Development of a systematic drug screening method for cord blood donation for transfusion to extremely preterm neonates

BACKGROUND: Cord blood-derived red blood cell transfusions (CB-RBCs) are being developed for extremely preterm neonates to preserve physiological fetal hemoglobin levels. We assessed how standard blood donor medication screening could be adapted for this novel donor population. STUDY DESIGN AND METHODS: In the Drug-Cord study, conducted in the Netherlands in 2025, we developed a structured, stepwise drug screening method for CB donation. The standard donor drug list was supplemented with drugs commonly prescribed during pregnancy and childbirth identified by clinical experts, after which two pharmacists assessed selected drugs based on maternal systemic absorption, placental transfer, and potential risks to the extremely preterm recipient. RESULTS: The standard donor questionnaire included 988 drugs. After adding 21 drugs commonly prescribed during pregnancy, 1009 drugs were identified. Following exclusion of rarely used drugs (n = 399), 610 were appraised. Of these, 179 (29.3%) were contraindicated by Sanquin (1A), 230 were contraindicated due to neonatal toxicity (1B; n = 131, 21.5%) or insufficient safety data (1C; n = 99, 16.2%), leaving n = 201 (33%) drugs approved (2A-2D). DISCUSSION: A large proportion of drugs currently accepted for blood donation are unsuitable or cannot be reliably assessed for CB-RBC transfusion in extremely preterm neonates. These findings highlight critical knowledge gaps in neonatal pharmacology, underscoring the need for a CB-specific, precautionary, and dynamically updated CB-donor drug screening questionnaire.