Electrical impedance tomography in neonates: a review

Appropriate interventions informed by real-time assessment of pulmonary function in mechanically ventilated critically ill neonates can reduce the incidence of bronchopulmonary dysplasia, pneumothorax, intraventricular hemorrhage and other complications of newborn life. The respiratory system in neonates is uniquely different from older children, and its physiological and anatomic attributes increase neonatal vulnerability to respiratory distress and eventual failure. While significant advancements have been made in developing respiratory support for neonates, such support is accompanied by inherent risks to their delicate lungs. Ventilator-associated lung injury poses a critical concern that can be potentially decreased with more precise, non-invasive, non-radiating, bedside methods for assessing neonatal pulmonary function in real time. Electrical impedance tomography (EIT) is one such tool, with immense potential for real-time pulmonary function monitoring in neonates. Still relatively new and in the earliest stages of clinical adoption, EIT use in neonatal critical care has been reported in several studies. This review discusses the basic features of EIT, its distinct advantages over traditional pulmonary function monitoring tools, the scope of its adoption in neonatal clinical practice, challenges associated with clinical adoption, and prospects for future applications. IMPACT: 1. Individualized care assisted by bedside pulmonary function monitoring can positively impact neonatal critical care and outcomes. 2. Electrical impedance tomography (EIT) has the potential to improve neonatal pulmonary function monitoring and treatment outcomes. 3. Electrical impedance tomography can be adopted as a part of routine neonatal respiratory critical care, especially in the population of patients most at risk for bronchopulmonary dysplasia and acute respiratory complications.