Bronchopulmonary Dysplasia After Premature Birth: Causes, Risks, and Legal Options in New York

When a baby is born prematurely, the lungs may not be fully developed. The treatments that keep these infants alive — oxygen therapy, mechanical ventilation — can sometimes damage fragile lung tissue even as they sustain life. Bronchopulmonary dysplasia (BPD) is the name for the chronic lung disease that can result. It is one of the most common complications of premature birth, and it can affect a child’s breathing and overall health for years.

For parents in New York navigating a BPD diagnosis, the questions are often immediate and overwhelming. What caused this? Could it have been prevented? What does this mean for my child’s future? This article explains what BPD is, how it develops, the long-term health risks it carries, and when it may be a sign that something went wrong in the NICU.

What Is Bronchopulmonary Dysplasia (BPD)?

Bronchopulmonary dysplasia is a chronic lung condition that develops in premature infants whose lungs are not fully formed at birth. The term describes lung tissue that has been damaged or has failed to develop normally, impairing the infant’s ability to breathe and exchange oxygen effectively.

BPD most often affects babies born before 32 weeks of gestation. Their lungs are at a stage of development where the tiny air sacs (alveoli) and blood vessels are still forming. When these infants require oxygen support and mechanical ventilation to survive, the very treatments that keep them alive can also contribute to inflammation and scarring in the lungs.

The diagnosis is typically made when a baby still requires supplemental oxygen at 36 weeks postmenstrual age (the gestational age at birth plus the weeks since birth). The severity can range from mild cases that resolve with time to severe cases requiring long-term respiratory support.

How BPD Develops in Premature Infants

BPD develops through a combination of factors. Lung immaturity is the foundation — the earlier a baby is born, the less developed the lungs are. But the condition is not simply the result of being born too soon. It arises from the interplay between that immaturity and the stresses placed on the lungs after birth.

Premature lungs are fragile. They lack sufficient surfactant, a substance that keeps the air sacs open. Without it, the lungs can collapse, making breathing difficult or impossible. To compensate, NICU teams provide oxygen and sometimes use ventilators to mechanically inflate the lungs.

These interventions are lifesaving, but they are not without risk. Oxygen itself, in the wrong amounts, can be toxic to developing tissue. Mechanical ventilation can cause physical injury to delicate lung structures. Inflammation follows, and over time, the lung tissue can become scarred and stiff. The result is BPD — a lung that functions, but not as it should.

Common Causes and Risk Factors

Several factors increase the likelihood that a premature infant will develop BPD. Some are unavoidable consequences of extreme prematurity. Others may be influenced by the quality of care the infant receives in the NICU.

The primary risk factors include extremely low birth weight (under 1,000 grams), birth before 28 weeks of gestation, and the need for prolonged mechanical ventilation or high levels of oxygen.

Genetics may play a role. Some infants appear more susceptible to lung injury than others, even when they receive similar treatment. Emerging research suggests that maternal factors, such as levels of trans-vaccenic acid (TVA), may influence BPD risk, though this research is still in early stages and not yet a basis for clinical prevention strategies.

The Oxygen Balance Between Hypoxemia and Hyperoxemia

One of the most critical aspects of NICU care for premature infants is managing oxygen levels. Too little oxygen, a condition called hypoxemia, can damage the brain and other organs and increase the risk of BPD. Too much oxygen, known as hyperoxemia, is linked to a different serious complication: retinopathy of prematurity (ROP), which can cause vision loss.

NICU teams must walk a narrow line. The goal is to provide enough oxygen to support the infant’s development without crossing into levels that cause harm. This is called oxygen titration, and it requires constant monitoring and adjustment.

Time spent in hypoxemia has been shown to increase the odds of developing BPD. At the same time, prolonged exposure to high oxygen concentrations can injure the lungs directly through oxidative stress. The balance is delicate, and errors in oxygen management — whether from equipment malfunction, inadequate monitoring, or misjudgment — are a common focus in medical negligence claims involving BPD.

Mechanical Ventilation and Lung Immaturity

Mechanical ventilation is often necessary to keep a premature infant alive, but it is also a source of physical stress on the lungs. The pressure required to inflate immature lungs can cause barotrauma (injury from pressure) and volutrauma (injury from overexpansion of the air sacs).

Modern NICU protocols aim to use the gentlest ventilation settings possible, a strategy known as lung-protective ventilation. This includes using lower pressures, smaller tidal volumes, and shorter durations of invasive ventilation when feasible. Some infants can be supported with less invasive methods, such as CPAP (continuous positive airway pressure), which keeps the airways open without the need for a breathing tube.

