Neurodevelopmental Therapy in NICUs Caring for Infants with Bronchopulmonary Dysplasia

Bronchopulmonary dysplasia, the chronic lung disease of prematurity, remains one of the most consequential complications facing infants admitted to the neonatal intensive care unit. As survival rates for extremely preterm infants have climbed over recent decades, the population of babies living with BPD has grown in parallel, and with that growth has come renewed attention to a dimension of their care that extends far beyond the ventilator and the oxygen hood: the developing brain. New work published in the Journal of Perinatology examines how neonatal intensive care units that care for these medically fragile infants approach neurodevelopmental therapy, asking not only whether such services are delivered, but how consistently, by whom, and with what institutional support. The findings arrive at a moment when the long-term outlook for children with BPD is increasingly understood to depend as much on early developmental intervention as on pulmonary management.

The clinical stakes are considerable. Infants with bronchopulmonary dysplasia face elevated risks of motor delay, cerebral palsy, cognitive impairment, language difficulties, and behavioral challenges that can persist well into school age. Their prolonged hospitalizations, often stretching across many months, are characterized by exposure to invasive procedures, sedating and sometimes neurotoxic medications, extended mechanical ventilation, and the sensory environment of an intensive care unit that bears little resemblance to the womb. Yet the same extended stay also represents an extended opportunity, a window in which structured developmental care, physical therapy, occupational therapy, and family-centered interventions can be woven into daily management. The question the research addresses is whether neonatal units are systematically seizing that opportunity or leaving developmental support to happenstance and individual clinician initiative.

Neurodevelopmental therapy in the neonatal setting encompasses a broad spectrum of practices. At its most structured, it includes standardized developmental assessments performed at regular intervals, referrals to physical and occupational therapists with neonatal expertise, individually calibrated positioning and handling strategies, oral feeding support that respects the infant’s respiratory limitations, and structured programs that prepare families to continue stimulation and therapy after discharge. At its least structured, it amounts to informal bedside advice delivered when staffing allows. The literature has long suggested that early, intensive developmental intervention can improve trajectories for high-risk infants, but translating that evidence into routine practice across a heterogeneous network of intensive care units has proven difficult, and the new study illuminates precisely where the translation breaks down.

A central theme emerging from the work is the striking variability in how units that care for infants with BPD organize their developmental services. Some centers embed dedicated neurodevelopmental teams within the neonatal intensive care environment, with therapists rounding alongside neonatologists and nurses and contributing directly to individualized care plans. Others rely on consultation models in which therapists evaluate infants but remain peripheral to daily medical decision-making. Still others provide developmental programming only in fragments, dependent on the availability of personnel and the priorities of individual attending physicians. This patchwork means that two infants with comparable degrees of lung disease, admitted to different units, may receive profoundly different developmental care purely as a function of where they happen to be born.

The technical details of why this variability matters are grounded in the neurobiology of the preterm brain. The third trimester of pregnancy, which extremely preterm infants spend largely in the intensive care unit, is a period of extraordinary cerebral organization: cortical folding, myelination, synaptogenesis, and the pruning of neural circuits all proceed at a pace unmatched at any later stage of life. Sensory experience during this period literally shapes the architecture of the developing nervous system. Painful procedures, prolonged prone positioning, excessive light and noise, and handling practices that disrupt sleep can disrupt these processes, while calibrated positive sensory input, skin-to-skin contact, and supported early feeding experiences can support them. Neurodevelopmental therapy is, in this sense, not an adjunct to intensive care but an integral component of protecting the brain while the lungs are being treated.

For infants with bronchopulmonary dysplasia specifically, the developmental challenge is compounded by respiratory physiology. Many of these infants remain on oxygen support for months, and their limited respiratory reserve constrains the energy available for the motor demands of feeding, reaching, and exploratory movement. Oral feeding, one of the most complex motor tasks the newborn brain must coordinate, becomes a delicate negotiation between nutritional needs and respiratory stability. Therapists with neonatal expertise are trained to titrate intervention intensity to the infant’s physiologic tolerance, monitoring desaturation events, heart rate patterns, and behavioral stress cues to ensure that therapy strengthens rather than exhausts the child. That level of specialization is precisely what the study identifies as unevenly distributed across the units caring for this population.

