Scientists develop device to mimic the womb

Science | The system could save premature babies, but comes with big ethical questions
by Kiley Crossland
Posted 4/27/17, 02:54 pm

Researchers have developed a womb-like device they hope can save and improve the lives of extremely premature babies. The device has only been tested on baby lambs so far, but the Children’s Hospital of Philadelphia scientists plan to test it on premature humans in the next few years, according to a study published Tuesday in the journal Nature Communications.

The development shows more promise than any previous attempt to mimic the womb environment for critically preterm babies, but it also raises a host of ethical questions scientists and doctors are struggling to answer, including questions about its effect on the abortion debate.

The extra-uterine system is a plastic bag, called a Biobag, filled with artificial amniotic fluid. It has two tubes that connect to the baby’s umbilical cord. One tube runs to an oxygenator and infuses the baby’s blood with oxygen and nutrients and removes carbon dioxide. The other tube pumps the blood back into the baby’s body using the power of the baby’s own heartbeat.

During the study, infant lambs, placed in the sack within seconds of a cesarean section, were given a drug so they wouldn’t breathe air during delivery and could continue to breathe and swallow amniotic fluid in the Biobag like babies in utero. The researchers placed the Biobags in a warm, dark room and played the sound of the mother’s heartbeat.

So far, researchers have successfully cared for premature baby lambs for up to four weeks in Biobags with unprecedented results.

“They’ve had normal growth,” said Alan Flake, a fetal surgeon and the study leader. “They’ve had normal lung maturation. They’ve had normal brain maturation. They’ve had normal development in every way that we can measure it.”

Extreme prematurity is the leading cause of infant death and illness in the United States. Nearly one-third of all infant deaths and one-half of all cases of cerebral palsy are linked to premature birth, according to the study. Each year, about 30,000 U.S. babies are born before 26 weeks of gestation.

Medical advancements have enabled doctors to care for babies born as early as 22 to 23 weeks of gestation, however the methods they now use to keep those babies alive—incubators with ventilators—cause irreparable damage to underdeveloped organs. Premature lungs are not intended to breathe gas, and even the gentlest ventilators are a shock to the infants’ systems.

But the Biobag researchers hope to present another option, something they see as a “bridge between the mother’s womb and the outside world.”

“If we can develop an extra-uterine system to support growth and organ maturation for only a few weeks, we can dramatically improve outcomes for extremely premature babies,” Flake said.

The Biobag has practical challenges. Hooking up the tubes is hard because the umbilical cord shrinks when it is exposed to oxygen. The amniotic fluid can become contaminated, causing infection, and the baby’s heart sometimes can’t handle the job of pumping the blood through the oxygenator.

There are ethical challenges, as well, including whether the system could cause emotional stress on the baby and whether the lack of human connection could have adverse effects. Others worry the technology could develop and eventually be used to care for babies all the way from embryo to delivery, raising questions of possible coercion.

Scott Gelfand, a bioethicist at Oklahoma State University, told NPR he was concerned employers could require women use “artificial wombs” to avoid pregnancy or insurers could require the device for at-risk pregnancies. “The ethical implications are just so far-reaching,” he said.

But while this development is significant progress, it is not an “artificial womb,” according to John Pierce, a doctor and professor of obstetrics, gynecology, and internal medicine at Liberty University’s College of Osteopathic Medicine. He argued the term “womb” gives the Biobag system too much credit.

“An ‘artificial womb’ implies implantation and growth from the egg and the sperm until delivery,” Pierce said. While the system has shown great promise at taking already developed organs and helping them mature further without the risk of infection, Pierce said there was no way this system was as good as a natural womb, something he called a miraculous environment.

“When I start thinking about the complexity of recreating a womb without complications, it is mind boggling,” Pierce said, noting the things that happen without a mother even directing them in the womb, including the placenta providing the right nutrients in the right amount at the right time during development, the regulation of blood pressure and blood flow, and the ability to fight infection.

Pierce also pointed to the implications of the Biobag’s development on the abortion debate, much of which centers on the ever-changing idea of viability. “If you can end up having a baby born earlier and earlier, but you can electively abort a baby past that date, that gives us pause to say ‘Wait a minute, is that the right thing to do?’”

The team at Children’s Hospital of Philadelphia maintains the Biobag was only developed for premature babies considered viable today.

“I want to make this very clear: We have no intention, and we’ve never had any intention with this technology, of extending the limits of viability further back,” Flake says. “I think when you do that, you open a whole new can of worms.”

