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To Bank or Not to Bank Cord Blood: A National Survey of Pediatrician Counseling Practices

Bertram H. Lubin, Amanda Yeaton-Massey, Norman Lewak, Karen G. O'Connor. Research, Childrens Hospital Oakland Research Institute, Oakland, CA; Research, American Academy of Pediatrics, Elk Grove Village, IL.

Presented at the May 2009 Pediatric Academic Societies Annual Meeting.

Background: Public interest in the banking of newborns' cord blood for possible stem cell transplantation has increased in recent years, although questions and misunderstandings regarding its use continue. Little is known about pediatricians' experiences in counseling expectant parents on the decision whether to bank cord blood.

Objective: Measure pediatricians' attitudes and reported practices regarding counseling parents of patients on cord blood banking (CBB) during prenatal health supervision visits.

Design/Methods: National random sample, mailed AAP Periodic Survey in 2008 (N=1618; response=68%). Questions assessed pediatricians' awareness of CBB issues and AAP recommendations, and attitudes and practices regarding CBB counseling. Analysis was limited to 577 pediatricians who provide health supervision and saw expectant mothers in their practice during the 3 months prior to the survey. Multivariate analysis assessed associations between the provision of counseling, knowledge of CBB issues, and pediatricians' practice characteristics.

Results: A total of 27% of pediatricians discussed CBB with an expectant mother during the past 3 months. Nearly all of these pediatricians (95%) say the parent initiated this discussion. Only 18% of pediatricians feel confident discussing the benefits and limitations of CBB for either public, private or sibling use. Fewer than 4 in 10 pediatricians (38%) have more than a "vague" familiarity with the AAP policy statement on CBB and less than one-fifth (18%) think they have sufficient scientific knowledge about CBB. When controlling for pediatricians' practice characteristics, familiarity with the AAP recommendations on CBB is independently associated with both feeling knowledgeable about CBB (AOR 6.0, 95% CI 3.62-10.06) and discussing CBB with expectant mothers (AOR 2.3, 95% CI 1.15-3.43).

Conclusions: Few pediatricians discuss CBB with expectant parents. Most pediatricians acknowledge they lack sufficient information on CBB and are unaware of the AAP recommendations. However, familiarity with AAP policy is associated with having adequate scientific knowledge of CBB issues and wider discussion. If pediatricians are to play a greater role in providing accurate information on CBB to expectant parents, additional education resources will be needed.
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