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The EXTra-uterine Environment for Neonatal Development (EXTEND) - future treatment for prematurity and potentially

Julia Wawrla-Zepf1, Alan W Flake2

  • 1Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Seminars in Pediatric Surgery
|June 20, 2026
PubMed

Insights

The EXtra-uterine Environment for Neonatal Development (EXTEND) system supports extremely premature infants by mimicking womb conditions. This innovative technology promotes normal organ growth, reducing risks associated with prematurity.

Area of Science:

  • Neonatalogy
  • Developmental Biology
  • Bioengineering

Background:

  • Extremely premature infants (EPIs) face significant morbidity and mortality due to organ immaturity and iatrogenic injury.
  • Current neonatal management strategies have limitations in fully replicating the protective in-utero environment.

Purpose of the Study:

  • To introduce the EXtra-uterine Environment for Neonatal Development (EXTEND) system.
  • To evaluate EXTEND's capacity to support fetal development and organogenesis in an animal model, mimicking in-utero conditions.

Main Methods:

  • Utilized an animal model (fetal lambs) at a gestational age equivalent to 22-24 weeks in humans.
  • Supported fetuses within the EXTEND system for up to four weeks.

Main Results:

  • The EXTEND system successfully supported fetal lambs for up to four weeks.
  • Demonstrated normal organ growth, with a particular emphasis on normal lung development within the system.

Conclusions:

  • EXTEND shows promise in supporting extremely premature infants by replicating the intrauterine environment.
  • Advances in EXTEND bring it closer to clinical translation for treating premature infants and fetal disorders.

Keywords:
Congenital diaphragmatic herniaCongenital heart diseaseEXTENDIntrauterine growth restrictionPrematurityPrenatal gene therapy

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