Being born early is dangerous because
the body is not yet ready
Large preterm infants, babies born before 26 weeks of gestation, face great difficulties because their lungs, digestive system, circulation or brain are not ready to adapt to the outside world.
To finish developing properly, they would need to stay a little longer in the womb.
That would be the ideal option.
And precisely what the 'Artificial Placenta' project that has just presented BCNatal, the clinical and research center of the Hospital Clínic and the Sant Joan de Déu Hospital in Barcelona, aims to emulate.
The objective of the initiative, which has received funding of 3.35 million euros from the Fundación la Caixa for its first phase, is to
increase survival and reduce the serious neurological sequelae
suffered by most extremely premature newborns.
And to achieve this, the project is based on imitating as far as possible the conditions that a baby experiences in the womb.
"The fetus is ready to live inside the mother,"
Dr. Eduad Gratacós, project leader and director of BcNatal, explained at a press conference.
For this reason, in the artificial placenta that the team has already begun to develop, the extremely premature baby would not be kept in an incubator, but in "a liquid medium", inside a bag made of biocompatible materials, protected from sounds and lights. from the outside and connected, through its umbilical cord, to an external oxygenation system and supply of nutrients and other substances necessary for its development.
The baby would be monitored at all times using non-invasive techniques, Gratacós has clarified.
But "deceiving the fetus and making it believe that it has not left its mother to protect it is complicated", he has recognized as a specialist in Fetal Medicine.
It is necessary to set in motion a complex gear that involves multiple scientific disciplines and an exquisite coordination of hundreds of professionals.
The team has been working on the project for two years and has already developed some of the components of the placenta.
With the funding received, a first phase of research will now begin in which an experimental prototype will be developed and its suitability will be studied through trials with sheep fetuses, Gratacós pointed out.
In this period, it will be verified, for example, how is the survival for a month of a sheep fetus in the environment of the artificial placenta.
"It is very important to be sure that everything is developing correctly", stressed the researcher.
Later, the project will also evaluate
the long-term effects on brain, heart, lung and metabolic development
and the system will be optimized.
If all goes well,
within "five or six" technology could reach clinical practice
, has advanced Gratacós, who has acknowledged that the team is facing major challenges, such as making the connection to the baby through of the umbilical cord is effective, guarantee an adequate supply of oxygen or nutrients or be able to carry out an effective non-invasive monitoring.
It will also be necessary to protect the baby from light or noise - while ensuring that it does receive auditory or movement stimuli such as those it would receive in the womb - or to ensure that an adequate bond with the family is produced.
On the other hand, the project also wants to provide the artificial placenta with a technology that makes it possible to perform surgical interventions when necessary.
"We are developing a robotic arm and the ability to insert it into the bag where the baby is in a minimally invasive way," said Gratacós.
That of the artificial placenta "is a very old idea. But we are finally ready to carry it out," said the doctor, who described the initiative as "disruptive."
As he explained, every year more than 25,000 children are born in Europe with six months or less of gestation.
The survival of these little ones ranges between 25 and 75% and between 75% and 95% of the survivors have sequelae.
The Neonatal Units manage to raise many babies, the specialist has pointed out.
But, in reality, the fetus is in a very unnatural environment, for which it is not prepared and is subjected to very invasive technological interventions, which together cause side effects.
Replicating the environment of the placenta and allowing the organs to continue to develop in a more 'friendly' environment may be the most effective option for large premature infants, Gratacós pointed out.
The specialist has clarified that this option is designed for children born with a few weeks of gestation, not for all premature babies.
A child born at 35 weeks, whose lungs are already developed, would not need to be cared for in an artificial placenta, he indicated.
Gratacós has also pointed out that the project has previously undergone an international evaluation process and throughout the process it will have supervisory committees (for example, experts in bioethics or reproductive rights).
In addition to the Spanish research, three other groups (two from the United States and a consortium between Australia and Japan) are also developing experimental models of an artificial placenta to assist premature infants.
"The artificial placenta is going to generate a new field of knowledge", Gratacós stressed.
The expert added that the progress made will allow a deeper understanding of fetal development and predicted an increase in investments in R&D "in Barcelona, Catalonia and Spain."
For their part, both Josep Maria Campistol, general director of the Hospital Clínic and Manel del Castillo, managing director of the Sant Joan de Déu Hospital, agreed that the initiative could "change the natural history of many people and, without a doubt, it will have a very important transcendence for the whole society ".
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