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Advances in extracorporeal membrane oxygenator design for artificial placenta technology
David G Blauvelt1, Emily N Abada2, Peter Oishi1
1Department of Pediatrics, University of California, San Francisco, CA, USA.
Insights
Extreme prematurity poses significant risks due to immature lungs. Artificial placenta technology (Extracorporeal Life Support) offers a potential solution by supporting gas exchange, allowing lung development without mechanical ventilation.
Area of Science:
- Neonatal Medicine
- Biomedical Engineering
- Respiratory Physiology
Background:
- Extreme prematurity (<28 weeks gestation) presents major mortality and morbidity challenges, primarily due to immature lungs.
- Current mechanical ventilation strategies can worsen lung pathology in extremely preterm infants.
- Extracorporeal Life Support (ECLS), termed artificial placenta technology for neonates, provides an alternative gas exchange method.
Purpose of the Study:
- To review the unique challenges of applying ECLS to extremely preterm infants.
- To discuss recent advancements in artificial placenta technology.
- To analyze design considerations for artificial placenta membrane oxygenators.
Main Methods:
- Literature review focusing on ECLS in extreme prematurity.
- Analysis of engineering requirements for artificial placenta circuits.
- Examination of next-generation oxygenator technologies.
Main Results:
- ECLS has not been effectively applied to extremely preterm infants despite success in other populations.
- Specific challenges exist in adapting ECLS for the unique physiology of extremely preterm infants.
- Progress is being made in developing specialized membrane oxygenators for artificial placenta devices.
Conclusions:
- Artificial placenta technology holds promise for supporting extremely preterm infants with respiratory failure.
- Further research and engineering are needed to optimize ECLS devices for this vulnerable population.
- Next-generation oxygenators may enhance the efficacy and safety of artificial placenta systems.
Abstract:
Extreme prematurity, defined as a gestational age of fewer than 28 weeks, is a significant health problem worldwide. It carries a high burden of mortality and morbidity, in large part due to the immaturity of the lungs at this stage of development. The standard of care for these patients includes support with mechanical ventilation, which exacerbates lung pathology. Extracorporeal life support (ECLS), also called artificial placenta technology when applied to extremely preterm (EPT) infants, offers an intriguing solution. ECLS involves providing gas exchange via an extracorporeal device, thereby doing the work of the lungs and allowing them to develop without being subjected to injurious mechanical ventilation. While ECLS has been successfully used in respiratory failure in full-term neonates, children, and adults, it has not been applied effectively to the EPT patient population. In this review, we discuss the unique aspects of EPT infants and the challenges of applying ECLS to these patients. In addition, we review recent progress in artificial placenta technology development. We then offer analysis on design considerations for successful engineering of a membrane oxygenator for an artificial placenta circuit. Finally, we examine next-generation oxygenators that might advance the development of artificial placenta devices.
