Miura Yuichiro, Usuda Haruo, Watanabe Shimpei, Woodward Eleanor, Saito Masatoshi, Musk Gabrielle C, Kallapur Suhas G, Sato Shinichi, Kitanishi Ryuta, Matsuda Tadashi, Newnham John P, Stock Sarah J, Kemp Matthew W
School of Women's and Infants' Health, The University of Western Australia, Crawley, Western Australia, Australia.
Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan.
Artif Organs. 2017 Oct;41(10):959-968. doi: 10.1111/aor.12974. Epub 2017 Sep 11.
Ex vivo uterine environment (EVE) therapy is an experimental neonatal intensive care strategy wherein gas exchange is performed by membranous oxygenators attached to the umbilical vessels. Our aim was to assess the ability of a newly refined EVE system to maintain key physiological parameters in preterm lambs within optimal ranges for 48 h. EVE group; n = 6: Preterm lambs were delivered under general anesthesia at 115 ± 2 days of gestational age. Animals were submerged in a bath of artificial amniotic fluid on EVE therapy for 48 h. Physiological parameters were monitored in real-time over the length of the experiment. Control group; n = 11: Ewes carrying a single fetus (115 ± 2 days of gestational age) underwent recovery surgery to allow placement of a fetal carotid artery catheter. Fetuses received an infusion of sterile saline only. After euthanasia, EVE and Control group fetuses underwent necroscopy to perform static pressure-volume curves and for sampling of lung and cord blood plasma for molecular analyses. Five out of six fetuses in the EVE group completed the study period with key physiological variables remaining within their respective reference ranges for the duration of the 48 h study. Bacteremia was identified in four out of five EVE fetuses, and was associated with a systemic inflammatory response. Using our refined EVE therapy platform, preterm lambs were maintained in a stable physiological condition for 48 h. These findings represent a significant advance over earlier work with this system; however, the identification of bacteremia and a fetal inflammatory response suggests that further refinement to the EVE therapy platform is required.
体外子宫环境（EVE）疗法是一种实验性的新生儿重症监护策略，通过连接到脐血管的膜式氧合器进行气体交换。我们的目的是评估一种新改进的EVE系统在48小时内将早产羔羊的关键生理参数维持在最佳范围内的能力。EVE组；n = 6：早产羔羊在孕龄115±2天时在全身麻醉下分娩。动物在EVE疗法中浸泡在人工羊水浴中48小时。在实验过程中实时监测生理参数。对照组；n = 11：怀有单胎（孕龄115±2天）的母羊接受恢复手术，以便放置胎儿颈动脉导管。胎儿仅接受无菌生理盐水输注。安乐死后，EVE组和对照组胎儿进行尸检，以进行静态压力-容积曲线测定，并采集肺和脐带血血浆进行分子分析。EVE组六只胎儿中有五只完成了研究期，关键生理变量在48小时研究期间内保持在各自的参考范围内。五只EVE胎儿中有四只被鉴定为菌血症，并与全身炎症反应相关。使用我们改进的EVE治疗平台，早产羔羊在稳定的生理状态下维持了48小时。这些发现代表了在该系统早期工作基础上的重大进展；然而，菌血症和胎儿炎症反应的发现表明，EVE治疗平台需要进一步改进。
