Pediatric researchers at Children's Hospital of Philadelphia have developed a womb-like system to help babies born prematurely safely develop. The system has displayed efficacy with premature lambs, according to a new study published in the journal Nature Communications.
Critically preterm birth — infants born before 26 weeks of pregnancy — is the leading cause of infant mortality and morbidity in the United States. Approximately 30,000 critically preterm births occur every year.
"These infants have an urgent need for a bridge between the mother's womb and the outside world," said Alan Flake, MD, a fetal surgeon, director of CHOP's Center for Fetal Research and one of the study's authors. "If we can develop an extra-uterine system to support growth and organ maturation for only a few weeks, we can dramatically improve outcomes for extremely premature babies."
Here are seven things to know about CHOP's artificial womb.
1. The goal of the system is to support development and keep the infants safe from 23 weeks to 28 weeks gestational age when the likelihood of more severe outcomes related to extreme prematurity drop.
2. The new system has been in development for three years and was preceded by four prototypes, beginning with a glass incubator tank and evolving into the current womb-like system.
3. The new system was designed to replicate life in the uterus. It consists of a sealed "biobag" filled with amniotic fluid produced in a laboratory. Because even slight artificial pressure can overload a critically preterm infant's heart, there is no external pump to drive circulation. The device is also not affixed with a ventilator, as lungs cannot yet breathe atmospheric oxygen. Instead, the system is equipped with a low-resistance oxygenator which receives blood pumped from the baby's heart via the umbilical cord and fills the role of the placenta by exchanging oxygen and carbon dioxide.
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4. The lab-developed amniotic fluid also flows in and out of the biobag.
"Fetal lungs are designed to function in fluid, and we simulate that environment here, allowing the lungs and other organs to develop, while supplying nutrients and growth factors," said Marcus Davey, PhD, a fetal physiologist with CHOP's Center for Fetal Research and the designer of the system's inflow and outflow apparatus.
5. Researchers tested the system on eight preterm lambs that were the physiological equivalent of a 23- or 24-week-gestation-age human infant.
6. The womb-like biobag successfully sheltered the lambs for up to four weeks, during which they displayed normal brain and lung development. The lambs also opened their eyes and grew wool. Researchers are still working to refine the system, which will need to be downsized before it can be used to treat human infants.
7. CHOP researchers plan to keep the goal at treating infants born at approximately 23 weeks of gestation.
"Before 22-23 weeks of gestation, there are likely physiologic and technical limitations that will increase the risk and reduce the potential benefit of this therapy," wrote the study's authors. "Our goal is not to extend the current limits of viability, but rather to offer the potential for improved outcomes for those infants who are already being routinely resuscitated and cared for in neonatal intensive care units."
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