The research also directs attention to the institutional and systemic factors that determine whether neurodevelopmental services flourish or falter. Adequate therapist staffing ratios, dedicated funding for developmental programs, formal training pathways in neonatal therapy, and leadership that treats brain development as a quality metric alongside survival and growth all emerge as decisive variables. Units that have made developmental care a strategic priority tend to show more consistent assessment schedules, earlier therapy initiation, and stronger family engagement. Where such infrastructure is absent, even clinicians who are personally committed to developmental principles struggle to deliver them reliably. The implication is that improving outcomes for infants with BPD is not primarily a matter of individual clinician goodwill but of building systems in which developmental care is the default rather than the exception.

Families occupy a central position in this framework, and the study’s findings carry important implications for parents navigating prolonged intensive care stays. Parents of infants with BPD frequently report anxiety about their child’s future, and they are often the first to notice subtle delays in movement, feeding, or social engagement. Structured neurodevelopmental programs that involve parents as partners, teaching positioning strategies, coaching on developmental play, and preparing families for the transition home, convert the prolonged hospitalization into a period of skill-building for caregivers as well as infants. Equally important, standardized developmental follow-up after discharge allows the early signs of cerebral palsy, cognitive delay, or language impairment to be detected and addressed during the windows in which intervention is most effective, rather than at the point of school-entry failure.

The broader significance of this work lies in its reframing of what constitutes high-quality care for bronchopulmonary dysplasia. For much of the modern neonatal era, success in managing the disease was measured in survival, oxygen weaning, and growth velocity. Those metrics remain essential, but a growing body of long-term outcome research demonstrates that pulmonary health and neurodevelopmental health are inseparable in this population: children who escape severe lung disease can still carry substantial developmental burden, and developmental interventions delivered during the intensive care stay may influence outcomes that were once assumed to be fixed. By mapping the current landscape of neurodevelopmental therapy across units that care for these infants, the study provides a baseline against which progress can be measured and a pointed reminder that the lungs and the brain of the preterm infant must be treated as one patient, not two.

Looking forward, the research suggests concrete priorities for the neonatal community: standardizing developmental assessment protocols for infants with BPD, expanding access to therapists with neonatal subspecialty training, embedding developmental outcomes into unit-level quality improvement, and ensuring equitable delivery of services so that an infant’s developmental trajectory is not determined by geography or institutional circumstance. As the cohort of BPD survivors continues to grow, the neonatal intensive care unit is increasingly being judged not only by whether its smallest patients survive, but by how fully they thrive. Neurodevelopmental therapy, integrated deliberately and systematically into the care of infants with bronchopulmonary dysplasia, may prove to be one of the most powerful tools available for shifting that balance.

Subject of Research: Neurodevelopmental therapy practices in neonatal intensive care units caring for infants with bronchopulmonary dysplasia.

Article Title: Neurodevelopmental therapy in NICUs that care for infants with bronchopulmonary dysplasia

Article References: DeMauro, S. B., Burkhardt, M., Hanin, M., Miller, A. N., House, M., Ransom, M., DuPont, T., Lagoski, M., Wood, A., Brei, B. K., Brinker, K., Wittwer, C., Gibbs, K., & on behalf of the BPD Collaborative Neurodevelopment Group (2026). Neurodevelopmental therapy in NICUs that care for infants with bronchopulmonary dysplasia. Journal of Perinatology. https://doi.org/10.1038/s41372-026-02891-8

Image Credits: AI Generated

DOI: 10.1038/s41372-026-02891-8

Keywords: bronchopulmonary dysplasia, neonatal intensive care, neurodevelopmental therapy, preterm infants, developmental care, neonatology, infant brain development, occupational therapy, physical therapy, family-centered care, chronic lung disease of prematurity, developmental outcomes