Despite these advances, some degree of lung injury is often unavoidable in the smallest and most premature infants. The question in a potential negligence case is not whether ventilation was used, but whether it was used appropriately — with proper settings, monitoring, and timely adjustments.

Long-Term Health Risks for BPD Survivors

BPD is not a condition that resolves when the baby leaves the NICU. Many children with BPD face ongoing respiratory challenges that can affect their health and development for years.

Pulmonary Hypertension and Lung Damage

One of the most serious complications of BPD is pulmonary hypertension, a condition in which the blood pressure in the arteries of the lungs becomes abnormally high. This happens when the small blood vessels in the lungs are damaged or underdeveloped, forcing the heart to work harder to pump blood through them.

Pulmonary hypertension can be life-threatening. It increases the risk of heart failure and can limit a child’s ability to tolerate physical activity. Children with BPD and pulmonary hypertension may need medications to reduce blood pressure in the lungs, supplemental oxygen at home, and regular follow-up with a pediatric pulmonologist and cardiologist.

Increased Risk of Severe RSV Infections

Children with BPD are at higher risk for severe respiratory infections, particularly respiratory syncytial virus (RSV). RSV is a common virus that causes cold-like symptoms in most children, but in infants with compromised lung function, it can lead to bronchiolitis, pneumonia, and respiratory failure.

BPD survivors are more likely to require hospitalization for RSV, and the illness can be severe enough to require intensive care. This heightened vulnerability persists through the first few years of life, during the peak RSV season (typically fall and winter).

Preventive measures are recommended for infants with BPD to reduce the risk of severe infection. As of the 2025–2026 RSV season, the American Academy of Pediatrics recommends nirsevimab, a long-acting monoclonal antibody given as a single dose, rather than palivizumab, which required monthly injections and has been discontinued. Ask your baby’s care team which RSV prevention option applies to your child before the next RSV season.

Repeated Hospitalizations and PICU Admissions

Children with BPD face a higher burden of illness overall. Research has found that infants with BPD have higher odds of unplanned admission to a pediatric intensive care unit (PICU) compared to preterm infants without BPD.

These admissions are often related to respiratory infections, asthma-like symptoms, or acute worsening of chronic lung disease. The need for repeated hospitalizations can be physically and emotionally exhausting for families and can disrupt a child’s early development and family routines.

Long term, some children with BPD develop chronic respiratory symptoms that resemble asthma, including wheezing, coughing, and shortness of breath with exertion. These symptoms may improve as the child grows and the lungs continue to develop, but some degree of reduced lung function can persist into adulthood.

Treatment and Management in the NICU

The treatment of BPD begins with prevention where possible and supportive care when it develops. NICU teams use a combination of strategies to minimize lung injury and support healing.

Surfactant replacement therapy is often given to premature infants shortly after birth to help keep the lungs inflated. Corticosteroids may be used in some cases to reduce inflammation, though their use is carefully weighed against potential side effects.

Oxygen therapy is adjusted continuously based on the infant’s needs. The goal is to maintain oxygen saturation in a target range — high enough to support organ function, but not so high as to cause toxicity.

Ventilation strategies are chosen based on the infant’s size, lung maturity, and clinical condition. Whenever possible, less invasive methods are preferred. Nutrition is also critical, as premature infants with BPD need adequate calories to support lung growth and repair.

Diuretics may be used to reduce fluid buildup in the lungs, and some infants are treated with bronchodilators to help open the airways. As the infant stabilizes, the focus shifts to weaning oxygen support and preparing for discharge, which may include arranging for home oxygen and follow-up care.

Planning for Your Child’s Ongoing Care

For families whose child has moderate to severe BPD, planning extends well beyond the NICU stay. Many children go home with supplemental oxygen, apnea monitors, or other equipment, along with a schedule of follow-up visits with pulmonology, cardiology, and other specialists. You can read more about what it means if your baby needs oxygen at home after NICU discharge.

For children with more severe, lasting complications, families sometimes work with a life care planner, a specialist who documents a child’s current and future medical, therapeutic, and equipment needs to build a comprehensive picture of lifetime costs. This kind of planning can be useful whether or not you’re pursuing a legal claim, since it helps you anticipate expenses and coordinate care as your child grows. You can read more about how a life care plan is put together for a child with a birth injury.

