Pumpless Extracorporeal Support of the Preterm Infant: Bridging Fetal and Postnatal Physiology

Preterm birth is a major cause of neonatal mortality and childhood morbidity and remains an unsolved clinical challenge despite advances in neonatal care. The preterm infant needs to be supported in an extracorporeal system physiologically analogous to the sterile fluid intrauterine environment. This would support ongoing growth and organ maturation with the potential to substantially improve survival and reduce morbidity. A physiologic system would require the ability to achieve gas exchange via the umbilical circulation, with the fetal heart acting as the pump that drives circuit flow. Previous efforts at developing such a system have borrowed from conventional extracorporeal membrane oxygenation technology, with the application of external pump-driven circuits to support fetal perfusion. These have demonstrated proof in principle of extracorporeal maintenance of fetal survival but have failed to achieve physiologic homeostasis or the long-term stability required for clinical application. Our laboratory has developed a system for extracorporeal support of the preterm infant, which we call EXtracorporeal Transitional Environment for Neonatal Development (EXTEND). Using this system, we have now achieved stable support of fetal lambs that are developmentally equivalent to the 22- to 24-week gestational age human infant for up to 4 weeks with stable hemodynamics, growth, and development. The achievement of long-term physiologic extracorporeal support of the extremely preterm in...
Source: NeoReviews recent issues - Category: Pediatrics Authors: Tags: Pediatric Drug Labeling Update Articles Source Type: news