Artificial Wombs and Modern Incubators
May 11, 2017
Sometimes what seems like science fiction can actually be science fact, and sometimes new technologies can have the potential for both good and bad uses. So-called “dual-use technology” is most often thought of in connection with potential military as well as civilian use, e.g., weaponized forms of viruses or bacteria vs. using such altered pathogens for vaccine development. At other times, the dual use may turn on bioethical evaluations of the use of technology, especially as it relates to use with human beings. The recently-developed artificial womb may be one such possibility. Scientists at Children’s Hospital of Philadelphia published their work on development of an artificial womb, testing the functionality with pre-term lambs. The simple design, utilizing a biobag as the sterile enclosure, coupled with several advances in linking circulatory system and facilitating oxygenation, give this new artificial womb the potential for successful gestation of pre-term infants (the full publication is available at Nature Communications.) This artificial womb is designed to give extremely pre-term infants the chance for a bit more development, especially for lung maturation, in a fluid-bathed environment similar to the normal womb, before they enter the air-filled world. In this sense, this artificial womb is really an innovative incubator.
Current treatment of extremely pre-term infants involves an incubator and intubation, along with stimulants for lung maturation, but the mechanical breathing apparatuses can often do more damage than good for the highly fragile lungs of such tiny infants. The fluid-filled bags in which the lambs were incubated provide an environment similar to the native womb, with fluid filling the lungs, and rather than a mechanical pump for circulation, which can cause significant damage to tissues, the fetal heart itself acts to pump the tiny volume of fluid to bring oxygenated blood to the lamb. Another innovation is a well-designed interface with the end of the umbilical cord, providing a snug fit and greatly reduced chance of hemorrhage, compared to insertion of needles into umbilical vein and artery.
Extremely premature babies at 20, 21 and 22 weeks after fertilization (22, 23 and 24 weeks gestational age) are now surviving outside the womb when given medical interventions, and the interventions and attitudes regarding intervention now indicate as many as 61 percent of these extremely pre-term infants may survive, including 25 percent without severe complications. But given further care and opportunity to develop and especially for lung maturation, it is likely many more would survive, and without complications.
This new artificial womb is definitely not akin to the laboratory “hatcheries” depicted in Aldous Huxley’s Brave New World. A year ago, we discussed the science that is pushing the envelope at the beginning of human life, growing human embryos in vitro for longer periods and even past the normal point of implantation into the uterine lining. Some are attempting to develop artificial wombs to supplant the normal womb for this early stage of development. Such designs do cross an ethical line, not only in terms of the instrumental use and destruction of human embryos inherent in such experiments, but also by virtue of the attitude this shows toward human life and normal human development. Such laboratory constructs for human embryo development are certainly no substitute for a mother’s womb; there are a great many fetal-maternal interactions very early and throughout development that we do not as yet understand, both in terms of biology as well as psycho-social connections.
Could this new, innovative incubator (the artificial womb for pre-term infants) also change the view around “viability,” both in medical and legal frameworks? It is potentially possible for this artificial womb to be put into service for infants even earlier in development. The aim of this innovative artificial womb is support for extremely pre-term babies, to give them a better chance for survival. In that respect, the real issue is keeping in focus the humanity and care of this tiniest of patients.