Unit 7 - Future Directions

Within neonatology, an exciting emerging technology is the artificial womb. Extreme prematurity is the leading cause of infant mortality and morbidity in developed nations, and even with advances in viability limits to 22 weeks gestational age, only 9% of infants born at this age survive (De Bie et al., 2020). It is extremely painful and frustrating for parents when a baby is born only a couple weeks before a viable age and there is nothing that can be done to save their life. The idea behind the artificial womb is to provide an extremely premature infant with an environment similar to the womb where they can grow and receive nourishment until they can be “born” again at a more advanced age. This new technology has the potential to save many lives and to give babies born too early a chance at life.

Here is a news article and video explaining how an artificial womb has been used on lambs:

Hamzelou, J. (2017). Artificial womb helps premature lamb fetuses grow for 4 weeks. New Scientist. Retrieved from
https://www.newscientist.com/article/2128851-artificial-womb-helps-premature-lamb-fetuses-grow-for-4-weeks/

Here is a journal article explaining the science behind the technology:

Partridge, E. A., Davey, M. G., McGovern, P. E., Mejaddam, A. Y., Vrecenak, J. D., Mesas-Burgos, C., Olive, A., Caskey, R. C., Weiland, T. R., Han, J., Schupper, A. J., Connelly, J. T., Dysart, K. C., Rychik, J., Hedrik, H. L., Peranteau, W. H., & Flake, A. W. (2020). An extra-uterine system to physiologically support the extreme premature lamb. Nature Communications, 8(15112). Retrieved from https://www.nature.com/articles/ncomms15112

Currently, premature babies are put into an incubator after they are born. This provides heat, but is filled with air and requires the baby to breathe with their underdeveloped lungs in order to provide their bodies with gas exchange. These babies are hooked up to ventilators, which can provide high pressure and damage the immature lungs. With use of an artificial womb, the baby would be placed in a fluid-filled bag and they would be hooked up to an artificial placenta through the umbilical cord. The artificial placenta would provide gas exchange and therefore the baby would not be required to breathe. The lambs used in the experiments were born via c-section and placed into the artificial wombs at an age roughly equal to a human gestation of 23-24 weeks. The lambs were kept in the wombs for 4 weeks and then removed. Most were euthanized and examined, and all appeared to have had healthy development with no abnormalities in the brain or lungs. Some of the lambs were “born” again and allowed to live, with the oldest now 1-year-old and healthy. This provides promising prospects for human use of the artificial placenta. Researchers in several countries have been working on developing artificial wombs for human use. Human trials have not yet begun, but may in just a few years.

An explanation of one system being developed in the Netherlands is provided in this video:

Devlin, K. (2019). The world’s first artificial womb for humans. BBC News. Retrieved from https://www.bbc.com/news/av/health-50056405

Some challenges to clinical translation of this technology include improving hemodynamics and optimization of nutrition and growth factors. Also, more detailed research on organ function in animals who received artificial womb support must be done before moving on to human trials. A detailed report on challenges and next steps are provided here:

De Bie, F. R., Davey, M. G., Larson, A. C., Deprest, J., & Flake, A. W. (2020). Artificial placenta and womb technology: Past, current, and future challenges towards clinical translation. Prenatal Diagnosis, 41, 145-158.

Image from Partridge et al. (2020)