Development of an artificial placenta for support of premature infants: narrative review of the history, recent milestones, and future innovation

Abstract

Over 50 years ago, visionary researchers began work on an extracorporeal artificial placenta to support premature infants. Despite rudimentary technology and incomplete understanding of fetal physiology, these pioneering scientists laid the foundation for future work. The research was episodic, as medical advances improved outcomes of premature infants and extracorporeal life support (ECLS) was introduced for the treatment of term and near-term infants with respiratory or cardiac failure. Despite ongoing medical advances, extremely premature infants continue to suffer a disproportionate burden of mortality and morbidity due to organ immaturity and unintended iatrogenic consequences of medical treatment. With advancing technology and innovative approaches, there has been a resurgence of interest in developing an artificial placenta to further diminish the mortality and morbidity of prematurity. Two related but distinct platforms have emerged to support premature infants by recreating fetal physiology: a system based on arteriovenous (AV) ECLS and one based on veno-venous (VV) ECLS. The AV-ECLS approach utilizes only the umbilical vessels for cannulation. It requires immediate transition of the infant at the time of birth to a fluid-filled artificial womb to prevent umbilical vessel spasm and avoid gas ventilation. In contradistinction, the VV-ECLS approach utilizes the umbilical vein and the internal jugular vein. It would be applied after birth to infants failing maximal medical therapy or preemptively if risk stratified for high mortality and morbidity. Animal studies are promising, demonstrating prolonged support and ongoing organ development in both systems. The milestones for clinical translation are currently being evaluated.

Perfluorocarbons in Research and Clinical Practice: A Narrative Review

“…Notably, these effects are highly desirable during AP support, in particular, the high secretion of surfactant, which is beneficial to lung development and function. 67,69…”

Untitled

“…Uterus initiiert(Fallon/Mychaliska 2021), welche weitere 50 Jahre später die ersten erfolgreichen tierexperimentellen Studien nach sich ziehen sollte. Längerfristig werden damit klinische Studien mit menschlichen Föten angestrebt(Patridge et al 2017;Usuda et al 2019).…”

Artificial womb: a paradigm shift for saving extremely premature infants

“…A new extracorporeal membrane oxygenation-based technology called artificial womb (AW) designed for EPIs is characterized by five components: extracorporeal circulation, maintenance of fetal circulation, fluid-filled lungs, vascular access entirely or partly through the umbilical vessels, and a specialized environment for organs under development. [ 2 ] Another term, artificial placenta (AP), was confused with AW in former studies. Since the term "womb" has a more abundant meaning than "placenta," we use AW instead of AP in this article.…”