{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T14:55:41Z","timestamp":1784213741639,"version":"3.55.0"},"reference-count":23,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2019,7,28]],"date-time":"2019-07-28T00:00:00Z","timestamp":1564272000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Artificial Organs"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:label\/><jats:p>EXTEND (EXTra\u2010uterine Environment for Neonatal Development) is a novel system for supporting extremely premature infants that replicates in utero conditions by maintaining a sterile fluid environment and providing gas exchange via a pumpless arteriovenous oxygenator circuit connected to the umbilical vessels. Target gestational age (GA) for EXTEND support in human infants is 23\u201027 weeks, when immature lungs are most susceptible to injury in the setting of air ventilation. We previously demonstrated physiologic support of premature lambs cannulated at 105\u2010117 days GA (lungs developmentally analogous to the 23\u201027 week GA human infant) for up to 28 days on EXTEND. In the present study, we sought to determine the technical feasibility of umbilical vessel cannulation in 85\u201096 days GA lambs delivered to EXTEND at weights equivalent to the 23\u201027 week GA human infant (500\u2010850\u00a0g). Five preterm lambs were cannulated at 85\u201096 days GA (term 145 days) and supported on EXTEND for 4\u20107 days. All lambs underwent umbilical artery and umbilical vein cannulation. Circuit flows and pressures were monitored continuously, and blood gases were obtained at regular intervals for assessment of oxygen parameters. Systemic pH and lactate were measured at least once daily. Mean body weight at cannulation was 641\u00a0\u00b1\u00a071\u00a0g (range 480\u2010850\u00a0g). All lambs were cannulated successfully (cannula size varied from 8 to 12\u00a0Fr), and mean survival on EXTEND was 140\u00a0\u00b1\u00a07 hours. Mean circuit flow was 213\u00a0\u00b1\u00a015 mL\/kg*min, mean pH was 7.37\u00a0\u00b1\u00a00.01, and mean lactate was 1.6\u00a0\u00b1\u00a00.2 mmol\/L. During the initial 120 hours after EXTEND cannulation, there were no significant differences between 85\u201096 days GA lambs and 105\u2010117 days GA lambs in weight\u2010adjusted circuit flows, oxygen delivery, pH, or lactate levels. This study demonstrates successful umbilical cord cannulation and adequate circuit flows and oxygen delivery in midgestation lambs size\u2010matched to the 23\u201027 week GA human fetus, which represents an important step in the translation of EXTEND to clinical practice.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aor.13524","type":"journal-article","created":{"date-parts":[[2019,6,25]],"date-time":"2019-06-25T21:43:15Z","timestamp":1561498995000},"page":"1154-1161","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Technical feasibility of umbilical cannulation in midgestation lambs supported by the EXTra\u2010uterine Environment for Neonatal Development (EXTEND)"],"prefix":"10.1111","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8059-0028","authenticated-orcid":false,"given":"Matthew A.","family":"Hornick","sequence":"first","affiliation":[{"name":"Center for Fetal Research, Department of Surgery, Children\u2019s Hospital of Philadelphia Research Institute Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali Y.","family":"Mejaddam","sequence":"additional","affiliation":[{"name":"Center for Fetal Research, Department of Surgery, Children\u2019s Hospital of Philadelphia Research Institute Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick E.","family":"McGovern","sequence":"additional","affiliation":[{"name":"Center for Fetal Research, Department of Surgery, Children\u2019s Hospital of Philadelphia Research Institute Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Hwang","sequence":"additional","affiliation":[{"name":"Center for Fetal Research, Department of Surgery, Children\u2019s Hospital of Philadelphia Research Institute Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiancheng","family":"Han","sequence":"additional","affiliation":[{"name":"Center for Fetal Research, Department of Surgery, Children\u2019s Hospital of Philadelphia Research Institute Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William H.","family":"Peranteau","sequence":"additional","affiliation":[{"name":"Center for Fetal Research, Department of Surgery, Children\u2019s Hospital of Philadelphia Research Institute Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily A.","family":"Partridge","sequence":"additional","affiliation":[{"name":"Center for Fetal Research, Department of Surgery, Children\u2019s Hospital of Philadelphia Research Institute Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus G.","family":"Davey","sequence":"additional","affiliation":[{"name":"Center 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