- Approximately 30,000
infants are born critically preterm (less than 26 weeks gestation) in the
- Preterm infants have a high risk of mortality and even
if they survive, they are often afflicted with longterm disability due to immaturity of
their lungs and other organs.
- Current device acts as a
bridge between the womb and the outside environment and can support the infants
up to 28 weeks after which they have a good chance of
Survival and normal
development of highly premature babies
now be possible with unique womb-like device developed by neonatal researchers
at the the Center
for Fetal Diagnosis and Treatment at Children's Hospital of
Aim of the Research
neonatal care practices can improve survival of infants as young as 23 weeks
weeks of gestation. These infants weigh hardly a pound (about 600 grams) and
have between 30-50 percent chance of living. However, many of them have
longterm disabilities due to their organ immaturity.
‘A novel device that simulates life in the womb could support the development of preterm babies as young as 23 weeks in a manner superior to existing neonatal care.’
aim of the research team is to support
the life and development of organs in these premature infants between 23-28
weeks when they have a much better chance of survival in the external world.
program brought together the combined expertise of several specialists at CHOP,
including neonatologists, respiratory therapists, fetal medicine specialists,
perfusionists and others. The initial thrust for the research program came over 5
years ago from CHOP research fellow Emily Partridge, MD, PhD, who has faced the
challenges of caring for severely preterm infants first hand.
study leader Alan W. Flake, MD, a fetal surgeon and director of the Center for
Fetal Research at CHOP, " "Our system could
prevent the severe morbidity suffered by extremely premature infants by
potentially offering a medical technology that does not currently exist,".
Methods of the Research
- The team of scientists took over 3
years to develop and refine their prototype to the current model. They tested
the device on 6 preterm lambs having a gestational age equivalent to 23-24
gestation of a human fetus.
- The device simulates life in
the womb as closely as possible, based on knowledge from previous neonatal
research. Unlike artificial life support systems, there is no pump to do the
work of the heart or a ventilator as the fetal lungs are still immature and
cannot breathe in atmospheric oxygen.
- The fetal heart
pumps blood via the umbilical cord into a low-resistance external oxygenator
built into the device that does the work of the mother's placenta in exchanging
oxygen and carbon dioxide.
- The sealed, and sterile
environment inside the system is protected from variations in temperature,
light, pressure and specifically from the risk of
- In addition, amniotic fluid, developed in the
laboratory, flows into and out of the bag maintaining a fluid
filled environment within.
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 fetal physiologist Marcus G. Davey, PhD, who
designed and redesigned the system's inflow and outflow apparatus.
Results of the Trial
new system can operate for up to 670 hours (28 days) and some animals remained
lambs showed normal breathing and swallowing, and had normal growth,
neurological function and organ maturation opened their eyes, grew wool, and
became more active.
is a marked improvement over attempts by earlier research to develop an
artificial placenta, but these pump less systems functioned only for 60 hours
maximum and the animals suffered neurological damage.
Scope of the Research
and Future Plans
research team plan to reduce the size of the device to match the size of human
infants which are about one third the size of fetal lambs. They plan to further
evaluate and refine the system.
the prototype is developed into a successful device to support human infants,
Flake hopes that in a decade from now preterm infants will continue normal
development in chambers filled with amniotic fluid rather than in incubators.
This will improve the quality of life for
infants and reduce the huge health costs to the administration due to
emphasizes that they have no plans to support fetuses less than 23 weeks since
the extremely small fetal size and degree of organ immaturity will mean
unacceptably huge risks. However, he added, "This system is potentially
far superior to what hospitals can currently do for a 23-week-old baby born at
the cusp of viability. This could establish a new standard of care for this
subset of extremely premature infants."