For expectant mothers, going into labor early can be terrifying. Premature babies are at an increased risk for serious health problems. The earlier a baby is born, the higher risk of health challenges they have, including digestive issues, a weakened immune system, heart problems, and lung injuries, among others.

At the Children’s Hospital of Philadelphia (CHOP), Alan Flake, MD, and his lab have developed an artificial womb model to help babies born prematurely reduce the risk of these health challenges. A project regarding this model began in 2017 and was recently completed with the help of current Duke School of Medicine researchers. Results were published in Scientific Reports.

The artificial womb model, which they have coined “EXTEND” for EXTrauterine Environment for Neonatal Development, keeps a growing fetus in an amniotic-like fluid until they reach late preterm gestational age. “The theory is,” said Jennifer L. Cohen, MD, assistant professor of pediatrics and lead author, “once the premature lungs ‘meet’ air, damage is done in that first breath.”

With the EXTEND model, doctors perform a C-section-type surgery in which the baby is never exposed to air and is instead continuing to breathe in fluid until they can be placed in the artificial womb, which is a fluid-filled bag.

The team used EXTEND with an animal model to look at transcriptomic and RNA sequencing analysis data to see how brain tissue from the subjects in the EXTEND model compared to preterm and late pre-term subjects.

This is the first time RNA sequencing was used in the EXTEND model to see if there were RNA and gene expression changes occurring as a result of the artificial womb. These data are critical to ensure EXTEND would not cause any additional harm to the neurodevelopmental outcomes of the preterm baby.

“When we compared those three groups using RNA sequencing analyses,” Cohen said, “we saw that the results using EXTEND were more similar to the late preterm gestational age model kept in the womb.”

Because of these findings, the team at CHOP is continuing research towards translating the EXTEND model into human clinical trials. However, Cohen is quick to note that the EXTEND model will not be used to make a non-viable pregnancy viable, but instead could help very early premature babies survive with less morbidity.

“This provides the first glimpse into what we need to be thinking about in terms of neurodevelopmental sequelae that might occur as a result of something new,” Cohen said. “And the early data in this preclinical model suggests safety in that the results are more similar to a late preterm gestational age brain.”

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