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PubMed This is a summary of 19 peer-reviewed journal articles Updated
Neonatology

Beyond the Lungs: Heart and Brain Health in BPD

At a Glance

Bronchopulmonary Dysplasia (BPD) can cause complications beyond the lungs, including pulmonary hypertension and white matter injury in the brain. Early screening with echocardiograms and interventions like physical therapy are crucial for supporting your baby's long-term development.

Bronchopulmonary Dysplasia (BPD) is a condition that can affect more than just the lungs. Because the body’s systems are deeply interconnected, the challenges in the lungs can sometimes lead to complications in the heart and the developing brain [1][2]. Understanding these risks allows you and your medical team to monitor your baby closely and start supportive therapies as early as possible.

The Heart-Lung Connection: Pulmonary Hypertension

One of the most significant complications of BPD is Pulmonary Hypertension (PH) [3]. This occurs when the blood pressure in the arteries of the lungs becomes too high.

In a healthy lung, a vast network of tiny blood vessels wraps around the air sacs to pick up oxygen. In BPD, this network is often “simplified” or “pruned,” meaning there are fewer vessels [4][5]. Because there are fewer paths for the blood to travel through, the heart has to pump harder to push blood into the lungs [5][6].

  • Screening: Doctors typically screen for PH using an echocardiogram (an ultrasound of the heart) [7]. This is often done around 36 weeks postmenstrual age, but babies with more severe BPD may need multiple scans over time [7][8].
  • Impact: If left untreated, PH can cause the right side of the heart to become overworked [6]. However, many babies respond well to treatments like supplemental oxygen and medications (such as sildenafil) that help relax the lung’s blood vessels [9][10].

The Lung-Brain Axis and Neurodevelopment

Researchers have identified what they call the lung-brain axis—a link between the inflammation in a premature baby’s lungs and the health of their developing brain [2].

When the lungs are inflamed or struggling, the body releases chemical signals that can reach the brain [2][11]. This can sometimes lead to white matter injury (also called periventricular leukomalacia or PVL), which affects the “wiring” of the brain that sends messages between different areas [11][12].

What This Means for Development

The risk of developmental delays often correlates with the severity (or Grade) of the BPD [3][13].

  • Motor Delays: Some children may experience delays in sitting, crawling, or walking [14].
  • Cognitive Impact: There may be challenges with learning or “executive function” (skills like focus and memory) later in childhood [14][15].
  • Cerebral Palsy: In more severe cases, particularly those involving significant white matter injury, there is an increased risk of cerebral palsy [16].

The Power of Early Intervention

While these risks can sound frightening, a severe BPD grade at 36 weeks is a clinical tool for resource planning, not a definitive prophecy. Many infants with severe BPD go on to achieve normal cognitive milestones [17][18]. The brain of a premature infant is incredibly plastic, meaning it has a remarkable ability to adapt and form new connections [17].

Knowing these risks is a tool for empowerment. It ensures that your baby will be closely followed by neonatal follow-up clinics and connected with early intervention services like physical, occupational, and speech therapy [19]. These therapies are designed to support your child’s unique developmental path and help them reach their full potential.

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Common questions in this guide

What is the risk of my baby developing pulmonary hypertension with BPD?
Babies with BPD often have fewer blood vessels in their lungs, which forces the heart to pump harder and can cause high blood pressure in the lung arteries. Doctors will typically screen for this condition, known as pulmonary hypertension, using an echocardiogram around 36 weeks.
How does lung inflammation in BPD affect my baby's brain development?
Lung inflammation can release chemical signals that travel to the brain, potentially causing white matter injury. This affects the brain's wiring and can increase the risk for motor delays, cognitive challenges, or cerebral palsy.
What treatments are available for pulmonary hypertension in babies with BPD?
Many babies respond well to supplemental oxygen and specific medications like sildenafil. These treatments help relax the blood vessels in the lungs, making it easier for blood to flow and reducing the workload on the right side of the heart.
What early intervention therapies should we consider for a baby with severe BPD?
Early intervention services like physical, occupational, and speech therapy are highly recommended. Because a premature infant's brain is incredibly adaptable, these therapies provide crucial support to help your child overcome delays and reach their developmental milestones.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on my baby's BPD grade, what is the risk of them developing pulmonary hypertension?
  2. 2.When is the next screening echocardiogram scheduled to check the blood pressure in my baby's lungs?
  3. 3.Can you explain if my baby has shown signs of white matter injury, and how that might affect their development?
  4. 4.What early intervention services (like physical or occupational therapy) should we start thinking about now?
  5. 5.How are we managing my baby's lung inflammation to protect their developing brain?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (19)
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    Bronchopulmonary dysplasia.

    Thébaud B, Goss KN, Laughon M, et al.

    Nature reviews. Disease primers 2019; (5(1)):78 doi:10.1038/s41572-019-0127-7.

    PMID: 31727986
  2. 2

    Perinatal Hyperoxia and Developmental Consequences on the Lung-Brain Axis.

    Obst S, Herz J, Alejandre Alcazar MA, et al.

    Oxidative medicine and cellular longevity 2022; (2022()):5784146 doi:10.1155/2022/5784146.

    PMID: 35251477
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    The Impact of Pulmonary Hypertension in Preterm Infants with Severe Bronchopulmonary Dysplasia through 1 Year.

