework, forming the basis for future hypothesis-driven research aimed at further characterizing AUCB utilization in this specific clinical context. Participant distribution A total of 42 completed responses were analyzed. The majority of respondents were neonatologists (50%), followed by perfusionists and neonatal nurses (Figure 1). Geographically, most participants were based in Spain (78%), with the remainder responders representing a diverse group of other European countries (Figure 2). Professional characteristics and Institutional Profile Main results from the survey have been summarized in Figure 3. Regarding clinical experience, 35% of respondents reported between 10 and 20 years of practice in neonatal cardiac surgery, while 55% had less than 10 years of experience. The majority of participants were affiliated with specialized pediatric hospitals (45%). In terms of institutional case volume, more than half of the respondents indicated that their centers performed fewer than 50 neonatal cardiac surgical procedures annually. Use of autologous umbilical cord blood (AUCB) Among all surveyed professionals, only 4 respondents (10%) reported that their institution currently employs autologous umbilical cord blood in the context of neonatal cardiac surgery. In these centers, AUCB had been implemented within the preceding one to three years and was generally reserved for selected patient subgroups. The primary indications for its use included reducing transfusion-related complications and minimizing exposure to allogeneic blood products. In centers utilizing AUCB, administration occurred most commonly in the postoperative period. Among respondents reporting perceived clinical benefits (n=3), the most frequently observed advantages included a reduction in transfusion requirements and decreased overall exposure to donor-derived blood components. Perceived Barriers and Limitations In institutions not currently utilizing AUCB, several barriers were identified. The most frequently cited challenges included logistical difficulties related to blood collection and storage (18%), insufficient supporting scientific evidence (15%), preferential reliance on alternative blood sources (13%), and limited training or expertise (10%). Notably, the most commonly identified overarching barrier was lack of education and formal training, reported by 78% of respondents. Additional barriers included regulatory or institutional restrictions, such as national policies limiting AUCB collection or application. Only 8% of respondents indicated that they considered the existing scientific evidence sufficient to justify routine clinical implementation of AUCB in neonatal cardiac surgery. Interest in Future Development Despite the limited current use of AUCB, overall receptivity toward the approach was favorable. Respondents expressed a high level of interest in the development of AUCB programs, with an average interest score of 4.6 out of 5. Many participants indicated their willingness to receive additional information, contribute to collaborative initiatives, and participate in the development of standardized protocols and future multicenter research efforts. Discussion Blood transfusion remains a cornerstone of neonatal cardiac surgery requiring CPB; however, its well-recognized association with increased morbidity and mortality in neonates continues to drive the search for alternative strategies (1). Advances in blood conservation, including miniaturized CPB circuits and modified ultrafiltration, have mitigated the transfusion burden to some extent. Nevertheless, achieving transfusion-free neonatal cardiac surgery remains highly challenging due to the disproportionate relationship between circuit priming volumes and neonatal blood volumes (2). In this context, AUCB transfusion has emerged as a promising modality, offering unique biological advantages such as full autologous compatibility, absence of alloimmunization or infectious transmission, high fetal hemoglobin concentrations, anti-inflammatory cytokine content, and favorable rheological properties that optimize microvascular flow (3). In our survey, only 10% of European institutions reported using AUCB in neonatal cardiac surgery, underscoring both its limited adoption and the heterogeneity of current clinical practice. This low penetration contrasts with growing evidence demonstrating its feasibility and safety. Early studies demonstrated successful AUCB collection and transfusion in neonates with prenatally diagnosed congenital anomalies (4). More recent reports have extended these findings specifically to neonatal cardiac surgery, where AUCB has been successfully used as a complete substitute for homologous blood in CPB priming and perioperative management (5). Notably, in carefully selected cases such as arterial switch operations performed within the first hours of life, AUCB has enabled a complete avoidance of donor blood exposure, associated with shorter hospital stays and reduced healthcare costs (7). Beyond the field of cardiac surgery, AUCB has demonstrated broader therapeutic potential in neonatal medicine. Pilot studies have shown that AUCB infusion is feasible and safe in neonates