Could an artificial placenta reduce the incidence of neonatal death?
Preterm birth is a leading cause of neonatal death. While we’ve seen amazing advances in neonatal intensive care technology, many babies are still born too soon to benefit from them.
This is because extremely premature infants, born prior to 24 weeks gestation, often have lungs too fragile to handle even the gentlest of ventilation techniques. Without proper oxygen, infants’ organs are unable to continue to develop properly outside their mother’s womb, leading to serious long term health complications and/or death.
Enter The Artificial Placenta
Researchers from the University of Michigan have begun working on an artificial placenta, which mimics the womb environment to provide oxygen to the tiniest of babies. While it hasn’t made it to clinical trials with human babies yet, so far it has kept five premature lambs alive for one week.
Why This Advancement Could Be Huge
New ventilation, medication and nutritional techniques have been vital in saving many premature infants. However, for those born extremely prematurely, these advancements are often still unable to help them develop outside the womb.
Immature lungs and other organs are often unable to develop properly once outside the mother’s womb, despite various advances. Using an artificial placenta means a baby would be able to receive vital oxygen without needing the lungs to do the work, especially as they can become damaged in the process.
George Mychaliska, M.D., the principal investigator, and director of U-M’s Fetal Diagnostic and Treatment Center, says, “If a baby’s lungs are severely immature, they cannot provide the brain, heart and other organs the oxygen they need to survive”. This is why the development of an artificial placenta, for use with human infants, would be a huge advancement in neonatal medicine.
Mychaliska explains how changing our approach to premature infant care could be important, saying “We thought, ‘Why don’t we solve the problem of prematurity by re-creating the intrauterine environment? Maybe we should treat this tiny baby like a fetus. Maybe we should treat these babies as if they are still in the womb'. This is a complete paradigm shift. Our research is still in a very preliminary stage, but we’ve passed a significant milestone that gives us promise of revolutionizing the treatment of prematurity”.
How Does The Artificial Placenta Work?
The placenta, which develops with each pregnancy, is a pretty amazing organ. The placenta provides the nutrition, oxygen and fluids your baby needs. Your blood flows to the placenta, where nutrients and oxygen are exchanged to ensure your baby grows. It is the lifeline between you and your baby. Your baby receives 100% of what it needs via the placenta.
After birth, your baby utilises its lungs to obtain oxygen, and receives nutrition and fluids via breast milk or a breast milk substitute. Premature babies often receive oxygen via their lungs, but with some type of ventilation support. They might or might not receive breast milk or breast milk substitute orally. They often receive IV fluids and nutrition, as well as nutrition via a type of feeding tube.
In extremely premature infants, the lungs can be too immature to provide oxygen to the body, even with the best of ventilation support. And without proper oxygen, their organs cannot develop and function, even with the best of nutritional support.
An artificial placenta is designed to provide oxygen to the whole body, without forcing the lungs to do this work. The artificial placenta utilises extracorporeal membrane oxygenation (ECMO), which is the same technology used to support the heart and lungs during certain surgical procedures and recovery.
This technology in a way recreates the womb environment, facilitating further fetal development until the baby is developmentally ready to face postnatal life. Rather than aiming to improve current technology, this artificial placenta is working towards creating a whole new approach to care for the most premature of infants. By approaching treatment in a way that would support fetal life, rather than the life of a near term baby, we might be able to help extremely premature infants thrive.
The five premature lambs, kept alive for a week to date, are vital to obtaining funding to further this research. They were transferred to the artificial placenta before even taking their first breath; this might allow their lungs to develop properly, without damage.
When Will Human Infants Be Able To Use An Artificial Placenta?
The research is still ongoing, but Mychaliska is hopeful we can utilize the technology with human infants soon. “Our research is rapidly progressing. Given our recent advances, we believe that the artificial placenta may be used in premature babies in the next five years”.
The technology has been in the works for decades. The idea of an artificial placenta was mentioned nearly fifty years ago, with the invention of the cardiopulmonary bypass. While we aren’t quite ready for human clinical trials, the success with the lambs so far is extremely promising.