When BPD May Be a Sign of Medical Negligence

Not every case of BPD is the result of medical error. Extreme prematurity carries inherent risks, and even with excellent care, some infants will develop chronic lung disease. But in some cases, BPD may be linked to negligence — to care that fell below the accepted standard and caused or worsened the condition.

Improper Oxygen Titration and Monitoring

The most common area of concern in BPD negligence cases is oxygen management. If oxygen levels are not monitored closely, if alarms are ignored, if equipment malfunctions go unnoticed, or if clinical staff fail to adjust oxygen delivery in response to the infant’s changing condition, the result can be prolonged hypoxemia or hyperoxemia — both of which increase the risk of BPD.

Negligence may also involve the failure to use appropriate monitoring equipment, such as pulse oximetry, or the failure to respond to abnormal readings in a timely way. In some cases, understaffing or inadequate training may contribute to lapses in care.

Other potential areas of negligence include the use of overly aggressive ventilation settings, failure to wean the infant from mechanical ventilation when appropriate, or failure to diagnose and treat infections or other complications that worsen lung injury. You can read more about how NICU negligence claims work in New York.

New York Birth Injury Law and Statutes of Limitations

In New York, medical negligence claims involving injuries to a child are subject to specific legal rules. These cases require proof that the healthcare provider failed to meet the standard of care expected in the medical community and that this failure caused harm to the child.

Establishing causation in a BPD case can be complex. It requires a detailed review of the medical records, expert testimony from neonatologists and other specialists, and an understanding of what the infant’s outcome might have been with appropriate care.

Under New York law, medical malpractice claims generally must be filed within two and a half years of the malpractice. For a child, New York’s infancy tolling rule can extend this deadline, but never beyond ten years from the date of the malpractice. You can read more about how New York’s infant tolling rules apply to birth injury deadlines.

It is important to understand that pursuing a legal claim does not mean blaming the NICU staff for your child’s prematurity. It means asking whether the care provided met the standard expected and whether different decisions might have prevented or reduced the severity of your child’s lung injury.

Frequently Asked Questions

If My Baby Develops BPD, Does That Mean the NICU Did Something Wrong?

Not necessarily. BPD is a common, often unavoidable complication of extreme prematurity, and many babies develop it even with excellent care. What matters for a legal review isn’t whether your baby has BPD, but whether specific care decisions, such as how oxygen levels were monitored and adjusted, fell below the accepted standard. An attorney can help you understand whether your child’s particular case shows signs of a preventable lapse in care.

Is BPD Different From Pulmonary Hypertension of the Newborn (PPHN)?

Yes, these are different conditions even though the names sound similar. PPHN typically develops in the first hours or days after birth, often in full-term or near-term babies, when the newborn’s circulation doesn’t transition normally after delivery. The pulmonary hypertension linked to BPD develops later, as a chronic complication in premature babies with ongoing lung disease. You can read more about persistent pulmonary hypertension of the newborn to understand how that condition differs.

How Will I Know if My Baby’s BPD Is Mild or Severe?

Your baby’s neonatology team will classify BPD based on how much respiratory support your baby still needs at 36 weeks postmenstrual age, ranging from no extra oxygen to full ventilator support. Ask your care team directly which category applies to your baby and what it means for their expected recovery timeline, since this classification is one of the better predictors of long-term breathing outcomes.

What Questions Should I Ask Before My Baby with BPD Is Discharged Home?

Ask whether your baby will need home oxygen, how to use and monitor any equipment, what symptoms should prompt an urgent call versus an ER visit, and which specialists (pulmonology, cardiology) will follow your child afterward. It’s also worth asking about RSV prevention options for the coming season, since current recommendations for at-risk infants have changed in recent years.

Can I Request My Baby’s NICU Oxygen and Ventilator Records if I’m Concerned About How BPD Was Managed?

Yes. Under New York law, parents have the right to request their child’s complete medical records, including oxygen saturation logs, ventilator settings, and nursing documentation. These records are typically what an attorney or independent medical expert would review first to evaluate whether oxygen titration and ventilation were managed appropriately.

Understanding Your Child’s BPD Diagnosis

Bronchopulmonary dysplasia is one of the most common complications of extreme prematurity, and most children improve significantly as they grow, even if some breathing challenges continue for years. Understanding how BPD develops, what treatment your baby is receiving, and what long-term care and monitoring may be needed can help you support your child’s recovery. If you have concerns about how your baby’s oxygen levels or ventilation were managed in the NICU, reviewing the medical records with your care team, and if needed, an attorney, can help you understand what happened.