The availability of a textile 32-electrode belt for neonatal EIT imaging with simple, fast, accurate and reproducible placement on the chest strengthens the potential of EIT to be used for regional lung monitoring in critically ill neonates and infants.

Use of humidifiers in nursery units must be avoided as the risk of disseminating Legionella in neonates is very high. In neonates legionellosis should be suspected when signs of infection first appear and take an unusual course, even when no pulmonary infiltrates appear.

Electrical impedance tomography (EIT) allows non-invasive and radiation-free monitoring of regional ventilation distribution and changes in end-expiratory lung volume in critically ill patients of all ages. In the vulnerable neonatal and pediatric population, EIT can be used to identify adverse events like atelectasis, pneumothorax and endotracheal tube malposition and potentially guide the personalized selection of ventilator settings. Previous studies have examined EIT in small patient groups during short measurement periods of only a few hours or less under highly controlled circumstances. What This Study Adds to the Field:In the Continuous Regional Analysis Device for Neonate Lungs (CRADL) project, we performed the first multi-center observational study on the use of EIT in critically ill neonates and young children with or at risk for respiratory failure. Including 200 patients, we demonstrated that continuous EIT monitoring for up to 72 hours is feasible, safe and can be used for continuous monitoring of ventilation distribution in neonates and infants in a routine clinical setting.

Objective: Non-adhesive textile electrode belts offer several advantages over adhesive electrodes and are increasingly used in neonatal patients during continuous electrical impedance tomography (EIT) lung monitoring. However, non-adhesive belts may rotate in unsedated patients and discrepancies between chest circumference and belt sizes may result in a gap between electrodes near the sternum. This project aimed to determine the effects of belt rotation and sternal electrode gap on commonly used lung EIT parameters. Approach: We developed a simulation framework based on a three-dimensional finiteelement model and introduced lung regions with little or no ventilation that could be changed according to a decremental positive end-expiratory pressure (PEEP) trial. Four degrees of sternal gap and belt rotation were simulated and their effect on the EIT parameters silent spaces, centre of ventilation, global inhomogeneity index and overdistension/collapsed lung (OD/CL) analysed. Additionally, seven premature infants were examined to assess the influence of leftward and rightward belt rotations in a clinical setting. Main results: Small violations of the electrode equidistance criterion and rotations of the belts less than one electrode space exert only minor effects on the EIT parameters and do not impede the interpretation. Rotations of two and three electrode spaces induce nonnegligible effects that might lead to flawed interpretations. The "best PEEP" determined with the OD/CL approach was robust and identifiable with all studied sternal gaps and belt rotations.Significance: We revealed an important challenge for neonatal EIT applications related to a wide electrode gap at the sternum and belt rotation, which should be avoided in clinical application.

Abstract-Each year 15 million babies are born prematurely and many suffer from respiratory failure due to immaturity of the lung and lack of control of breathing. Although respiratory support, especially mechanical ventilation, can improve their survival, it may also cause injury to the vulnerable lung resulting in severe and chronic pulmonary morbidity, lasting into adulthood. Heterogeneity of lung aeration, with areas of over inflation and collapse, plays a crucial part in the mortality and morbidity due to respiratory failure. This regionally different distribution of lung aeration cannot be detected by currently available bedside monitoring tools and imaging methods. Thus, an imaging technique for continuous non-invasive bedside monitoring of infants´ lung function is urgently needed. In order to address this, CRADL will use EIT technology to establish a tool for monitoring regional lung function and to guide interventions in the paediatric population.Electrical impedance tomography (EIT) is a non-radiative, inexpensive technique that can facilitate real time monitoring of lung aeration, and recent studies have shown that it is effective in monitoring aeration in preterm babies. CRADL will show how EIT can provide new cost effective, easy to use, respiratory management tools and clinical protocols that can be universally adopted to reduce deaths and disability in preterm babies by delivering a clinical device that provides continuous, non-invasive, radiation free, bedside information on regional lung aeration and ventilation during daily clinical care of (preterm) infants and children with respiratory failure. CRADL will also assess the effectiveness, efficacy and safety of such a system in guiding respiratory management and supportive care of the most common causes of paediatric respiratory failure (respiratory distress syndrome, bronchiolitis and acute respiratory distress syndrome), with the final goal of reducing short and long term adverse effects of disease and side effects of its treatment.This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 668259. This reflects only the author's views and that the Commission is not responsible for any use that may be made of the information it contains.