Artificial placentas being tested by Perth researchers

The Women and Infants Research Foundation (WIRF) is working on a technology to provide nutrients and oxygen to pre-term babies to allow them additional time to develop.

In Australia around 8% of babies are born preterm between 20 and 36 weeks, according to the Australian Institute of Health and Welfare, with the majority born between 32 and 36 weeks.

Their lack of developed lungs, skin and other organs put them at greater risk of illness and death. Prematurity is the leading cause of death in children under the age of five years.

These babies are also at greater risk of long-term neurological disability, admission to neonatal intensive care, severe morbidity in the first weeks of life, prolonged hospital stay after birth, readmission to hospital in the first year of life and increased risk of chronic lung disease.

But the WIRF work offers hope to one day improve those odds. The Ex Vivo Uterine Environment (EVE) process is being trialled with lamb foetuses to recreate the conditions of pregnancy outside a human mother's body.

While the idea may sound futuristic, scientists around the world have been considering the concept of a preterm life support system in place of the human placenta since the 1950s.

As WIRF chief scientist Professor Matt Kemp, who is working on the project at UWA, told Medical Forum the technology has continuously changed over the years.

“The initial conceptualisations were around gas exchange and nutrient delivery, but more recently it is clear that the growth controlling parameters or functions are really important to drive a normal pattern of growth,” he said.

“So, while it may have initially been around survival versus death, we are now more interested in long-term outcome.

“When the technology was originally conceived it was around handling anything up to 30 weeks of gestation but now, given how good obstetrics and neonates are at keeping babies alive, we are really talking from 21 week."

Prof Kemp said the number of preterm babies that would benefit from this technology would be small given the advancements in current treatment options.

He likened the technology to a miniature ECMO (extracorporeal membrane oxygenation). 

“It would be a very, very sick foetus that didn’t have any reasonable likelihood of surviving with current technology," he said.

"So 20-21 weeks, growth restricted, maybe congenital abnormality and probably infected - factors that in combination would mean they would be otherwise unlikely to survive.”

Surgical intervention would also be required before the foetus was born to stop it from breathing outside of the womb, which would prompt it to move from foetal circulation to post-natal circulation.

Prof Kemp said the procedure would likely be similar to a cesarean section where the umbilical cord would be catheterised and the placental control transferred to the artificial system.

He said due to the complexity of the systems that researchers are trying to simulate and the need to design using systems that recapitulate, there was still work to be done before an artificial placenta may realistically be used to provide support to a human foetus.

However, there were still some positives being discovered along the way.

Prof Kemp said the work itself, considering the processes required to best simulate a human placenta, was providing valuable insight into understanding optimal conditions for growth in a foetus.