Here at Med Device Monday, we explore a variety of topics. From specific medical devices to the role of technology to what FDA has been up to. Today we're talking about a device that's not yet on the market, but which certainly makes it seem like the future is now!
It wasn't that long ago that it was common for women and babies to die in childbirth. As American medicine advanced and healthcare improved along with our understanding of safe labor and delivery, women survived more and babies did too. As time has marched on, fetal viability has increased, while time necessary in the womb has decreased: fetuses can now sometimes survive after just 22 weeks in utero. It appears that time may only continue to shorten as we see the introduction of artificial wombs.
Before we go further, let's be clear: the best place for a developing fetus is inside a healthy and willing mother. The ideal is for babies to stay inside and develop in their natural environment for as long as they need to, because the earlier a baby is born, the higher the risk for complications, lifelong medical problems, and death. But as we know, remaining in utero is not always possible. And if babies are or need to be born prematurely, technology and medicine continue to advance to save them.
An article from NPR discusses the artificial womb seen above. While this technology is not yet ready for human fetuses, it has been successful in keeping lamb fetuses alive for about a month. As soon as babies take their first breath of air, their lungs cease developing, which has all kinds of long-ranging implications. The study explains the intent of the device quite nicely:
"In the United States, extreme prematurity is the leading cause of infant morbidity and mortality, with over one-third of all infant deaths and one-half of cerebral palsy attributed to prematurity. Advances in neonatal intensive care have improved survival and pushed the limits of viability to 22 to 23 weeks of gestation. However, survival has been achieved with high associated rates of chronic lung disease and other complications of organ immaturity, particularly in infants born before 28 weeks. In fact, with earlier limits of viability, there are actually more total patients with severe complications of prematurity than there were a decade ago. Respiratory failure represents the most common and challenging problem, as gas exchange in critically preterm neonates is impaired by structural and functional immaturity of the lungs. This condition, known as bronchopulmonary dysplasia, is now understood to be related to an arrest in lung development secondary to premature transition from liquid to gas ventilation, explaining why even minimally invasive modes of neonatal ventilation have not reduced the incidence of bronchopulmonary dysplasia. There is clearly an urgent need for a more physiologic approach to support the extreme premature infant."
The "womb" is a clear plastic bag in which the fetus is placed, along with artificial amniotic fluid. Outside of the bag, a machine attached to the umbilical cord functions as a placenta, a concept the study says has been the subject of research for 50 years. The "placenta" functions as an organic one does, furnishing nutrition and oxygen and taking away carbon dioxide. The fetus is monitored with ultra sounds, and it even gets to hear soothing recordings of a mother's heartbeat.
One thing that I think is extra cool about this device is that it may not only save lives, but will likely provide further insight into fetal development. Check out this little lamb in its artificial environment. It's truly something to behold.
As previously stated, actual approval and usage of a device like this for humans is a long way off. Not only are there obvious medical risks, but there's an ethical discussion to be had, too. The leaders of the study say they have no intentions of using a device like this to increase viability outside of the womb: they say they wouldn't use it on fetuses before 22 weeks. But of course, just the possibility of a device like this does open the door. There are many factors worth considering for a potential device like this, but from a medical standpoint, it is pretty impressive.