Placenta Artificial: um método alternativo no suporte de vida de neonatos prematuros na medicina veterinária

Autores

  • Gleidson Benevides de Oliveira
  • Lívia Batista Campos
  • Muriel Magda Lustosa Pimentel
  • Fernanda Araújo dos Santos
  • Moacir Franco de Oliveira
  • Marcelo Barbosa Bezerra

Palavras-chave:

suporte de vida extracorpóreo, assistência pulmonar, neonatologia, animais

Resumo

O modelo de placenta artificial tem como finalidade recriar o ambiente intrauterino, mantendo a circulação fetal e realizando as trocas gasosas e, ao mesmo tempo, permitir a maturação pulmonar. A placenta artificial apresenta-se como uma estratégia de suporte extracorpórea para neonatos prematuros cujos pulmões ainda não estejam completamente desenvolvidos. Este sistema é composto basicamente por uma bomba centrífuga, um oxigenador de membrana e cânulas inseridas nos vasos fetais para renovação do sangue. As tentativas de desenvolver uma placenta artificial foram abandonadas em meados da década de 80, mas com os avanços tecnológicos, em especial com o surgimento dos oxigenadores de membrana de fibra oca e os oxigenadores não microporosos compostos de biomateriais, deixaram os pesquisadores esperançosos no desenvolvimento do modelo ideal de placenta artificial. Este artigo apresenta uma revisão dos fatos históricos e discute os avanços e perspectivas da utilização de modelos de placenta artificial na medicina veterinária.

Referências

Rimensberger PC. Neonatal respiratory failure. Curr Opin Pediatr. 2002; 14:315-21.

Ventre KM, Arnold JH. High frequency oscillatory ventilation in acute respiratory failure. Paediatr Respir Rev. 2004; 5:323-332.

Bahrami KR, Van Meurs KP. ECMO for neonatal respiratory failure. Semin Perinatol. 2005, 29:15-23.

Kuwabara Y, Okai T, Imanishi Y, Muronosono E, Kozuma S, et al. Development of extrauterine fetal incubation system using extracorporeal membrane oxygenator. Artif Organs. 1987; 11 (3):224-227.

Kuwabara Y, Okai T, Kozuma S, et al. Artificial placenta: long-term extrauterine incubation of isolated goat fetuses. Artif. Organs. 1989; 13:527-531.

Unno N, Kuwabara Y, Shinozuka N, Akiba K, et al. Development of artificial placenta: oxygen metabolism of isolated goat fetuses with umbilical arteriovenous extracorporeal membrane oxygenation. Fetal Diagn Ther. 1990; 5(3-4):189-195.

Seo T, Ito T, Lio K, Kato J, Takagi H. Experimental study on the hemodynamic effects of veno-arterial extracorporeal membrane oxygenation with an automatically driven blood pump on puppies. Artif Organs. 1991; 15:402-407.

Unno NK, Kuwabara Y, Shinozuka N, et al. Development of an artificial placenta: optimal extracorporeal blood flow in goat fetuses during long-term extrauterine incubation with umbilical arterio-venous extracorporeal membrane oxygenation. Artif Organs Today. 1992; 2:197-204.

Unno NK, Kuwabara Y, Narumiya-Takikawa Y, et al. Development of an artificial: endocrine responses of goat fetuses during long-term extrauterine incubation with umbilical arteriovenous extracorporeal membrane oxygenation. Endrocrinol J. 1994; 41:69-76.

Kamimura T, Murata Y, Quilligan EJ, Ibara S, Fujimori K, et al. Oxygenation in fetal lambs supported by extrauterine right atrium to artery extracorporeal membrane oxygenation. Am J Obstet Gynecol. 1996; 174:535-9.

Medical Advisory Secretariat (MAS). Extracorporeal lung support technologies - bridge to recovery and bridge to lung transplantation in adult patients: an evidence-based analysis. Ontario Health Technol Assess Ser. 2010; 10 (5):1-46.

Reoma JL, Rojas A, Kim AC, Khouri JS, Boothman E, et al. Development of an artificial placenta I: pumpless arterio-venous extracorporeal life support in a neonatal sheepmodel. J Pediatr Surg. 2009; 44 (1): 53-9.

