PURPOSE: The treatment of extreme prematurity remains an unsolved problem. We developed an artificial placenta (AP) based on extracorporeal life support (ECLS) that simulates the intrauterine environment and provides gas exchange without mechanical ventilation (MV) and compared it to the current standard of neonatal care. METHODS: Extremely premature lambs (110-120 days; term=145d) were used. AP lambs (n=9) were cannulated (jugular drainage, umbilical vein reinfusion) for ECLS. Control lambs (n=7) were intubated, ventilated, given surfactant, and transitioned to high-frequency oscillatory ventilation. All lambs received parenteral nutrition, antibiotics, and steroids. Hemodynamics, blood gases, hemoglobin, and circuit flows were measured. RESULTS: Four premature lambs survived for 1 week on the AP, with one surviving 6 days. Adequate oxygenation and ventilation were provided by the AP. The MV lambs survived 2-8 hours. Each of these lambs experienced a transient improvement with surfactant, but developed progressive hypercapnea and hypoxia despite high airway pressures and HFOV. CONCLUSIONS: Extremely premature lambs were supported for 1 week with the AP with hemodynamic stability and adequate gas exchange. Mechanically ventilated lambs succumbed within 8 hours. Further studies will assess control of fetal circulation and organ maturation on the AP.
PURPOSE: The treatment of extreme prematurity remains an unsolved problem. We developed an artificial placenta (AP) based on extracorporeal life support (ECLS) that simulates the intrauterine environment and provides gas exchange without mechanical ventilation (MV) and compared it to the current standard of neonatal care. METHODS: Extremely premature lambs (110-120 days; term=145d) were used. AP lambs (n=9) were cannulated (jugular drainage, umbilical vein reinfusion) for ECLS. Control lambs (n=7) were intubated, ventilated, given surfactant, and transitioned to high-frequency oscillatory ventilation. All lambs received parenteral nutrition, antibiotics, and steroids. Hemodynamics, blood gases, hemoglobin, and circuit flows were measured. RESULTS: Four premature lambs survived for 1 week on the AP, with one surviving 6 days. Adequate oxygenation and ventilation were provided by the AP. The MV lambs survived 2-8 hours. Each of these lambs experienced a transient improvement with surfactant, but developed progressive hypercapnea and hypoxia despite high airway pressures and HFOV. CONCLUSIONS: Extremely premature lambs were supported for 1 week with the AP with hemodynamic stability and adequate gas exchange. Mechanically ventilated lambs succumbed within 8 hours. Further studies will assess control of fetal circulation and organ maturation on the AP.
Authors: Junewai L Reoma; Alvaro Rojas; Anne C Kim; Joseph S Khouri; Erika Boothman; Kristy Brown; James Grotberg; Keith E Cook; Robert H Bartlett; Ronald B Hirschl; George B Mychaliska Journal: J Pediatr Surg Date: 2009-01 Impact factor: 2.545
Authors: Brian W Gray; Ahmed El-Sabbagh; Alvaro Rojas-Pena; Anne C Kim; Samir Gadepali; Kely L Koch; Tony R Capizzani; Robert H Bartlet; George B Mychaliska Journal: ASAIO J Date: 2012 Mar-Apr Impact factor: 2.872
Authors: Terry C Major; David O Brant; Charles P Burney; Kagya A Amoako; Gail M Annich; Mark E Meyerhoff; Hitesh Handa; Robert H Bartlett Journal: Biomaterials Date: 2011-06-22 Impact factor: 12.479
Authors: Terry C Major; David O Brant; Melissa M Reynolds; Robert H Bartlett; Mark E Meyerhoff; Hitesh Handa; Gail M Annich Journal: Biomaterials Date: 2009-12-29 Impact factor: 12.479
Authors: Elaine M Boyle; Gry Poulsen; David J Field; Jennifer J Kurinczuk; Dieter Wolke; Zarko Alfirevic; Maria A Quigley Journal: BMJ Date: 2012-03-01
Authors: Anush Sridharan; Misun Hwang; Shelby Kutty; M Beth McCarville; Harriet J Paltiel; Maciej Piskunowicz; Sphoorti Shellikeri; Elizabeth Silvestro; George A Taylor; Ryne A Didier Journal: Pediatr Radiol Date: 2021-05-15
Authors: Matthew A Hornick; Marcus G Davey; Emily A Partridge; Ali Y Mejaddam; Patrick E McGovern; Aliza M Olive; Grace Hwang; Jenny Kim; Orlando Castillo; Kathleen Young; Jiancheng Han; Sheng Zhao; James T Connelly; Kevin C Dysart; Jack Rychik; William H Peranteau; Alan W Flake Journal: J Physiol Date: 2018-03-02 Impact factor: 5.182
Authors: Ahmed M El-Sabbagh; Brian W Gray; Andrew W Shaffer; Benjamin S Bryner; Joseph T Church; Jennifer S McLeod; Sara Zakem; Elena M Perkins; Renée A Shellhaas; John D E Barks; Alvaro Rojas-Peña; Robert H Bartlett; George B Mychaliska Journal: ASAIO J Date: 2018 Jul/Aug Impact factor: 2.872
Authors: Jennifer S McLeod; Joseph T Church; Megan A Coughlin; Benjamin Carr; Clinton Poling; Ellery Sarosi; Elena M Perkins; Matias Caceres Quinones; Pavel Hala; Raja Rabah; Elizabeth Freiheit; Alvaro Rojas-Pena; Robert H Bartlett; George B Mychaliska Journal: J Pediatr Surg Date: 2019-03-01 Impact factor: 2.545
Authors: Joseph T Church; Nicole L Werner; Meghan A Coughlin; Julia Menzel-Smith; Mary Najjar; Benjamin D Carr; Hemant Parmar; Jeff Neil; Dimitrios Alexopoulos; Carlos Perez-Torres; Xia Ge; Scott C Beeman; Joel R Garbow; George B Mychaliska Journal: J Pediatr Surg Date: 2018-03-08 Impact factor: 2.545
Authors: Florian Schmidt; J Kuebler; M Ganter; T Jack; L Meschenmoser; M Sasse; M Boehne; H Bertram; P Beerbaum; H Koeditz Journal: Pediatr Surg Int Date: 2015-10-28 Impact factor: 1.827
Authors: Joseph T Church; Elena M Perkins; Megan A Coughlin; Jennifer S McLeod; Katherine Boss; J Kelley Bentley; Marc B Hershenson; Raja Rabah; Robert H Bartlett; George B Mychaliska Journal: Neonatology Date: 2018-02-23 Impact factor: 4.035
Authors: Joseph T Church; Megan A Coughlin; Elena M Perkins; Hayley R Hoffman; John D Barks; Raja Rabah; J Kelley Bentley; Marc B Hershenson; Robert H Bartlett; George B Mychaliska Journal: J Pediatr Surg Date: 2018-06-08 Impact factor: 2.545