with hypoxic-ischemic encephalopathy (HIE), with no serious adverse events and favorable neurodevelopmental outcomes at 18 months (8). The underlying neuroprotective mechanisms involve anti-apoptotic and anti-inflammatory effects, angiogenesis stimulation, trophic factor release, and mitochondrial transfer (9, 10). Similar protective effects have been described in preterm white matter injury models, where AUCB promotes endogenous neurogenesis and mitigates neuroinflammation (11). Furthermore, AUCB-derived cell therapy has shown potential to enhance cardiac function and remodeling in complex congenital heart disease, as evidenced by early experience in hypoplastic left heart syndrome (12). Despite these encouraging findings, our study identified multiple barriers impeding AUCB adoption. The primary obstacle cited was insufficient education and training (78%), followed by regulatory restrictions, logistical challenges in collection and storage (18%), perceived lack of scientific evidence (15%), and reliance on alternative blood sources (13%). Strikingly, only 28% of respondents considered current evidence sufficient to support routine clinical use. This perception gap underscores a disconnect between emerging scientific data and bedside practice, likely reflecting limited dissemination of knowledge and absence of standardized clinical protocols (12). Concerns regarding limited AUCB collection volumes, which may occasionally necessitate supplemental allogeneic transfusions, remain a valid consideration. Technical challenges surrounding timely collection, especially in unscheduled deliveries, further complicate logistics. Additionally, the risk of contamination during vaginal delivery, although generally low with proper sterile technique, continues to be perceived as a potential safety issue (3). Importantly, our findings highlight an opportunity to reposition AUCB not merely as an isolated transfusion alternative but as an integral component of comprehensive Patient Blood Management (PBM) programs tailored for neonates. PBM encompasses a multidisciplinary, evidence-based approach aiming to optimize hemoglobin levels, minimize unnecessary transfusion, and improve perioperative outcomes. Incorporating AUCB into PBM algorithms may enhance clinical safety while simultaneously improving resource efficiency in high-risk neonatal cardiac surgery (1). To advance the field, focused educational initiatives, collaborative research networks, and development of international consensus guidelines are urgently needed. Bridging the translational gap between existing evidence and clinical implementation will be critical to unlock the full potential of AUCB in neonatal cardiac care. The demonstrated feasibility of very early surgical intervention using AUCB may ultimately help redefine the timing and safety of complex neonatal cardiac procedures (12). Limitations This study has several important limitations. First, the relatively small sample size (42 respondents) and the overrepresentation of participants from Spain (78%) limit the generalizability of the findings across the broader European landscape. While the survey was distributed through multiple professional societies, the overall response rate was modest, and participation may have been influenced by self-selection bias, potentially favoring individuals with pre-existing interest or familiarity with AUCB. Second, the geographical imbalance may have prevented a comprehensive capture of the variability in institutional practices, regulatory frameworks, and healthcare infrastructures across different European countries. As such, the results may not fully reflect the heterogeneity of barriers or facilitators present in other national contexts. Third, the use of a non-validated, ad hoc questionnaire—although developed by expert consensus—introduces potential limitations in measurement accuracy. The absence of formal psychometric validation may affect the reproducibility and external validity of the survey instrument. Finally, the cross-sectional and anonymous nature of the study precludes any assessment of causal relationships or temporal trends in clinical practice. Longitudinal studies would be valuable to monitor evolving institutional attitudes, practice changes, and the impact of future educational or policy-driven interventions on AUCB adoption. Despite these limitations, the present study offers valuable preliminary insights into current clinical perceptions and utilization patterns of AUCB in neonatal cardiac surgery. It highlights key areas for future research, educational focus, and collaborative guideline development. Conclusion This European survey highlights a substantial gap between emerging scientific evidence and current clinical adoption of autologous umbilical cord blood (AUCB) in neonatal cardiac surgery. Despite growing data supporting its safety, feasibility, and capacity to reduce allogeneic transfusion exposure and optimize perioperative outcomes, AUCB use remains limited, highly variable, and institution-dependent across Europe. The principal barriers identified include insufficient education and training, logistical challenges related to collection and storage, and