Fujimori K, Murata Y, Quilligan EJ, Nagata N, Hirano T, Sato A. Distribution of oxygenated blood flow at three different routes of extracorporeal membrane oxygenation inexteriorized fetal lambs. J Obstet Gynaecol Res. 2001; 27 (2):103-9.

Frenckner B, Radell P. Respiratory Failure and Extracorporeal Membrane Oxygenation. Semin Pediatr Surg. 2008; 17:34-41.

Gray BW, El-Sabbagh A, Rojas-Pena A, Kim AC, Gadepalli S, et al. Development of an artificial placenta IV: 24-hour venovenous extracorporeal life support in premature lambs. ASAIO J, 2012; 58:148–154, 2012.

Schoberer M, Arens J, Lohr A, Seehase M, Jellema RK, et al. Fifty Years of Work on the Artificial Placenta: Milestones in the History of Extracorporeal Support of the Premature Newborn. Artif Organs. 2012; 36 (6): 512–6.

Rochow N, Chan EC, Wu WI, Ponnambalam RS, Fusch G, Berry L, et al. Artificial placenta - Lung assist devices for term and preterm newborns with respiratory failure. Int J Artif Organs. 2013; 36 (6): 377-91.

Callaghan JC, Angeles JD. Long-term extracorporeal circulation in the development of an artificial placenta for respiratory distress of the newborn. Surg Forum. 1961; 12:215–7.

Callaghan, JC.; Cardozo, D.; Boracchia, B.; Aleksiuk, A. Study of prepulmonary bypass in the development of an artificial placenta for prematurity and respiratory distress syndrome of the newborn. 1969; J thorac cardiovasc surg. 1962; 44:600–7.

Zapol WM, Kolobow T, Pierce JG, Vurek GG, Bowman RL. Artificial placenta: two days of total extrauterine support of the isolated premature lamb fetus. Science. 1969; 166:617–8.

Gray BW, Shaffer AW, Mychaliska GB. Advances in Neonatal Extracorporeal Support: The Role of Extracorporeal Membrane Oxygenation and the Artificial Placenta. Clin Perinatol. 2012; 39: 311–29.

Unno NK, Kuwabara Y, Okai T, et al. Metabolic and endocrine responses to cold exposure in chronically incubated extrauterine goat fetuses. Pediatr Res. 1998; 43:452-60.

Kozuma S, Nishina H, Unno N, Kagawa H, et al. Goat fetuses disconnected from the placenta, but reconnected to an artificial placenta, display intermittent breathing movements. Biol Neonate. 1999; 75:388-97.

Unno N, Kuwabara Y, Okai T, Kido K, et al. Development of an artificial placenta: survival of isolated goat fetuses for three weeks with umbilical arteriovenous extracorporeal membrane oxygenation. Artif Organs. 1993; 17 (12):996-1003.

Yasufuku MK, Hisano K, Sakata M, Okada M. Arterio-venous extracorporeal membrane oxygenation of fetal goat incubated in artificial amniotic fluid (artificial placenta): influence on lung growth and maturation. J Pediatr Surg. 1998; 33:442-8.

Sakata M, Hisano K, Okada M, Yasufuku M. A new artificial placenta with a centrifugal pump: long-term total extrauterine support of goat fetuses. J Thorac Cardiovasc Surg. 1998; 115 (5):1023-31.

Lim MW. HISTORICAL NOTE: The history of extracorporeal oxygenators. Anaesthesia. 2006; 61:984–95.

Gray BW, El-Sabbagh A, Zakem SJ, Koch KL, et al. Development of an artificial placenta V: 70 h veno-venous extracorporeal life support after ventilatory failure in premature lambs. J Pediatr Surg. 2013; 48 (1):145-53.

Ivascu FA, Somand DM, Skrzypchak AM, Chambers SD, Bartlett RH, Hirschl RB. Development of an artificial placenta: CO2 elimination and hemodynamics as a function of arteriovenous blood flow. J Pediatr Surg. 2005; 40:1034– 7.

El-Ferzli GT, Philips JB, Bulger A, Ambalavanan N. Evaluation of a pumpless lung assist device in hypoxia-induced pulmonary hypertension in juvenile piglets. Pediatr Res. 2009; 66 (6):677-81.

Arens J, Schoberer M, Lohr A. et al. NeonatOx: a pumpless extracorporeal lung support for premature neonates. Artif Organs. 2011; 35 (11):997-1001.

