Technology developed at the Technion will protect the airways of premature babies who need ventilation

Researchers at the Faculty of Biomedical Engineering point out for the first time the damage of the air jet coming out of the breathing tube

A new artificial model of the airways of premature babies, and experiments done on it, are expected to reduce the harm caused to breathing babies. The study published in the Interface Journal of The Royal Society was conducted by PhD student Eliram Nof and Prof. Joshua Schnittman from the Faculty of Biomedical Engineering at the Technion and Prof. Danny Weissman, director of the Neonatal Unit at the Carmel Medical Center.

More than 10% of babies in the world are born prematurely. These babies in general, and premature babies in particular, are limited in their functioning in various aspects since the systems in their bodies did not have time to develop properly. One of these systems is the respiratory system, which reaches full function only at a late stage in embryonic development. This is why premature birth is characterized in many cases by respiratory distress, partly due to the lack of a unique fatty substance, surfactant, which prevents the collapse of the lung's nadia and makes breathing easier.

Fortunately, modern medicine knows how to deal with this problem and save the premature babies, mainly by giving an external surfactant that is integrated into the respirator using a respirator - a breathing machine that flows air into the baby's trachea through a tube inserted through the mouth.

However, in its current form, the use of the respirator is not without its problems. One of the possible side effects of premature breathing is the damage to the lung tissues. There is no standardization in the act of breathing, since each baby requires a personal adjustment of the data of the artificial respiration - the percentage of oxygen in the injected air, the air volume, the pressure, the rate, and more. The doctors do their best to adapt this data to the baby's needs and reduce harm to him, and still, many babies are harmed in this process, which is essential to saving their lives.

This is where the unique model developed by Technion researchers comes into play. After prolonged research activity at the level of the mathematical model, Nof and Prof. Schnittman developed a physical model, made of silicon, which simulates - in XNUMXD and real size - the upper respiratory tract in the body of a premature baby.

The researchers were surprised to discover a phenomenon that is not mentioned at all in the medical literature: a jet of air coming out of the tube inserted into the mouth of the premature baby. "Until now, they knew that the tube could directly injure the delicate tissue, but they did not consider the effect of the air flow at all," says Nof. "In the current study, we discovered for the first time that due to its location, this jet exerts strong frictional forces on the epithelial tissue - the layer of cells that lines the upper respiratory tract. These forces may cause damage, including inflammation, which is a real risk of premature delivery."

The researchers examined the aforementioned finding in the silicone model and discovered that indeed, the jet exerts pressure on the lung tissue that could cause significant damage. In the continuation of the research, they intend to sow living biological cells on the tissue and examine the effect of the jet on them.

The good news, however, is that from the findings, the researchers made recommendations regarding the desired ventilation data. In their estimation, adjusting the ventilation data to the flow configuration in the baby's respiratory system may prevent the damages described here and improve the chances of these babies to develop a normal respiratory system.

These conclusions are in line with the overall trend in the premature department at the Rambam Medical College - a trend of reducing invasiveness in treatment and of reducing the use of invasive ventilation as much as possible.

According to Dr. Liron Bornstein, a senior physician in the intensive care department for newborns and premature infants at Rambam, "With the progress in medicine, we are now able to treat younger premature infants and more complex illnesses. However, respiratory morbidity is still a significant factor in mortality and morbidity of premature infants. The technology presented in this article - creating a model of a specific area of ​​the lung and studying the forces exerted on the tissue by the air jet created in invasive ventilation - can advance us in understanding the mechanisms that lead to the ventilation damage that we want to prevent and in the development of more gentle ventilation techniques, suitable for the premature population."

Prof. Josue Schnittman was born in France and grew up in the USA and Switzerland. In the summer of 2010, with a doctorate from ETH Zurich, he immigrated to Israel and joined the Technion faculty. He won many awards, including the Young Researcher Award from the International Society for Aerosols in Medicine (ISAM) for researchers under the age of 40. Currently, he is the head of the biofluids laboratory at the Faculty of Biomedical Engineering. Prof. Schnittman developed the first diagnostic tool that enables quantitative monitoring of the dynamics of particles in the respiratory system. This is an "acinus-on-chip" that is relevant both to the assessment of health risks (infection, etc.) and to the evaluation and planning of drugs for the respiratory system.

Eliram Nof immigrated to Israel alone at the age of 18 from the USA to enlist in the IDF. After the end of his military service, he completed a bachelor's and master's degree in a fast track at the Faculty of Mechanical Engineering at Ben Gurion University. He also did his master's degree at Ben Gurion, under the guidance of Prof. Oren Shadot and Prof. Gabi Ben-Dor in the shock wave research laboratory - researching the effects of supersonic flow in collaboration with the Ministry of Defense. In preparation for his doctorate, Eliram decided to apply the background he acquired in the field of flow to problems in the world of medicine, and this is how he came into contact with Prof. Schnittman, who guides him in his doctoral thesis.

For an article in the Interface Journal of The Royal Society