Related Experiment Video
Updated: Oct 12, 2025
Clinical Practice Protocol of Creative Music Therapy for Preterm Infants and Their Parents in the Neonatal Intensive Care Unit
Published on: January 7, 2020
A supportive physiologic environment for the extreme premature infant: Improving life outside the womb
1Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States.
Insights
The Extra-uterine environment for newborn development (EXTEND) system supports premature lambs, mimicking the womb to improve outcomes for extremely premature infants. This technology aims to reduce mortality and morbidity in neonatal intensive care units.
Area of Science:
- Neonatalogy
- Developmental Biology
- Bioengineering
Background:
- Extreme prematurity is a leading cause of infant mortality and morbidity.
- Current neonatal intensive care unit (NICU) support is often non-physiologic for extremely premature infants.
- Developing a more physiologic environment is crucial for improving outcomes.
Purpose of the Study:
- To introduce the Extra-uterine environment for newborn development (EXTEND) system.
- To present EXTEND as a novel approach to neonatal care.
- To outline the potential of EXTEND in improving outcomes for extremely premature infants.
Main Methods:
- Development of the EXTEND system, featuring a sterile fluid environment.
- Implementation of a pumpless arteriovenous extracorporeal oxygenator circuit.
- Utilizing umbilical vessels for vascular access in premature fetal lambs.
Main Results:
- Premature fetal lambs demonstrated normal growth and development for up to 4 weeks on the EXTEND system.
- Fetal physiology was maintained throughout the support period.
- Organ system analysis indicated normal development.
Conclusions:
- The EXTEND system successfully supports normal development in premature fetal lambs.
- This technology has the potential to be a paradigm shift in neonatal care.
- Further research and human translation are planned.
Abstract:
Extreme prematurity remains an unsolved problem and is the leading cause of pediatric mortality and morbidity in developed countries. The extreme premature infant is physiologically a fetus, and current supportive measures in our NICUs are for the most part non-physiologic. In order to improve morbidity and mortality in this population, we have developed the Extra-uterine environment for newborn development (EXTEND) system which seeks to mimic as closely as possible the environment of the womb. The primary components of EXTEND include a sterile fluid environment, a pumpless arteriovenous extracorporeal oxygenator circuit, and vascular access via umbilical arterial and venous vessels. While supported on the EXTEND system, premature fetal lambs grow and develop normally for up to 4 weeks. Fetal physiology is maintained, and detailed organ system analysis supports normal development. This article summarizes current progress in the development of EXTEND, the pathway for human translation, ethical considerations related to EXTEND, and anticipated clinical applications of this potentially paradigm changing technology. LEVEL OF EVIDENCE: IV.
Related Concept Videos
01:26Requirements for Human Life
Oxygen
Atmospheric air is only about 20 percent oxygen, but that oxygen is a key component of the chemical reactions that keep the body alive, including the reactions that produce ATP. Brain cells are susceptible to a lack of oxygen because they require a...
01:14Fetal Circulation
Two umbilical arteries transport blood from the fetus to the placenta. At the placenta, the blood absorbs oxygen and nutrients while simultaneously eliminating waste products. This oxygen-enriched and nutrient-rich blood then returns to the fetus through one...
01:25Transmission-based Precautions II: Airborne and Protective Environment
Airborne precautions:
Use airborne precautions when treating patients known or suspected to have diseases that spread through the air—for example, tuberculosis or measles. These organisms are present in smaller droplets expelled by an infected person and...
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:29Decreased Body Temperature
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....