Bronchopulmonary dysplasia and extremely preterm birth: time for a broader perspective on long-term outcomes

Bronchopulmonary dysplasia is a hallmark respiratory complication of prematurity and remains a major health determinant of individuals born very preterm. Its impact, however, extends far beyond the neonatal period and far beyond the lungs. Children, adolescents and adults born very preterm often follow diverse developmental trajectories that diverge from typical postnatal growth. These trajectories often display early airflow limitation, as well as features of increased cardiovascular vulnerability and altered multisystemic profiles. Although common respiratory labels such as asthma are often applied to these patients, evidence highlights distinct pathobiological mechanisms rooted in arrested alveolar and vascular growth, with a possible contribution from persistent airway inflammation and oxidative stress. Extrapulmonary involvement, including cardiovascular, neurodevelopmental, neurosensory, renal and metabolic domains, further shapes long-term outcomes and should be systematically integrated into long-term monitoring. Yet, despite improving survival and growing recognition of this multisystemic burden, current evidence remains insufficient to design a dedicated, holistic, multidisciplinary follow-up programme tailored to the diverse subgroups of preterm-born individuals. Increasing awareness among healthcare professionals of the long-term implications of prematurity is essential to ensure that these patients receive appropriate and coordinated attention. Emerging lines of research, spanning new preventive and therapeutic options, advanced imaging, mechanistic studies, and long-term cohort designs, hold promise in elucidating the biological determinants of disease. Integrating these insights into clinical pathways, together with sustained implementation of family-centred care models, will be crucial to optimise organ function trajectories, delay deterioration and ultimately improve the quality of life of the growing population of survivors of prematurity.