Dena Davis, a bioethicist at Lehigh University, told NPR she had similar concerns: “Up to now, we’ve been either born or not born. This would be halfway born, or something like that. Think about that in terms of our abortion politics.”

Flake said the researchers have been interacting with the FDA and hope to take the Biobag to clinical trials one to two years from now.

Kiley Crossland

Kiley is a former WORLD correspondent.

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Comments

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  • Minivan Man's picture
    Minivan Man
    Posted: Fri, 04/28/2017 07:39 am

    Very interesting article. The effects of this womb-like bag are far-reaching.  Lots of things to consider.

  • Koni in WA
    Posted: Sat, 04/29/2017 05:19 pm

    I know I am going to spark controversy (and I honestly don't mean to) but here goes...First off let me say my daughter is a NICU nurse and saving babies like this is her profession, joy and definite calling.  I am so proud of her and amazed by what she does; but I have always had a few misgivings. I believe every life is precious from conception, and we need to insure their safety, and there are definitely babies who, through no fault of their own, by accident or design need medical intervention - but where do we draw the line to avoid the risk of playing God. As tragic and painful as it is I believe God does take some of these babies before or right after birth for reasons that only He understands -  but we always trust in His heart, knowing that his plans for us and for that baby are always for the ultimate best. He sees down the road and knows what will be. I sometimes feel that the heroic methods designed to save some of these babies (I'm talking about the micro,micro preemies) are kindof blurring the line between medicine and the hand of God. I don't believe that this view smacks of euginics because I believe every baby deserves a chance no matter who they are and what their need is. And God has His miracles even without (or in spite of) medical intervention. Time and again. my daughter tells us of many babies who are born that you can definitely see God's hand at work against the odds.  If this sounds rambling and even at times contradictory it probably is as this is definitely not settled in my mind - but I believe this is an issue that we should wrestle with. Eventhough the researcher in the article assures us that they have no intention to extend the limits on viability I wonder - think back on all of the other similar assurances we have had from scientists; nobody ever intends to push the envelope - until they do.  Like one of the characters in Jurassic Park stated: "Just because we can, does that mean that we should".

  • Laura W
    Posted: Sat, 04/29/2017 07:45 pm

    Well, if you put it that way, isn't all medicine “playing God" to some extent? How about using antibiotics to treat an infection that would otherwise have been fatal? Sure, antibiotics have been around for a long time, but at one point they were at the cutting edge of medical science too. God is the one who ultimately decides how much time each one of us has on earth, but the parable of the Good Samaritan teaches us that we shouldn't just leave people to their ”fate", but should help them as best we can. God does have his reasons for ending some lives much sooner than we might expect, but I don't think he ever tells us that there are some neighbors we shouldn't try to save.

  • Minivan Man's picture
    Minivan Man
    Posted: Mon, 05/01/2017 12:14 pm

    This article brings to mind several questions.  Does God ever intend a child to die?  How much suffering is God will to let a person endure?  At what point does a person step into action?  What action shall a person take?  

     

  • Koni in WA
    Posted: Tue, 05/02/2017 12:40 pm

    Laura W, I wasn't saying that we should definitely throw this technology out the window - as you can see from my letter I am conflicted as well. I appreciate almost all medical advances, I believe that God gives us the knowledge and ability and I thank Him for them.  I'm just saying sometimes we should slow down and ask the hard questions and walk into these issues with some resolve - even if it ends up being a conclusion that we don't really like. I know this is an issue that can be very emotional as we all know, or at least have heard of, babies who were saved by heroic measures - so it tends  to put a personal face on it. This makes an objective conclusion near impossible.  I'm also saying we should be wary of scientists who say "Oh, we would never..." because there are always those with more curiosity than brains.

  • Laura W
    Posted: Tue, 05/02/2017 08:53 pm

    Sure, I'm just trying to understand what you are conflicted about. I could see a few possible concerns with using this technology, such as people wanting to remove babies from wombs prematurely for trivial reasons, or using this as a stepping stone to develop a device that could actually facilitate the development of a child from conception all the way through to full gestation (there are multiple problems with how this ability could be used). However, the only concern I see you raise is "blurring the line between medicine and the hand of God" or "playing God". I'm not sure what you mean by this--can you elaborate? I don't understand what you see in this technology that is materially different from something like using antibiotics.

    P. S. In case you were wondering, I don't have any particular personal connection to this, just that caring for babies in general has always been close to my heart.

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