A paradigm shift in the treatment of extreme prematurity: the artificial placenta.
OBJECTIVE
Extremely low gestational age newborns (ELGANs), born at less than 28 weeks' estimated gestational age, suffer the greatest consequences of prematurity. There have been significant advances in their care over the last several decades, but the prospects for major advances within traditional treatment modalities appear limited. An artificial placenta using extracorporeal life support (ECLS) has been investigated in the laboratory as a new advance in the treatment of ELGANs. We review the concept of an artificial placenta, the purported benefits, and the most recent research efforts in this area.


RESULTS
For 50 years, researchers have attempted to develop an artificial placenta based on ECLS. Traditional artificial placenta strategies have been based on arteriovenous ECLS using the umbilical vessels with moderate success. Recently, the use of venovenous ECLS and miniaturization of ECLS components have shown potential for creating a next-generation artificial placenta.


CONCLUSIONS
ELGANs suffer the greatest morbidity and mortality of prematurity, and are poised to benefit from a paradigm shift in the treatment. Although challenges remain, the artificial placenta is feasible. An artificial placenta would not only protect ELGANs from the complications of mechanical ventilation, but also support their development until a stage of greater maturity, preparing them for a life free of the sequelae of prematurity.
aSection of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan Health System bSection of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Ryan P
RP
Davis
Benjamin
B
Bryner
George B
GB
Mychaliska
D001187:Artificial Organs; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005865:Gestational Age; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D010920:Placenta; D011247:Pregnancy; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome