The artificial placenta: Continued lung development during extracorporeal support in a preterm lamb model.

Area of Science:

• Neonatal physiology
• Respiratory medicine
• Extracorporeal technologies

Background:

• Mechanical ventilation (MV) can cause lung injury in preterm infants.
• Developing lungs require support to mature properly.
• Artificial placenta (AP) technology offers a potential alternative to MV.

Purpose of the Study:

• To evaluate the efficacy of an artificial placenta (AP) utilizing extracorporeal life support (ECLS) in supporting lung development.
• To compare lung injury and development in lambs supported by AP with those undergoing mechanical ventilation.

Main Methods:

• Preterm lambs (118 days gestational age) were supported with venovenous ECLS (VV-ECLS) via jugular drainage and umbilical vein reinfusion, maintaining fluid-filled lungs.
• Control groups included lambs undergoing early (118 days) or late (128 days) MV.
• Lung compliance, oxygenation index (OI), histological injury scores, and alveolar development markers were assessed.

Main Results:

• AP lambs demonstrated significantly higher lung compliance (2.79 Cdyn) compared to early MV (0.83 Cdyn) and late MV (3.04 Cdyn) controls.
• AP support resulted in a lower oxygenation index (6.20) and reduced lung injury scores (1.8) versus early MV (36.8 OI, 6.0 injury).
• Quantification of alveolar development showed higher double-positive staining for PDGFR-α and α-actin in AP lambs (0.012) compared to early (0.003) and late (0.004) MV groups.

Conclusions:

• Artificial placenta (AP) support facilitates continued lung development in preterm lambs.
• AP technology protects developing lungs from injury associated with mechanical ventilation (MV).
• This study highlights the potential of AP-ECLS as a lung-protective strategy for extremely preterm neonates.