
An extra-uterine system to physiologically support the extreme premature lamb - artsandsci
https://www.nature.com/articles/ncomms15112
======
jawns
In case you're wondering, the study's authors point out:

> Our goal is not to extend the current limits of viability, but rather to
> offer the potential for improved outcomes for those infants who are already
> being routinely resuscitated and cared for in neonatal intensive care units.

One of the biggest current problems with pre-term babies, the study notes, is
a respiratory condition called bronchopulmonary dysplasia:

> an arrest in lung development secondary to premature transition from liquid
> to gas ventilation

So having the lambs (and, eventually, the preterm infants) remain in a liquid
environment allows their immature lungs to continue developing, so that when
they eventually transition to gas ventilation (breathing air), their lungs are
able to function correctly.

~~~
omginternets
>Our goal is not to extend the current limits of viability

In the interest of looking at thing squarely in the face, this can eventually
(and therefore _will_ ) be used to extend the "current limits of viability".

It's important not to put blinders on because this has a very real impact on
medical ethics. Is it ethical, for instance, to develop human embryos outside
of the womb for convenience?

~~~
tormeh
>Is it ethical, for instance, to develop human embryos outside of the womb for
convenience?

Why not, assuming outcome is identical?

~~~
Chaebixi
Because, over the long term, it would reduce the selective pressure on the
ability to gestate embryos in vivo, unnecessarily increasing dependence on
technology.

We should try to avoid adding extinction to the list of consequences of the
collapse of technological civilization.

~~~
derefr
How _could_ "technological civilization" collapse, at this point? We have
extremely well-distributed records—spoken, written, digital, and more—of all
of our technology and how to use it. "We forgot how" worlds are just
impossible at this point, unless we all get a disease that renders us
incapable of tool-usage, reading, and speech. (At which point we're not human
anyway.)

~~~
aperrien
Although I agree that this is unlikely, until we are multi planetary, with at
least four worlds/stations, this is not the case.

~~~
derefr
To restate that: what precise type of disaster would destroy "technological
civilization"—presumably, all traces of it, because it's pretty easy to
bootstrap back up†—but not the human species itself? Because that's the only
case where humans not being capable of non-technologically-assisted
reproduction would matter.

† See the book _The Knowledge_ , and then consider a world where you have
access to not only that, but also hard copies of the US Patent filing
database, and 6 billion people to parallelize the bootstrapping process
across. (And even that ignores the amount of "skipping ahead" that just the
existing knowledge already loaded into people's heads would enable.)

Unless we all got amnesia at once, _and_ all lost the ability to read (and
those who can, to read braille), we'd be back to civilization before the
generation was over—and back to simple longevity-extending practices like
freezing sperm and ova long before that.

~~~
serf
>To restate that: what precise type of disaster would destroy "technological
civilization"—presumably, all traces of it, because it's pretty easy to
bootstrap back up†—but not the human species itself?

Technology onset: Grey-goo type scenario

Human onset: massive cultural shift to demonize knowledge.

It's happened before. It didn't wipe all technology away, but it slowed
progress to a stand-still.

~~~
derefr
Do you think it'd be possible to _choose_ to "demonize knowledge", in a world
where we _know_ that the only way to reproduce requires technology? I would
expect our biological imperative to reproduce would get the better of that
attempted social more quite quickly.

------
surgeryres
To clear some confusion - they did not grow this lamb in the bag starting from
conception.

The major limiting factor as to when it can be transferred to the bag is when
the umbilical vessels are large enough to safely and efficiently cannulate.
Oxygenation, nutrient delivery and waste removal are all done via the
umbilical vessels through external devices.

The biggest road block in growing a baby in a bag fully ex utero would be the
period before when the umbilical vessels are accessible. Before this time in
utero, local mommy angiogenesis in the wall of the placenta serves the role of
the umbilical vessels. Replicating this ex utero is a completely different
problem.

~~~
bayesian_horse
Yes, a different problem. But at the other end, it is already possible and
even routine to raise fertilized ova into implantable embryos in vitro.

This new method however does fill a medical need, or at least shows the road
to filling that need, meaning the problems of raising prematurely born
infants.