    Lagatta JM, Hysinger EB, Zaniletti I, et al.

    The Journal of pediatrics 2018; (203()):218-224.e3 doi:10.1016/j.jpeds.2018.07.035.

    PMID: 30172426
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    Pathogenesis and Physiologic Mechanisms of Neonatal Pulmonary Hypertension: Preclinical Studies.

    Young KC, Schmidt AF, Tan AW, et al.

    Clinics in perinatology 2024; (51(1)):21-43 doi:10.1016/j.clp.2023.11.004.

    PMID: 38325942
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    Interleukin-1 Receptor Antagonist Protects Newborn Mice Against Pulmonary Hypertension.

    Bui CB, Kolodziej M, Lamanna E, et al.

    Frontiers in immunology 2019; (10()):1480 doi:10.3389/fimmu.2019.01480.

    PMID: 31354700
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    Platelets are indispensable for alveolar development in neonatal mice.

    Huang Z, Lin B, Han D, et al.

    Frontiers in pediatrics 2022; (10()):943054 doi:10.3389/fped.2022.943054.

    PMID: 36016884
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    [Clinical features and prognosis of bronchopulmonary dysplasia complicated by pulmonary hypertension in preterm infants].

    Wang CH, Shi LP, Ma XL, DU LZ

    Zhongguo dang dai er ke za zhi = Chinese journal of contemporary pediatrics 2018; (20(11)):893-896.

    PMID: 30477618
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    Screening for pulmonary hypertension in preterm infants with bronchopulmonary dysplasia: when, how often and does it matter?

    Gentle SJ, Carlo WA, Ambalavanan N

    Archives of disease in childhood. Fetal and neonatal edition 2026; (111(2)):F177-F182 doi:10.1136/archdischild-2024-328405.

    PMID: 40912904
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    Diagnosis and management of pulmonary hypertension in infants with bronchopulmonary dysplasia: a guide for paediatric respiratory specialists.

    Chan S, Brugha R, Quyam S, Moledina S

    Breathe (Sheffield, England) 2022; (18(4)):220209 doi:10.1183/20734735.0209-2022.

    PMID: 36865938
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    Pulmonary hypertension specific treatment in infants with bronchopulmonary dysplasia.

    Kadmon G, Schiller O, Dagan T, et al.

    Pediatric pulmonology 2017; (52(1)):77-83 doi:10.1002/ppul.23508.

    PMID: 27333438
  11. 11

    Hyperoxia-activated circulating extracellular vesicles induce lung and brain injury in neonatal rats.

    Ali A, Zambrano R, Duncan MR, et al.

    Scientific reports 2021; (11(1)):8791 doi:10.1038/s41598-021-87706-w.

    PMID: 33888735
  12. 12

    Corpus Callosum Growth and Neurodevelopmental Outcome Are Negatively Influenced by Systemic Infection in Very Low-Birth-Weight Infants.

    Korček P, Korčeková Z, Berka I, et al.

    Journal of child neurology 2021; (36(10)):883-887 doi:10.1177/08830738211016239.

    PMID: 34048279
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    Pulmonary hypertension in preterm neonates with bronchopulmonary dysplasia: a meta-analysis.

    Mascarenhas D, Al-Balushi M, Al-Sabahi A, et al.

    Archives of disease in childhood. Fetal and neonatal edition 2025; (110(4)):344-352 doi:10.1136/archdischild-2024-327547.

    PMID: 39603794
  14. 14

    Pulmonary function and bronchopulmonary dysplasia classification: insights from the Spanish Registry.

    Ramos-Navarro C, Sánchez-Luna M, Pérez-Tarazona S, et al.

    European journal of pediatrics 2024; (183(9)):3757-3766 doi:10.1007/s00431-024-05629-w.

    PMID: 38858227
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    Differences in Comorbidities and Clinical Burden of Severe Bronchopulmonary Dysplasia Based on Disease Severity.

    Kim HR, Jung YH, Kim BI, et al.

    Frontiers in pediatrics 2021; (9()):664033 doi:10.3389/fped.2021.664033.

    PMID: 34277516
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    Respiratory Outcomes Following Late Postnatal Dexamethasone Administration in Preterm Infants With Bronchopulmonary Dysplasia.

    House M, Rowe J, Walters A, et al.

    Pediatric pulmonology 2025; (60(9)):e71275 doi:10.1002/ppul.71275.

    PMID: 40923652
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    Delta like 4 regulates cerebrovascular development and endothelial integrity via DLL4-NOTCH-CLDN5 pathway and is vulnerable to neonatal hyperoxia.

    Ke X, Xia S, Yu W, et al.

    The Journal of physiology 2024; (602(10)):2265-2285 doi:10.1113/JP285716.

    PMID: 38632887
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    Comparison of New Bronchopulmonary Dysplasia Definitions on Long-Term Outcomes in Preterm Infants.

    Katz TA, van Kaam AH, Schuit E, et al.

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  19. 19

    A review and guide to nutritional care of the infant with established bronchopulmonary dysplasia.

    Miller AN, Curtiss J, Taylor SN, et al.

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    PMID: 36494567

This page provides educational information about heart and brain complications associated with BPD. It does not replace professional medical advice from your baby's neonatologist or pediatric specialists.

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