A Clearer Picture of Preterm Lungs

Could electrical impedance tomography improve real-time respiratory care?

For preterm infants, lung structure and function change rapidly over time. Yet clinicians lack a reliable, low-risk way to continuously evaluate lung development at the bedside for this vulnerable population. Katelyn Enzer, MD, a pediatric pulmonologist at Children’s Hospital Colorado, says more detailed data could improve clinical care. Through a partnership with mathematicians at Colorado State University (CSU), she and her collaborators are exploring a growing field in pediatrics: electrical impedance tomography. 

What is electrical impedance tomography (EIT)?  

EIT is a noninvasive, radiation-free way to collect images and data from the body. The body’s tissues have varying electrical properties, which change as a person breathes and blood flows. These properties can be detected by applying an electrical current through electrodes placed on a person’s body and measuring the resulting voltage. The resulting images can identify changes in airflow and blood flow in real-time. EIT technology has been used in thousands of adult studies with promising results. However, researchers are just scratching the surface of its impact and application in pediatrics. 

Because EIT doesn’t use radiation and can be done at the bedside, it’s a good fit for preterm infants and other patients who cannot complete standard pulmonary function testing, which often requires the patient to perform specialized breathing maneuvers. 

“The field is really growing as more and more babies are born preterm,” Dr. Enzer says. “The neonatal intensive care unit is having wonderful success keeping them supported. But that also means a large number of babies need pulmonary help.” That’s where Jennifer Mueller, PhD, founder of CSU’s Electrical Impedance Imaging Laboratory comes in. Dr. Mueller has worked with EIT for 25 years — analyzing, tweaking and improving hardware and software for clinical applications.

“Being able to make a difference and contribute to the care of these infants — that’s what motivates me,” she says. 

While other hospitals may use EIT machines, the ACT5, developed in collaboration between Colorado State University and the University of Albany, is unique to Children’s Colorado. ACT5 acquires electrocardiogram signals from all electrodes attached to the body simultaneously, displaying real-time images of conductivity and susceptivity at 50 frames per second.

“The machine Dr. Mueller’s team created has a better ability to measure sensitive changes in the lungs of airflow and blood flow. The analysis that she’s able to do after we get the measurements gives us a new ability to measure things that you would not be able to do with the machines you can buy,” Dr. Enzer says.

How EIT research can improve clinical care  

Dr. Enzer and Dr. Mueller have partnered on studies examining EIT’s ability to detect ventilation and perfusion heterogeneity in infants with bronchopulmonary dysplasia, as well as how anatomical atlases can improve the clarity and clinical use of EIT for preterm infants. They are also collaborating on an upcoming study focused on preterm infants with pulmonary hypertension. Beyond the NICU, Dr. Mueller has partnered with other Children’s Colorado researchers to study the potential use of EIT in patients with cystic fibrosis, pulmonary vein stenosis and muscular dystrophy.

Across these projects, a clear theme has emerged: The more high-quality data EIT can provide, the more insight clinicians can gain. Dr. Enzer is hoping this research makes EIT the standard of care, enabling faster, more informed diagnoses at the bedside.

“Everywhere we turn there’s a new application for these babies,” Dr. Enzer says. “We need to understand changes in the lungs as they grow. This adds such an important piece to existing knowledge. This is the future.” 

This partnership reflects a broader shift in medicine toward data-driven approaches, where advanced modeling and quantitative methods can enhance traditional clinical insights. 

“We do our best,” Dr. Enzer says. “But we can always do better.” 

And that’s what the team hopes to do with EIT — one image at a time.