Effects of an artificial placenta on brain development and injury in premature lambs

Purpose: We evaluated whether brain development continues and brain injury is prevented during Artificial Placenta (AP) support utilizing extracorporeal life support (ECLS). Methods: Lambs at EGA 118 days (term = 145; n = 4) were placed on AP support (venovenous ECLS with jugular drainage and umbilical vein reinfusion) for 7 days and sacrificed. Early (EGA 118; n = 4) and late (EGA 127; n = 4) mechanical ventilation (MV) lambs underwent conventional MV for up to 48 h and were sacrificed, and early (n = 5) and late (n = 5) tissue control (TC) lambs were sacrificed at delivery. Brains were harvested, formalin-fixed, rehydrated, and studied by magnetic resonance imaging (MRI). The gyrification index (GI), a measure of cerebral folding complexity, was calculated for each brain. Diffusion-weighted imaging was used to determine fractional anisotropy (FA) and apparent diffusion coefficient (ADC) in multiple structures to assess white matter (WM) integrity. Results: No intracranial hemorrhage was observed. GI was similar between AP and TC groups. ADC and FA did not differ between AP and late TC groups in any structure. Compared to late MV brains, AP brains demonstrated significantly higher ADC (0.45 ± 0.08 vs. 0.27 ± 0.11, p = 0.02) and FA (0.61 ± 0.04 vs. 0.44 ± 0.05; p = 0.006) in the cerebral peduncles. Conclusions: After 7 days of AP support, WM integrity is preserved relative to mechanical ventilation. Type of study: Research study.