The BCNatal fetaLife project for the most extremely premature babies achieves a survival of 21 days in a liquid incubator

After more than five years, the scientific team behind the fetaLife project has developed a functional prototype of an artificial placenta, or liquid foetal incubator, which has achieved 21 days of survival in good condition in an experimental model, and more than 13 months of postnatal survival after removal from the device, with favourable neurodevelopmental outcomes. Led by Dr Eduard Gratacós, this disruptive initiative, supported by the ”la Caixa” Foundation with 7.65 million euros, is being carried out at BCNatal, a clinical and research centre for foetal and neonatal medicine affiliated with Hospital Sant Joan de Déu, Hospital Clínic Barcelona and the Universitat de Barcelona.

The director general of Hospital Clínic Barcelona, Josep Maria Campistol; the managing director of Hospital Sant Joan de Déu Barcelona, Miquel Pons; the assistant general manager of Research and Fellowships at the ”la Caixa” Foundation, Àngel Font; the director of BCNatal, lead of the fetaLife project and professor at the Faculty of Medicine and Health Sciences of the Universitat de Barcelona, Eduard Gratacós; and the medical and scientific coordinator of the fetaLife project at BCNatal, Elisenda Eixarch, today presented the new results of Europe’s first experimental artificial placenta project.

Over more than five years of work, the scientific project has developed an initial integrated prototype of a liquid incubator, or artificial placenta, which has exponentially increased survival within the system, currently reaching 21 days in good condition in an experimental model. In addition, more than 13 months of postnatal survival have been achieved, with favourable neurodevelopmental outcomes following time spent in the liquid incubator.

This represents a milestone in this highly complex scientific project, supported by the ”la Caixa” Foundation with 7.65 million euros. Its aim is to increase survival and, above all, to reduce the severe complications affecting the majority of extremely premature newborns, that is, those born at six months’ gestation or earlier.

A liquid incubator is a system in which a very premature neonate can live in a manner similar to life in the womb, providing a more natural solution. The prototype developed by BCNatal, of which several versions have already been produced, includes a liquid environment and allows the premature baby to continue developing while connected to an extracorporeal circulation system via its umbilical cord.

Technological improvements and significant advances in medical support protocols – which include the administration of nutrition, hormones and other medications, and anticipate possible clinical scenarios and the medical interventions required to address them – have made it possible to improve survival within the system and achieve a successful neonatal transition. This transition simulates the steps envisaged for its future application in humans: transfer from the liquid incubator to a conventional incubator once the organs have matured.

The proprietary monitoring system remains key, as it enables continuous remote supervision by the medical team, allowing for intensive control of the condition and development of the foetus. Another major advance achieved to date has been the improvement of the extracorporeal circulation system. This is composed of a membrane oxygenator and a set of components (tubing and cannulas) specifically designed to facilitate blood flow and oxygenation, simulating what occurs naturally in intrauterine life through the maternal placenta and the umbilical cord.

Experimental validation phase to move towards clinical application

Using an ovine model, the team has so far designed and described the surgical techniques and protocols required to carry out a transition from the uterus to a liquid incubator prototype without incident, and has achieved a 21-day survival period within the system.

A significant step has been taken towards bringing the system closer to clinical application: demonstrating that neonatal transition is possible. Neonatal transition is a process similar to the “birth” of the foetus, in which it moves from the liquid incubator to extrauterine life and begins to use its lungs like any other newborn. The project has conducted trials that have resulted in viable neonates following their maintenance in the liquid incubator. In one specific case, that of the sheep Gaia, now more than one year old, long-term neurodevelopment has been studied, with normal results obtained.

From the outset, in 2021, the project has had its own committee on ethical, social and safety aspects, in which the families of neonates are represented. The ethical dimension involved in transferring the system for use in humans is led by the Institut Borja de Bioètica, with which the project’s research team works closely.

The project has been analysed and positively evaluated on two occasions by a panel of internationally renowned experts in foetal and neonatal medicine from five countries.

This is an example of the multiplier effect of collaboration between public institutions and philanthropy in biomedical research and innovation. BCNatal is a clinical and research centre in foetal and neonatal medicine affiliated with Hospital Clínic Barcelona and Hospital Sant Joan de Déu. For its part, the ”la Caixa” Foundation, which has supported the project from the outset with 7.65 million euros, has made the experimental phase of the project possible and has positioned it as the only one of its kind in Europe.

Following the results obtained, fetaLife Technologies was established in 2025, a spin-off company of Hospital Clínic, Hospital Sant Joan de Déu and the Universitat de Barcelona, aimed at bringing the technology closer to clinical practice. Over the coming year, the project team will focus its efforts on introducing a technological improvement, in collaboration with industry, to adapt the system for use in humans, as well as on initiating the ethical and legal preparations required for the approval of a first-in-human study, scheduled for 2028–2029, subject to the necessary investment. This new phase is expected to attract additional funding partners. For its part, the ”la Caixa” Foundation has already announced that it will continue to support the project, which has also received donations from other organisations.

A disruptive solution to save the lives of premature newborns

Although more than 90% of pregnancies reach full term without complications, foetal life remains one of the most critical stages in human development. One of the main challenges yet to be resolved is extreme prematurity (six months’ gestation or less), a condition that affects 25,000 families every year in Europe alone. Survival among extremely premature babies, even in centres of excellence, is low (between 25% and 75%), and a significant proportion of survivors experience serious lifelong complications.

Before six months of pregnancy, the foetus’s lungs, intestines and brain are underdeveloped and not ready to function properly. An extremely premature newborn is, in reality, a foetus that must survive in a highly unnatural environment. Weighing less than 1,000 grams, these newborns require respiratory support and intravenous feeding to stay alive, but this can lead to complications and have an impact on their future lives. For this reason, the liquid incubator could provide a solution that improves the quality of life of these neonates.

The research group led by Dr Gratacós is highly interdisciplinary and involves the direct participation of more than 35 researchers from various fields – including physicians across different specialties, biologists, engineers and nursing staff – as well as the collaboration of a further 35 professionals, although at certain stages the project has involved up to 150 people.

In addition to the BCNatal fetaLife project, there are currently only four groups worldwide – one in Philadelphia and another in Michigan (United States), a consortium between Australia and Japan, and another group in Toronto (Canada) – that have developed similar experimental models and achieved significant advances in recent years.

About BCNatal

BCNatal is a joint centre under the framework of the Sant Joan de Déu – Hospital Clínic Healthcare Partnership. With nearly 7,000 births and between 100 and 120 foetal surgeries each year, a workforce of 600 healthcare professionals, almost a hundred of whom are dedicated to R&D&i, BCNatal is one of the largest clinical maternal–foetal and neonatal units in Europe. It is also a pioneering centre in both clinical practice and research in foetal surgery, with specialists who have developed and performed some of the techniques now used in this field for the first time worldwide. The centre, which hosts doctors from all five continents for specialised training, ranks among those with the highest international scientific output in its field.

BCNatal has led major research projects in foetal medicine and surgery, and has extensive experience in interdisciplinary collaboration with centres of excellence in biotechnology, providing it with the expertise and critical mass necessary to develop a project as ambitious as the one presented.