Artificial Wombs: From Concept to reality

The race to develop and bring artificial wombs to the commercial market is in full swing. Progress has advanced from laboratory experiments involving animals to the stage of preparing for human trials.

What is artificial womb?

An artificial womb is an experimental medical device intended to provide a womblike environment for extremely premature infants. In most of the technologies, the infant would float in a clear “biobag,” surrounded by fluid. The idea is that preemies could spend a few weeks continuing to develop in this device after birth, so that when they’re transitioned from the device, they’re more capable of surviving and having fewer complications with conventional treatment.

Why is this important?

Premature birth affects approximately 1 in 10 babies worldwide. Infants born between 28 and 37 weeks are currently transferred to neonatal intensive care units (NICUs), to support their heart and lung development. ?For ?extremely premature infants (<28 weeks), however, exposure to air is very harsh on their organs and may lead to long-term cardiac, neurological and metabolic problems or complications in breathing. Despite advances in medicine and technology, current care in the NICU is a far from optimal substitute for the protective environment of the natural maternal womb.

Lung development is a big challenge in ensuring the survival of extremely premature infants. Instead of relying on air, neonates within an artificial womb would receive lab-created amniotic fluid to fill their lungs, closely resembling the natural amniotic environment of the uterus. Neonatologists would skillfully introduce tubes into the blood vessels of the umbilical cord, enabling the infant's blood to traverse an artificial lung for the vital uptake of oxygen.

Who are the leading players in this space?

Vitara Biomedical

Vitara Biomedical is considered a front runner with the device called EXTEND(EXTrauterine Environment for Newborn Development). It was invented by Alan Flake and Marcus Davey at the Children’s Hospital of Philadelphia. The technology used in the EXTEND system has been tested on lamb fetuses. It reported that about 300 were used in animal testing. The lambs can survive and develop inside the sack for three or even four weeks.

Perinatal Life Support Project(PLS)

This is the European Union consortium which aims to " develop a novel, alternative environment, more similar to the mother’s womb. In this PLS system, extremely premature babies would be transferred to an environment where the lungs remain filled with fluid and the umbilical cord will be attached to an artificial placenta to improve their organ development and ease the transition to newborn life. This project aims to increase the chances of survival for extremely premature babies and not to change the viability threshold"

There are other notable projects from Australia, Canada and other countries. Researchers at the University of Michigan are working on similar technology intended to be used within preemies for whom conventional therapies aren’t likely to work. Rather than floating in fluid, the infants would only have their lungs filled. It’s a system that could be used in existing ICUs with relatively few modifications

How does this technology work?

The procedure requires a carefully choreographed transfer. First, the baby must be delivered via cesarean section and immediately have tubes inserted into the umbilical cord before being transferred into the fluid-filled container.

The technology would likely be used first on infants born at 22 or 23 weeks who don’t have many other options. “You don’t want to put an infant on this device who would otherwise do well with conventional therapy,” Mychaliska says. At 22 weeks gestation, babies are tiny, often weighing less than a pound. And their lungs are still developing. When researchers looked at babies born between 2013 and 2018, survival among those who were resuscitated at 22 weeks was 30%. That number rose to nearly 56% at 23 weeks. And babies born at that stage who do survive have an increased risk of neurodevelopmental problems, cerebral palsy, mobility problems, hearing impairments, and other disabilities.?

This is the most complex development and might take years.