Editor’s Note: Harriet Hall (she/her/hers) is a pediatrics resident at the University of Virginia. Prior to medical school, she completed a master’s in bioethics. She is interested in how ethics intersects with our work in pediatrics, specifically when caring for our medically complex patients.
Treatment for cerebral palsy (CP) remains largely therapy based (physical therapy, occupational therapy, and orthotics). It is time intensive for patients and families and usually results in only modest changes in the function and quality of life for those patients.
In an article being early released in Pediatrics this week, entitled “Cord Blood Treatment for Children With Cerebral Palsy: Individual Participant Data Meta-Analysis,” Megan Finch-Edmonson, PhD, from the University of Sydney and colleagues performed a systematic review and individual participant meta-analysis on the effect of umbilical cord blood (UCB) treatment on the gross motor functioning of participants (10.1542/peds.2024-068999). UCB is thought to decrease inflammation and boost the immune system. UCB treatment for patients with CP has been investigated in multiple clinical trials, but the results have been mixed.
Data from 341 patients (170 UCB treated, 171 controls) were analyzed. The mean age was 54.6 months but ranged from 8 months to 19 years. The majority of patients received UCB intravenously and from an unrelated donor.
The authors found that, in general, there was clinical improvement in patients who received UCB. The effect of UCB treatment was greatest in those under 5 years of age and with milder CP. UCB treatment showed the most benefit 6–12 months after treatment. Additionally, UCB treatment was more effective at higher doses. There was no increase in adverse or serious adverse events.
It is important to recognize that the etiology of CP is often unknown, and that was the case in 22% of UCB-treated and 21% of placebo-treated participants included in this study.
This article only focused on the effect of UCB treatment on gross motor function. Further research is needed to determine the impact of UCB treatment on other areas of development, such as fine motor and cognition. These are important points for families as they consider whether UCB treatment is consistent with their own goals for treatment.
In an accompanying invited commentary, Peter Rosenbaum, MD, from McMaster University and Robert Palisano, ScD, from Drexel University raised an important question about how providers will counsel families on the benefits of UCB treatment (10.1542/peds.2024-070467). It will be crucial to tailor our guidance to families, based on an individual patient’s age and severity of CP, as the effect of UCB treatment varies based on those factors. Additionally, Rosenbaum and Palisano stress that it is important to explain to families that the benefits of UCB treatment take at least 6–12 months, because they rely on increased neural plasticity over an extended period of time.
UCB treatment offers an avenue for improving the gross motor function of patients with CP, particularly those under 5 years old with mild CP, outside of the traditional therapy-based interventions. It is a new tool in the toolbelt for improving the function and quality of life for this patient population.
