Heartbreaking.

That's really the only word that describes losing a child to premature birth. But as Lauren Neergaard of The Associated Press reports, far fewer parents could suffer that trauma, thanks to the efforts of a team of doctors from Children's Hospital of Philadelphia. The doctors have created a device that stands in for a uterus.

The rationale behind the genius design

Today, when a baby is born prematurely, doctors typically place the child on a ventilator and other equipment to give the baby a fighting chance. But that's not an ideal solution, because the baby's lungs often simply aren't ready to handle air. They need to develop more, kept moist by the amniotic fluid, before they really can work as they're supposed to. Led by fetal surgeon Dr. Alan Flake, doctors theorized that, if they could replicate the womb environment, babies would have a better chance of maturing to a point where the lungs and other organs would function sufficiently.

Device components and testing

The team came up with a 2-part system to do the job of the uterus:

  • Pumpless circulatory system--forms a connection through the umbilical cord vessels, allowing blood to flow out of the fetus, through an oxygenator and back, exchanging gas as the placenta normally would
  • Biobag--a sack filled with artificial amniotic fluid

Flake and his team then delivered lambs by cesarean at 105 days after fertilization, the equivalent to 22 weeks in human fetal development. That amount of time is what most doctors and scientists see as pushing the limits of human viability. The team put the lambs in the biobag for 28 days. The results were extremely promising, with the lambs appearing to develop completely normally. Examination of the lambs' organs further verified that the lambs were comparable in development to lambs of older gestational age, including in brain development.

Great promise, but mixed reaction

Reaction to the team's accomplishment has varied. Some individuals are thrilled, seeing enormous potential.

Melissa Alvarado of Austin, Texas is an NRP-licensed RN with Level III neonatal certification. She believes the device offers hope. "Anytime a baby needs to be delivered less than 24 weeks, there is a gut wrenching silence over the unit," she says. "We all know what that means. The doctors have to present all the information so that parents can make an informed decision on whether they want to resuscitate or not. [...] We use everything we've got. Every piece of technology, every prayer, every treatment that should work or help. Yet some babies still don't survive. So, I suppose I don't see what's wrong with this next level of technology. For the babies that will survive, this could aid in their quality of life later down the road. Their lungs would function better. Kidneys, eyes, organs that just needed longer in utero to develop, could actually do so!"

But as Rob Stein of National Public Radio reports, others are cautious. Critics say the device raises serious ethical questions, such as whether/how the device would

  • increase stress and pain for the fetus.
  • be used to grow humans from embryos.
  • result in authority figures/professionals coercing women who want abortions to put their fetuses in artificial wombs.
  • Prompt employers to require women to use artificial wombs to avoid maternity leave.
  • Influence bonding, given the lack of normal prenatal human contact.

Flake stresses that he has no intention of using the system to extend viability further back. And the team still has a long way to go before they're ready to try the system on a human fetus. Still, for better or for worse, the groundwork to save lives and drastically shift the approach to premature infant care is laid.