Center for Fetal Research, Department of Surgery, The Children's Hospital of Philadelphia Research Institute, Room 1116B, 3615 Civic Center Boulevard, Philadelphia, Pennsylvania 19104, USA.
Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, Pennsylvania 19104, USA.
Nat Commun. 2017 Apr 25;8:15112. doi: 10.1038/ncomms15112.
In the developed world, extreme prematurity is the leading cause of neonatal mortality and morbidity due to a combination of organ immaturity and iatrogenic injury. Until now, efforts to extend gestation using extracorporeal systems have achieved limited success. Here we report the development of a system that incorporates a pumpless oxygenator circuit connected to the fetus of a lamb via an umbilical cord interface that is maintained within a closed 'amniotic fluid' circuit that closely reproduces the environment of the womb. We show that fetal lambs that are developmentally equivalent to the extreme premature human infant can be physiologically supported in this extra-uterine device for up to 4 weeks. Lambs on support maintain stable haemodynamics, have normal blood gas and oxygenation parameters and maintain patency of the fetal circulation. With appropriate nutritional support, lambs on the system demonstrate normal somatic growth, lung maturation and brain growth and myelination.
在发达国家，由于器官不成熟和医源性损伤的综合作用，极早产是新生儿死亡和发病的主要原因。到目前为止，使用体外系统来延长妊娠的努力仅取得了有限的成功。在这里，我们报告了一种系统的开发，该系统结合了无泵式氧合器回路，通过脐带接口与羊膜腔内的封闭“羊水”回路连接，该回路紧密复制了子宫内的环境。我们表明，与极早产儿相当的胎儿羔羊可以在这种体外设备中得到生理支持长达 4 周。支持下的羔羊保持稳定的血液动力学，血气和氧合参数正常，并保持胎儿循环通畅。通过适当的营养支持，该系统上的羔羊表现出正常的体生长、肺成熟和脑生长及髓鞘形成。
