From Structure to Function: Clinical Utility of Advanced Pulmonary Imaging in Infants

Neonatal lung disease is characterized by heterogeneous structural and functional abnormalities that may be missed by global clinical measures alone. Although chest radiography remains a routine neonatal intensive care unit imaging tool, advances in pulmonary imaging now enable select modalities to provide radiation-free, bedside, and regionally resolved pulmonary assessment. This review summarizes the emerging imaging modalities in neonatal respiratory care, including computed tomography (CT), magnetic resonance imaging (MRI), lung ultrasonography (LUS), and electrical impedance tomography (EIT), highlighting their underlying principles, clinical applications, and limitations. LUS and EIT provide complementary bedside tools for frequent assessment of lung aeration and continuous monitoring of regional ventilation to help guide neonatal respiratory management and treatment. Although CT offers 3D evaluation of parenchymal lung disease, MRI can serve as radiation-free alternative for both structural and functional imaging while assessing disease severity and predicting short-term health outcomes. Together, these techniques support improved characterization of neonatal lung disease and individualized respiratory management.