The year was 2013 when an Australian researcher and professor Matthew Kemp sat in the evening with his colleagues in Japan.
The conversation turned to babies – more specifically, very premature babies. Would it be possible to improve the life chances of often seriously ill and underdeveloped babies?
It is now nine years since the evening in Japan, and Kemp and his colleagues are trying to resolve the issue they have set themselves with the help of an artificial court.
When looking at statistics on babies born dead in Finland in 2018, 2019 and 2020, it turns out that 166 Keskos died. In addition, more than half of babies who died in the week after birth were premature. Although Finland is a model country in terms of low infant mortality, improving the treatment of premature babies would help at least dozens of children every year.
The figures are small internationally. According to the World Health Organization (WHO), 15 million babies are born prematurely each year worldwide.
About a million of these babies die.
Kemp focuses especially on babies born around the fifth month of pregnancy. Premature babies are babies born at or before about the seventh month of pregnancy.
At about the fifth month, the baby weighs an average of 400 grams, about the same as a medium-sized cucumber.
An adult newborn weighs an average of 3.5–3.7 kg in Finland, almost nine times.
The lungs of such preterm infants have not adapted to life outside the womb. In addition, the regulation of blood circulation, vision and intestinal function are still evolving.
The sheep developed normally in the artificial uterus
The EVE technology of Kemppi and his colleagues is simple in principle. The baby is transferred to a transparent “bag” that is filled with synthetic amniotic fluid.
The baby’s umbilical cord is attached with catheters to a Rubik’s cube-sized device that oxidizes the oxygen-free blood from the baby. The device then sends the oxygenated blood back to the baby along a tube running through the umbilical cord.
The baby’s heartbeat keeps the uterus functioning, meaning the baby can regulate the amount of oxygen he or she receives.
– Basically, we oxidize the fetus in a new way, it’s not very weird after all, Kemp smiles.
EVE is tested in sheep. Sheep are common experimental animals in studies related to childbirth and pregnancy because they are largely similar in size and development to human babies.
In an experiment conducted in 2019, the sheep were in the artificial womb for five days. The sheep were transferred to the artificial uterus at 95 days of age.
The experiment was a success: seven sheep developed normally in the artificial womb for five days. According to Kemppi, the sheep would have survived in the womb longer.
However, he does not feel the need to focus too much on long-term studies, and is more interested in the data that can be collected during the first five days.
– We know that in people, death, serious brain damage and other things we want to avoid in treatment usually occur within 72 hours of starting treatment, and within five days at the latest, Kemp says.
Clinical trials in infants, despite progress, are still a long way off. Human experiments require permission from the ethics council, which Kemppi says would not hurt at the moment.
“The technology is not yet advanced enough to promise a good enough chance of surviving a premature baby for the ethics council to approve clinical trials,” says Kemp.
The study has seen breakthroughs, but there is no complete artificial womb yet
EVE is by no means the only artificial court project in the world.
In Israel, the Weizmann Science Institution approaches artificial courts from a different angle than Kemppi’s team. Doctor Jacob Hanna last year, after seven years of trial and error, he and his colleagues managed to raise mice in a test tube.
Mouse embryos developed in rotating test tubes from five days of age to eleven days. Their limbs and internal organs developed normally.
The development of a mouse in the womb takes about twenty days. Hanna’s mice thus spent about half of their fetal stage at the artificial abode.
In the Netherlands, baby dolls that mimic premature babies are being developed for an artificial uterine examination at Eindhovenine General Hospital. The purpose is to make the dolls simulate the breathing of a human child.
These dolls would be designed to test how safely a baby can be transferred from a biological uterus to an artificial uterus. They could also reduce animal testing in the development of the artificial uterus.
Three years ago, the study received € 2.9 million in funding from the EU as part of the Horizon 2020 project, which is set to run until 2024.
So is the direction that we could have a working artificial utilization technology as early as 2030?
– Never say never. But at the moment, we are still a long way from that. We do not have long-term data on what happens when a developmentally endangered fetus is caught in such technology, Kemp says.
The complete functioning of the biological uterus is still a mystery
The artificial court sounds futuristic, but research on it has been done for over sixty years.
– Material on artificial uterine technology was first published as early as 1958, and the concept has still not been implemented. It’s a really long time for an idea that isn’t very complicated after all.
Kemp refers to the Swedish Karolinska Institute, which published diagrams of artificial courts in 1958.
Despite the achievements of recent years and decades of research, the perfect artificial abode for a human baby to survive has not been created. In Kemp’s view, one reason for this is that artificial uterine research simply takes a lot of time and money.
– One mistake can mean that EUR 20 000 or EUR 30 000 has been wasted, and after a couple of days we have to start again. And there are many other people involved in the process besides myself. Then there’s a bad day for many other than me, Kemp laughs.
The study of artificial uteri is also hampered by the fact that human development in the womb is still in many respects a mystery.
– We know a lot, but a lot is still dark. For example, premature birth is still difficult to predict. We have some models that can be used, but they are not accurate. The best way to predict a premature birth is still a previous preterm birth, Kemp explains.
The artificial uterus is not meant to be the beginning of baby care
The word artificial court can evoke images of matrix-like baby cultures.
For example, a petition to the European Commission was filed last year against an artificial trial in the Netherlands, and names are currently being collected.
However, according to Kemppi, the purpose of the EVE project is not to develop an artificial uterus in which a child would develop from a cell into a baby.
– It is important to have ethical debates based on what is actually being developed and researched. The EVE is basically an oxidizer only for younger babies. No one would question putting a baby born in the 30th week of pregnancy in an oxidizer, Kemp says.
Kemp refers to a device that can oxidize a patient’s blood. It is used to treat premature babies. The same technology has also been used to treat coronary patients.
You can discuss the topic on 17.4. until 11 p.m.