Artificial Placenta - Lung Assist Devices for Term and Preterm Newborns with Respiratory Failure

Abstract

Respiratory insufficiency is a major cause of neonatal mortality and long-term morbidity, especially in very low birth weight infants. Today, non-invasive and mechanical ventilation are commonly accepted procedures to provide respiratory support to newborns, but they can reach their limit of efficacy. To overcome this technological plateau and further reduce mortality rates, the technology of an "artificial placenta", which is a pumpless lung assist device connected to the umbilical vessels, would serve to expand the therapeutic spectrum when mechanical ventilation becomes inadequate to treat neonates with severe respiratory insufficiency. The first attempts to create such an artificial placenta took place more than 60 years ago. However, there has been a recent renaissance of this concept, including developments of its major components like the oxygenator, vascular access via umbilical vessels, flow control, as well as methods to achieve hemocompatibility in extracorporeal circuits. This paper gives a review of past and current development, animal experiments and human case studies of artificial placenta technology.

Artificial Placenta: A Novel Approach for Preterm Neonates: Review of Literature

“…The most appealing solution for correcting respiratory insufficiency in EPI and to reduce the overall mortality rates associated with it, is by returning them to a uterine-like environment by using "artificial placenta", which is a pump-less lung assisted device connected to the umbilical vessels [1].…”

“…Artificial placenta works on same principle as a normal placenta works in-utero, serving as an interface between maternal and fetal circulations thereby providing fetal nutrient, metabolite elimination, and exchange of gases [1]. In preterm infants, especially with severe respiratory insufficiency, the artificial placenta helps in gaseous exchange until the baby recovers from its initial cause of lung failure in its early neonatal period.…”

“…In preterm infants, especially with severe respiratory insufficiency, the artificial placenta helps in gaseous exchange until the baby recovers from its initial cause of lung failure in its early neonatal period. Hence, artificial placenta which is connected to umbilical vessels, similar to natural placenta, works in parallel with systemic circulation [1]. It is basically a pump-less device which is driven by arteriovenous pressure difference alone.…”

“…It is basically a pump-less device which is driven by arteriovenous pressure difference alone. In addition to forming partial fetal circulation, the artificial placenta also helps in perfusion and ventilation of lungs [1]. It significantly helps in gaseous exchange of newborn, but, since the residual lung function is still present, artificial placenta does not meet the total body needs of newborn [28,29].…”

“…The artificial placenta was designed to mimic working of natural placenta in-utero and to allow partial fetal circulation and placental gaseous exchange while directly connected to umbilical vessels [1]. The first attempts to develop an artificial placenta as an effective alternation to provide respiratory support for newborns, especially preterm were made in mid-20th century [2].…”