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Babies’ lungs are not balloons: is it time to embrace electrical impedance tomography?

Pediatric Research volume 98, pages 373–375 (2025)Cite this article

The newborn lungs are complex organs, and many factors can affect their function. Indeed, it is well known that the newborn infant has specific breathing patterns to accommodate the unique properties of their respiratory system mechanics, allowing appropriate ventilation to occur at various absolute lung volumes, and through many combinations of tidal volume, respiratory frequency, and inspiratory and expiratory timings.1 Importantly, some pathological conditions are associated with decreased lung volumes because of anomalous or incomplete lung development, requiring the use of special interventions such as surfactant or various respiratory support modalities to ensure acceptable ventilation and oxygenation. Surprisingly, despite over 60 years of neonatal intensive care and significant technological advances in respiratory management, assessment of lung volumes can only be obtained at very finite time points and/or with the use of complex and/or invasive methods.2 Therefore, a continuous, individualized, noninvasive bedside tool, able to offer a more precise evaluation of lung mechanics and aeration in any patient, would allow for a more comprehensive understanding of disease severity and resolution, and a more prompt assessment of response to interventions.

Unlike most techniques used for pulmonary function measurements, electrical impedance tomography (EIT) can provide measurements of pulmonary mechanics and lung volumes, including global and regional evaluations of lung ventilation at the bedside.3 EIT was developed many years ago and has been mostly used for research, but recent advances in the technology have made it more attractive for evaluations during the transition from intra to extra uterine life, for adjustments while on invasive and non-invasive respiratory support, and for assessments of the effects of different airway interfaces, surfactant administration, ETT suction, and body position. In the current issue of the journal, Ako and colleagues provide a comprehensive review on the use of EIT in neonates, offering detailed information on the technology and its limitations. The review also delivers information on common EIT terms and definitions, and key measurements with corresponding clinical applications. While this review provides valuable insights, it is important to note that it was not conducted as part of a scoping review or systematic review, which may have led to the omission of some relevant studies and to the absence of standardized quality and risk of bias assessment of the literature.

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Authors and Affiliations

  1. Department of Pediatrics, Neonatology, McGill University Health Center, Montreal, QC, Canada

    Wissam Shalish & Guilherme M. Sant’Anna

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  1. Wissam Shalish
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  2. Guilherme M. Sant’Anna
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W.S. and G.M.S. were involved in reading and interpreting the results of the article for which a commentary has been written. W.S. and G.M.S. wrote, reviewed, and revised the draft of the commentary and approved the final version of the commentary.

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Correspondence to Guilherme M. Sant’Anna.

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Shalish, W., Sant’Anna, G.M. Babies’ lungs are not balloons: is it time to embrace electrical impedance tomography?. Pediatr Res 98, 373–375 (2025). https://doi.org/10.1038/s41390-025-04105-x

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