~~~
alphaoverlord
Yes, but that does not require complicated structures like blood vessels.
Embryos and ova are small enough to grow on cell culture in which diffusion is
enough to provide oxygen and nutrients, with only the need to replace culture
fluid every few days.

------
wesleytodd
I have been reading the ["The Vorkosigan
Saga"]([https://en.wikipedia.org/wiki/Vorkosigan_Saga](https://en.wikipedia.org/wiki/Vorkosigan_Saga))
and one of the consistent themes is the "Uterine Replicator". Sounds very much
like what this could become in the future.

Not only is this book series great and very entertaining, I think it tackles
some technology and social ideas that others in the genre do not.

~~~
azernik
In part this is the result of being written by a female, strongly feminist
author who has the gender implications of sci-fi technology in mind.

On a separate note, I quite enjoy the way that she also explores the
relationship of a "backwards" polity with a more advanced international
community.

------
marknadal
This is one of the most important and powerful work/research I have seen in
over a decade, I'm literally at tears realizing the potential of this
technology. Thank you so much for working on this, history will remember it
and be thankful.

~~~
BronSteeDiam
What makes you say that? What are some of the potential benefits?

~~~
egocodedinsol
Extreme premature births are the leading cause of infant mortality in the US.
Even if the infant survives, they often have incredibly complex consequences
that cause lifelong issues because, e.g. the lungs have not fully developed
but are required to be used after birth.

It's possible that keeping extremely premature infants in an 'artificial
uterus' could decrease some of these complications, especially those related
to respiration.

------
isoprophlex
What an amazing idea, pushing the boundaries of medicine...

In the table with experiment outcomes I see one lamb that survived for a while
without mechanical ventilation... Was this the best outcome of the set? I
couldn't make out if some of them were actually viable, and survived?

~~~
woliveirajr
Couldn't understand, too, if their lives were terminated on purpose or all
couldn't survive outside the environment. I'd appreciate any insight of it.

~~~
isotropy
Sounds like the lambs were terminated immediately after coming out of the
biobag, so the researchers could get a clear picture of how lung development
progressed in the biobag without confounding factors coming from spending too
much time in the open air.

------
mikeyouse
While this is amazing and I'm certain it's going to save a number of lives..
Does anyone else get the sense that we're going to start seeing "farms" full
of these bags in an effort to save time / money / stress on cows and sheep?

~~~
jawns
Remember that this technology does not cover the full gestation period. It
only works starting at the edge of viability.

In order for an extremely premature lamb to end up in one of these bags,
either preterm birth must be induced, or surgery must take place. Neither of
those options is low-cost or without the potential for significant
complications. You would likely end up with high rates of mortality and
morbidity, and even if the BioBags were able to successfully sustain the
animals, they would probably never be considered suitable for anything other
than research.

There may come a day when a BioBag is able to cover the full gestation period,
but even then, I highly doubt that it would be cheap enough for use with
livestock.

~~~
mikeyouse
Maybe my imagination it too dystopian today but I'm imagining artificial
insemination to get a dozen lambs gestating and then you could C-section (or
slaughter) the ewe after a few months.. That would take you from 1-2 lambs
every 2 years to a dozen lambs in year 1.

~~~
BronSteeDiam
That's basically how you get mice embryos at the moment. There are several
companies that provide this service.

------
vitorbaptistaa
Super interesting research! I wonder: is there a limit on how long the lamb
could be kept in this extra-uterine system? In other words, could the lamb be
grown in this system until it's an adult?

------
hprotagonist
CHOP regularly does top-notch work. This looks super cool.

~~~
tantalor
In case anybody else is confused:

[https://en.wikipedia.org/wiki/Children%27s_Hospital_of_Phila...](https://en.wikipedia.org/wiki/Children%27s_Hospital_of_Philadelphia)

------
DigitalJack
Brings Axlotl tanks to mind.

------
skocznymroczny
Wake me up when we can make women obsolete

------
jlebrech
this tech will render invalid the whole pro-life/pro-choice argument.