Miura Y, Matsuda T, Funakubo A, Watanabe S, et al. Novel modification of an artificial placenta: pumpless arteriovenous extracorporeal life support in a premature lamb model. Pediatr Res. 2012; 72 (5):490-4.

Zach TL, Steinhorn RH, Georgieff MK, Mills MM, Green TP. Leukopenia associated with extracorporeal membrane oxygenation in newborn infants. J Pediatr. 1990; 116: 440-4.

Graulich J, Sonntag J, Marcinkowski M, et al. Complement activation by in vivo neonatal and in vitro extracorporeal membrane oxygenation. Mediators Inflamm. 2002; 11:69-73.

Cheung PY, Sawicki G, Salas E, Etches PC, Schulz R, Radomski MW. The mechanisms of platelet dysfunction during extracorporeal membrane oxygenation in critically ill neonates. Crit Care Med. 2000; 28:2584-90.

Pak SC, Song CH, SO GY, Jang CH, Lee KH, Kim JY. Extrauterine Incubation of Fetal Goats Applying the Extracorporeal Membrane Oxygenation via Umbilical Artery and Vein. J Korean Med Sci. 2002; 17:663-8.

Hirschl RB, Schumacher RE, Snedecor SN, et al. The efficacy of extracorporeal life support in premature and low birth weight newborns. J Pediatr Surg. 1993; 28:1336–40.

Goldberg RN, Chung D, Goldman SL, et al. The association of rapid volume expansion and intraventricular hemorrhage in the preterm infant. J Pediatr. 1980; 96:1060–3.

Annich GM, Meinhardt JP, Mowery KA, et al. Reduced platelet activation and thrombosis in extracorporeal circuits coated with nitric oxide release polymers. Crit Care Med. 2000; 28:915–20.

Zhang H, Annich GM, Miskulin J, et al. Nitric oxide-releasing fumed silica particles: synthesis, characterization, and biomedical application. J Am Chem Soc. 2003; 125:5015–24.

Skrzypchak AM, Lafayette NG, Bartlett RH, et al. Effect of varying nitric oxide release to prevent platelet consumption and preserve platelet function in an in vivo model of extracorporeal circulation. Perfusion. 2007; 22:193–200.

Wu B, Gerlitz B, Grinnell BW, et al. Polymeric coatings that mimic the endothelium: combining nitric oxide release with surface-bound active thrombomodulin and heparin. Biomaterials. 2007; 28:4047–55.

Hsu LC. Heparin-coated cardiopulmonary bypass circuits: current status. Perfusion. 2001; 16 (5):417-28.

Zimmermann AK, Weber N, Aebert H, Ziemer G, Wendel HP. Effect of biopassive and bioactive surface-coatings on the hemocompatibility of membrane oxygenators. J Biomed Mater Res B Appl Biomater. 2007; 80 (2):433-9.

Watanabe H, Hayashi J, Ohzeki H, Moro H, et al. Biocompatibility of a silicone-coated polypropylene hollow fiber oxygenator in an in vitro model. Ann Thorac Surg. 1999; 67 (5):1315-9.

Polk AA, Maul TM, McKeel, DT, et al. A biohybrid artificial lung prototype with active mixing of endothelialized microporous hollow fibers. Biotechnol Bioeng. 2010; 106 (3):490-500.

Zimmermann AK, Aebert H, Reiz A, et al. Hemocompatibility of PMEA coated oxygenators used for extracorporeal circulation procedures. ASAIO J. 2004; 50 (3):193-9.

Awad JA, Cloutier R, Fournier L, et al. Pumpless respiratory assistance using a membrane oxygenator as an artificial placenta: a preliminary study in newborn and preterm lambs. J Invest Surg. 1995; 8(1):21–30.

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Publicado

2023-03-27

Como Citar

1.
Oliveira GB de, Campos LB, Pimentel MML, Santos FA dos, Oliveira MF de, Bezerra MB. Placenta Artificial: um método alternativo no suporte de vida de neonatos prematuros na medicina veterinária. RVZ [Internet]. 27º de março de 2023 [citado 21º de novembro de 2024];21(2):238-51. Disponível em: https://rvz.emnuvens.com.br/rvz/article/view/1345

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