Nature reports that human trials of artificial wombs could start soon. The purpose is to provide a womb-like environment for babies born prematurely, to enable them to survive and avoid lifelong problems like brain damage or asthma. Researchers at Children’s Hospital of Philadelphia “are seeking approval for the first human clinical trials” of the artificial womb “they’ve been testing, named the Extra-uterine Environment for Newborn Development, or EXTEND,” Nature says:
scientists hope that simulating some elements of a natural womb will increase survival and improve outcomes for extremely premature babies. In humans, that’s anything earlier than 28 weeks of gestation — less than 70% of the way to full term, which is typically between 37 and 40 weeks….
The US Food and Drug Administration (FDA) will convene a meeting of independent advisers on 19–20 September to discuss regulatory and ethical considerations and what human trials for the technology might look like. The committee’s discussion will be scrutinized by the handful of other groups around the world that are developing similar devices, and by bioethicists exploring the implications for health equity, reproductive rights and more.
“This is definitely an exciting step and it’s been a long time coming,” says Kelly Werner, a bioethicist and neonatologist at Columbia University Medical Center in New York City, who is not affiliated with groups developing artificial-womb technology. “Clinicians who work with premature babies will be closely following this meeting,” she says.
Preterm birth, defined by the World Health Organization as birth before 37 weeks of gestation, can happen spontaneously or because some conditions — such as an infection, hormone imbalance, high blood pressure or diabetes — can turn the womb into an inhospitable environment for the fetus.
It poses an enormous global health problem. Preterm birth is the largest cause of death and disability in children under five. In 2020, there were about 13.4 million such births worldwide, and complications related to preterm birth caused about 900,000 deaths in 2019.
Mortality is strongly linked with the baby’s gestational age at birth. At or before 22 weeks — considered the cusp of fetal viability — few fetuses survive outside the womb. By 28 weeks, most can survive, but often require significant life support. Artificial-womb technology aims to improve outcomes for preterm babies who are born in the period between 22 and 28 weeks, for whom survival has improved, but long-term health issues are frequent.
In a study2 of 2.5 million people in Sweden, for example, 78% of people born before 28 weeks of gestation had some sort of medical condition — ranging from asthma and hypertension to cerebral palsy and epilepsy — by the time they were adults. For full-term births, that rate was 37%.
Death and disability, especially in babies born at younger gestational ages, often occur because the lungs and brain are among the last organs to fully mature in humans. That’s why obstetricians try to prevent preterm birth whenever possible — the longer fetuses can safely stay in the womb, the higher their odds are of long-term survival and good health.
In a natural womb, a fetus receives oxygen, nutrients, antibodies and hormonal signals and gets rid of waste through the placenta, a transient organ in which fetal blood interacts with maternal blood. Of these various roles, artificial-womb technology is most focused on providing oxygen and removing carbon dioxide, replacing the mechanical ventilators that are often used for neonates. These can damage fragile developing lungs that would otherwise still be filled with amniotic fluid.
The artificial womb “would bridge a baby born extremely premature through those days and weeks when they’re most at risk for lung and brain damage”, Werner says. The CHOP group has signalled that it would wean babies off its system after a few weeks, when their organs are more fully developed and their likelihood of healthy survival is higher.
The group’s system would work by placing extremely premature babies into what it calls a Biobag, filled with an electrolyte-laden fluid designed to mimic amniotic fluid. Surgeons would connect the blood vessels in the umbilical cord to a system that oxygenates blood outside the body. The fetal heart would still pump blood as it does in the natural womb.
Doctors are also beginning to do womb transplants. A woman who was previously unable to have children recently received her sister’s womb in the first womb transplant in the United Kingdom.
Doctors recently did the first robotic liver transplant in America. Robots can fit in small spaces in people’s bodies that a surgeon can’t reach without cutting through living tissue, or doing other collateral damage. Doctors recently used a robot to carry out incredibly complex spinal surgery.
Promoting and defending liberty, as defined by the nation’s founders, requires both facts and philosophical thought, transcending all elements of our culture, from partisan politics to social issues, the workings of government, and entertainment and off-duty interests. Liberty Unyielding is committed to bringing together voices that will fuel the flame of liberty, with a dialogue that is lively and informative.
Comments
For your convenience, you may leave commments below using Disqus. If Disqus is not appearing for you, please disable AdBlock to leave a comment.