persistent perceptions of limited supporting evidence. Overcoming these challenges will require a concerted effort to develop standardized clinical protocols, implement targeted educational initiatives, and facilitate broader dissemination of existing research findings. Collaborative multicenter research and the establishment of European consensus guidelines will be critical to support the safe and evidence-based integration of AUCB into routine neonatal cardiac care. These steps are essential to promote more sustainable, patient-centered transfusion practices, enhance perioperative safety, and improve long-term outcomes for neonates undergoing complex cardiac surgery. Conflict of Interest Declaration: The authors declare no conflicts of interest. Funding declaration: This research received no external funding. References Fernández A, Chasovskyi K. The Use of Umbilical Cord Blood for Autologous Transfusion in Neonatal Open Heart Surgery. J Cardiothorac Vasc Anesth. 2020;34(2):483–8. Choi ES, Cho S, Jang WS, Kim WH. Cardiopulmonary Bypass Priming Using Autologous Cord Blood in Neonatal Congenital Cardiac Surgery. Korean Circ J. 2016 Sep;46(5):714-718. doi: 10.4070/kcj.2016.46.5.714. Epub 2016 Sep 28. PMID: 27721864; PMCID: PMC5054185. Nelson O, Jones R, Smith L, Brown C. Cord blood for autologous transfusion in infants with congenital anomalies: Volumes, sterility, and stability during storage. Transfusion. 2025;65:539-550. Imura K, Kawahara H, Kitayama Y, Satake S, Kubota T, Okuyama H, et al. Usefulness of cord-blood harvesting for autologous transfusion in surgical newborns with antenatal diagnosis of congenital anomalies. J Pediatr Surg. 2001;36(6):851-4. Sarin K, Chauhan S, Sharma P, Choudhary A, Singh A, Dagar M, et al. Use of autologous umbilical cord blood transfusion in neonates undergoing surgical correction of congenital cardiac defects: A pilot study. Ann Card Anaesth. 2018;21(3):270-4. Torrejón-Rodríguez L, Parra-Llorca A, Pinilla-González A, Lara-Cantón I, Albiach-Delgado A, Cernada M, Escrig R, Kuligowski J, Aguar Carrascosa M, Vento Torres M. Do Lower Levels of Fetal Hemoglobin in Preterm Infants Relate to Oxidative Stress? Antioxid Redox Signal. 2024 Mar;40(7-9):453-459. doi: 10.1089/ars.2023.0378. Chasovskyi K, Fedevych O, Vorobiova G, Chasovskyi O, Lazorishinets V. Arterial switch operation in the first hours of life using exclusively autologous umbilical cord blood. Interact Cardiovasc Thorac Surg. 2016;22(2):167-70. Tsuji M, Sawada M, Watabe S, Fujii T, Tsuji M, Fujii E, et al. Autologous Cord Blood Cell Therapy for Neonatal Hypoxic-Ischaemic Encephalopathy: A Pilot Study for Feasibility and Safety. Sci Rep. 2020;10(1):4603. Zdolińska-Malinowska I, Boruczkowski D, Hołowaty D, Krajewski P, Snarski E. Rationale for the Use of Cord Blood in Hypoxic-Ischaemic Encephalopathy. Stem Cells Int. 2022;2022:9125460. Nguyen T, Purcell E, Smith MJ, Pera M, Badawi N, Arigita-Prieto M, et al. Umbilical Cord Blood-Derived Cell Therapy for Perinatal Brain Injury: A Systematic Review & Meta-Analysis of Preclinical Studies. Int J Mol Sci. 2023;24(5):4351. Qiu H, Qian T, Wu T, Han S, Zhang L, Liu W, et al. Umbilical Cord Blood Cells for the Treatment of Preterm White Matter Injury: Potential Effects and Treatment Options. J Neurosci Res. 2021;99(3):778–92. Brizard CP, Elwood NJ, Kowalski R, Bell D, Justo R, Fraser JF, et al. Safety and Feasibility of Adjunct Autologous Cord Blood Stem Cell Therapy During the Norwood Heart Operation. J Thorac Cardiovasc Surg. 2023;166(6):1746-1755.e2. Figures legends Figure 1. Country of origin of survey respondents. Figure 2. Professional roles of participants. Figure 3. Survey results summary Information & Authors Information Version history V1 Version 1 28 July 2025 Peer review timeline Published Pediatric Blood & Cancer Version of Record 18 Nov 2025 Published Copyright This work is licensed under a Non Exclusive No Reuse License. Collection Pediatric Blood & Cancer Keywords cord blood neonatology surgery transfusion medicine Authors Affiliations Sonia Garcés-Sánchez Hospital Universitari i Politecnic La Fe View all articles by this author Álvaro Solaz-García Instituto de Investigacion Sanitaria La Fe View all articles by this author José Luis López-Guillén University of Toronto Division of Cardiology View all articles by this author Laura Torrejón-Rodríguez Hospital Universitari i Politecnic La Fe View all articles by this author Nerea Valles-Murcia Instituto de Investigacion Sanitaria La Fe View all articles by this author Alba Cayuela Hernández Hospital Universitari i Politecnic La Fe View all articles by this author Alejandro Pinilla-Gonzalez Hospital Universitari i Politecnic La Fe View all articles by this author Pilar Argente Navarro Hospital Universitari i Politecnic La Fe View all articles by this author Marta Aguar-Carrascosa 0000-0003-1553-4833 [email protected] Hospital Universitari i Politecnic La Fe View all articles by this author Metrics & Citations Metrics Article Usage 253 views 153 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Sonia Garcés-Sánchez, Álvaro Solaz-García, José Luis López-Guillén, et al. 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