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Tytuł:
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An extra-uterine system to physiologically support the extreme premature lamb.
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Autorzy:
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Partridge EA; 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.
Davey MG; 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.
Hornick MA; 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.
McGovern PE; 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.
Mejaddam AY; 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.
Vrecenak JD; 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.
Mesas-Burgos C; 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.
Olive A; 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.
Caskey RC; 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.
Weiland TR; 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.
Han J; 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.
Schupper AJ; 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.
Connelly JT; 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.
Dysart KC; Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, Pennsylvania 19104, USA.
Rychik J; Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, Pennsylvania 19104, USA.
Hedrick HL; 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.
Peranteau WH; 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.
Flake AW; 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.
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Źródło:
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Nature communications [Nat Commun] 2017 Apr 25; Vol. 8, pp. 15112. Date of Electronic Publication: 2017 Apr 25.
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Typ publikacji:
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Journal Article; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Original Publication: [London] : Nature Pub. Group
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MeSH Terms:
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Extracorporeal Membrane Oxygenation/*methods
Fetus/*physiology
Premature Birth/*therapy
Animals ; Animals, Newborn/physiology ; Extracorporeal Membrane Oxygenation/adverse effects ; Extracorporeal Membrane Oxygenation/instrumentation ; Female ; Fetal Monitoring ; Fetus/blood supply ; Hemodynamics/physiology ; Humans ; Infant, Extremely Premature/physiology ; Lung/physiology ; Models, Animal ; Oxygenators, Membrane ; Pilot Projects ; Pregnancy ; Premature Birth/physiopathology ; Sheep, Domestic ; Treatment Outcome
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Entry Date(s):
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Date Created: 20170426 Date Completed: 20181120 Latest Revision: 20201216
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Update Code:
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20240105
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PubMed Central ID:
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PMC5414058
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DOI:
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10.1038/ncomms15112
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PMID:
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28440792
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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.
Erratum in: Nat Commun. 2017 May 23;8:15794. (PMID: 28534492)
Comment in: Nature. 2017 May 31;546(7656):45-46. (PMID: 28569804)
Comment in: Pediatr Res. 2018 Dec;84(6):795-796. (PMID: 30323347)
