I recently attended a virtual international meeting of groups working on versions of an artificial placenta. These groups were as far afield as Canada, and the United States. The aim of the gathering was to discuss research and encourage collaboration. It was fabulous to hear how much progress has been made with a spike in activity over the last five years.
The main driver of this activity was the realization that current standards of neonatal care cannot help infants born around 3 months too early because their lungs are too immature to breathe air. The paradigm shift in thinking recognizes that a preterm infant is actually a “fetus” and therefore needs to be treated like a fetus!
Whilst this sounds like something from The Matrix or Aldous Huxley’s “Brave New World”, the biological facts remain, that all fetal systems before 37 weeks are geared to thrive in a fetal environment supported by the mother and placenta. In particular, fetal blood is different to a baby at term containing a type of haemoglobin that has a 30% higher affinity for oxygen, making it more efficient at capturing precious oxygen from Mother’s blood. The fetal circulation is quite different from that of an infant at birth. Fetal blood is pumped by the fetal heart to the placenta through the umbilical cord, where it takes up oxygen and is returned to the fetus. This refreshed blood goes straight to the brain and developing organs and critically, most blood bypasses the developing lungs which are immature and not ready to breathe air.
It makes good biological sense to return a preterm infant to a womb-like environment, supported by an artificial placenta. This is what artificial organ researchers hopes to achieve and in the process reduce mortality and particularly eliminate chronic ill health caused by premature birth and the application of mechanical ventilation to lungs that are fragile. Research into artificial placentation is well underway in several centres and some researchers believe that clinical translation could be as early as five years away.