**Background:** Preterm birth occurs in about 10% of pregnancies, with 1.1% of newborns born at less than 28 weeks PMA and weighing under 1500 g (VLBW). Advances in neonatal care have increased survival of extremely preterm infants, leading to more children with prematurity-related morbidities, particularly bronchopulmonary dysplasia (BPD). BPD affects 6–57% of preterm infants depending on the definition used. Even VLBW infants without a BPD diagnosis may have chronic lung disease of prematurity, with poor lung function posing a risk for a COPD-like phenotype later in life. This review aims to equip general pediatricians with practical information for the multidisciplinary follow-up of these patients.
**Methods:** This is a narrative review summarizing current evidence on the epidemiology, pathogenesis, prevention, and long-term management of prematurity and BPD. The authors synthesize findings from existing literature on respiratory, neurological, cardiovascular, nutritional, and sensory outcomes, as well as preventive strategies and family care.
**Key Results:** BPD is a multifactorial disease influenced by pre- and post-natal factors including intra- and extra-uterine growth restriction, preeclampsia, chorioamnionitis, maternal smoking, hyperoxia, mechanical ventilation, sepsis, and patent ductus arteriosus. Pathologically, BPD features reduced alveolar surface area, altered angiogenesis with possible pulmonary hypertension, and fibrotic interstitial changes. Prevention strategies include antenatal corticosteroids, early surfactant with less invasive techniques, gentle ventilation, targeted oxygen saturations, early caffeine, infection control, PDA treatment, and human milk nutrition. Systemic corticosteroids within the first 8–14 days of life reduce BPD incidence but carry risks of worse neurodevelopmental outcomes and higher mortality. Palivizumab reduces hospitalizations for severe RSV by 55% in preterm infants, especially those with BPD. Lung function in preschoolers can be assessed via forced oscillation or interrupter resistance techniques, with spirometry feasible from age 5. Children born extremely preterm are hospitalized more often in the first 2 years of life than term-born children. School-aged children with BPD show reduced FEV1 that may not improve with age, and by 20–25 years they do not match peers' lung function, carrying higher risk of early COPD. IUGR worsens both respiratory and neurological outcomes, with lower cognitive and motor scores at 22 months and increased autism risk (OR 2.12). BPD is independently associated with adverse neurological outcomes at 12 and 24 months corrected age. Preterm-born children are at higher risk of neuropsychiatric disorders including inattention, anxiety, autism spectrum disorders, and psychosis in adulthood. Cardiovascular risks include pulmonary hypertension, systemic hypertension, ischemic heart disease, and metabolic syndrome. VLBW infants also face chronic kidney disease risk, as 60% of nephrons develop in the last trimester. Feeding difficulties, gastroesophageal reflux, and extrauterine growth restriction are common. Vitamin D supplementation of 800–1000 IU/day until full term then 400 IU is recommended, along with oral iron 2–3 mg/kg/day until 6–12 months.
**Clinical Implications:** General pediatricians should coordinate a multispecialist team including neonatologists, pulmonologists, cardiologists, neurologists, neuropsychiatrists, nutritionists, gastroenterologists, nephrologists, ophthalmologists, audiologists, and therapists. Key follow-up elements include: respiratory monitoring with lung function tests; neurological assessments with Bayley III or Griffith scales at 12 and 24 months corrected age; cardiovascular monitoring including blood pressure and echocardiography for high-risk cases; nutritional support with appropriate caloric intake (120 kcal/kg/day) and supplementation; sensory screening for hearing and vision; and family mental health support. Inhaled corticosteroids and bronchodilators lack strong evidence for routine use in BPD and should be trialed carefully. The ERS task force recommends bronchodilators only for severe cases, those with asthma-like symptoms, repeated hospitalizations, or exercise intolerance. Smoking avoidance, hand hygiene, and judicious daycare attendance advice are important preventive measures. The comprehensive care approach, while costly, aims to optimize neurocognitive potential, prevent complications, and improve quality of life for these children and their families.