OBJECTIVE:To examine the demographic, clinical, and environmental characteristics of children with bronchopulmonary dysplasia (BPD) associated with respiratory readmissions. STUDY DESIGN:Demographic and clinical data were obtained from children with BPD recruited from 15 centers participating in the BPD Collaborative between 2018 and 2025. Subjects with any hospital readmission for respiratory reasons were compared with children not readmitted as assessed by questionnaires obtained at clinic visits during the first 3 years of life. Clustered regression models were used to identify variables associated with readmission. Secondary analyses were performed to identify factors associated with a higher number (≥2) of readmissions. RESULTS:There were 1615 participants who met inclusion criteria with a mean age of 9.4 ± 7.5 months at recruitment. During the study period, 352 (21.8%) had at least 1 readmission and 1263 had no reported readmission. In multivariable models, an increased likelihood of readmission was associated with a shorter initial neonatal intensive care unit hospitalization, use of a home ventilator, prescription of reflux medications, daycare attendance, and lower BPD control score. CONCLUSIONS:In young children with BPD, markers of medical complexity, such as home ventilator use for chronic respiratory failure and gastroesophageal reflux, were associated with a high likelihood of respiratory readmissions. Other potentially modifiable factors associated with readmissions include daycare attendance and respiratory symptom control. BPD severity was not associated with readmission risk. Identifying risk factors for respiratory readmission in the outpatient setting will help healthcare providers to provide targeted anticipatory guidance.

OBJECTIVE:To understand the prescribing patterns and clinical practices of providers for infants and children with bronchopulmonary dysplasia (BPD) in the outpatient clinic setting. METHODS:We conducted a survey of BPD Collaborative programs from diverse geographic areas inside and outside the United States from January 2025 through March 2025. RESULTS:Twenty-nine of 45 centers in the BPD Collaborative completed the survey, including 27 from the U.S. and 2 from other countries. The majority of respondents identified as pediatric pulmonologists (72.4%). Most healthcare providers endorsed that patient symptomatology was a major driver of decision making (79.3%) and greater BPD severity correlated with a higher likelihood of medication use. Beta-agonists and inhaled corticosteroids (ICS) were the most commonly prescribed medications across all levels of severity. While prescriptions for pulmonary hypertension (PH) medications and diuretics decreased with age, use of inhaled medications persisted or increased in frequency. Challenges obtaining medications included insurance authorization issues (69.0%) and medication costs (51.7%). Adherence to therapy was a concern for over half of BPD programs. CONCLUSIONS:Despite limited evidence for outpatient pharmacotherapy in children with BPD, we identified consistent cross-center practice patterns. Providers reported that while the utilization of therapies was associated with higher BPD severity and greater respiratory support, medications were prescribed across the spectrum of disease severity. Treatment practices varied by age group and were often hindered by common barriers to accessing medications. These findings underscore the need to revise clinical guidelines to enhance long-term outpatient pharmacotherapy for infants and children with BPD.

RATIONALE:Bronchopulmonary dysplasia (BPD) is the most common respiratory complication of preterm birth, and various environmental exposures have been associated with long-term outcomes. Rural patients face unique challenges with regard to their environmental exposures and distance to care. OBJECTIVE:To assess differences in acute and chronic respiratory outcomes between infants and children with BPD residing in rural areas, as defined by distance to tertiary care and population density, and those residing in urban and suburban areas. METHODS:A retrospective cohort study of 1116 subjects who were recruited from an outpatient BPD Clinic between January 2008 and January 2025 was performed. Data were collected through chart review and caregiver questionnaires obtained at routine clinic visits. Rurality was defined by both distance to Johns Hopkins Children's Center (JHCC) in miles as well as population density in persons per square mile (ppsm) of an individual's home zip code. Data were analyzed using chi-square, t-tests, and logistic regression. RESULTS:22.5% of the study population lived in rural zip codes with < 500 ppsm. Rural patients were more likely to be white and have private health insurance. When comparing clinical outcomes, patients living in rural areas were less likely to be prescribed oral steroids compared to those living in suburban or urban settings. CONCLUSIONS:Although there are demographic differences between those living in rural versus urban or suburban settings, outpatient respiratory outcomes are similar. Further work should explore specific environmental exposures and health care access issues that affect the rural population with BPD.

BackgroundExposure to fine particulate matter (PM2.5) increases asthma severity and reduces glucocorticoid responsiveness in children, yet the molecular mechanisms underlying PM2.5 sensitivity remain unclear. We previously identified a PM2.5-sensitive asthma phenotype and developed a PM2.5 sensitivity polygenic risk score (sPRS) correlated with asthma exacerbations and lung function decline.Research questionWe sought to determine whether genetic variants contributing to PM2.5 sensitivity converge on specific biological pathways or transcriptional regulators, and whether children with a high sPRS exhibit immune transcriptional signatures consistent with heightened PM2.5 susceptibility.MethodsGenes implicated by sPRS variants were mapped using regulatory annotation tools and evaluated for pathway and transcription factor target enrichment. Peripheral blood mononuclear cells (PBMCs) from high- and low-sPRS children matched on long-term ambient PM2.5 exposure were profiled using single-cell RNA sequencing. Donor-level pseudobulk differential expression was performed using a paired quasi-likelihood negative binomial framework, followed by exploratory pathway enrichment and perturbagen signature analyses.ResultssPRS-implicated genes were enriched for transcriptional regulators linked to SMAD2/3- and MAPK-associated signaling, suggesting TGF-β1-related pathway involvement. No genes reached false-discovery-rate-adjusted significance at the donor level in this small, matched cohort. However, secondary pathway-level analyses demonstrated concordant enrichment across multiple immune populations in inflammatory and stress-response signaling programs previously linked to PM2.5 exposure. Perturbagen signature analyses likewise highlighted small-molecule regulators of TGF-β1-associated pathways.InterpretationThese integrative genomic and transcriptomic analyses nominate TGF-β1-SMAD/MAPK signaling as a biologically plausible axis of genetic susceptibility to PM2.5 in pediatric asthma. Given the modest sample size and indirect nature of enrichment-based inference, these findings should be considered hypothesis-generating and motivate targeted functional validation.

This review critically examines the role of furosemide and chlorothiazide in the prevention and management of bronchopulmonary dysplasia (BPD). We describe their common use, pharmacotherapeutic mechanisms, and summarize evidence from clinical trials and cohort studies evaluating their effects on diuresis and respiratory outcomes. Most evidence comes from studies in the 1980s that generalize poorly to contemporary neonatal care. However, a trial in 80 extremely preterm infants was published in 2025, reporting no certain effect of furosemide on death or BPD or on adverse effects other than electrolyte imbalances. The trial was not designed to address BPD prevention. Two recent large observational studies reported associations between greater diuretic exposure and lower risk of death or BPD but are limited by potential confounding. Earlier trials suggest diuretics may offer short-term improvements in urine output, pulmonary mechanics and gas exchange. The role of diuretics in the prevention and management of BPD remains uncertain. While transient, modest improvements in diuresis and respiratory function are likely, existing evidence does not convincingly support either clinically meaningful benefit or harm. In the absence of robust evidence-based guidance, minimizing routine diuretic use and considering short-term, selective treatment with measurable individualized goals is prudent. Addressing the disconnect between widespread use and limited supporting evidence will require well-designed studies that consider optimal patient selection, timing, dosing and duration in the context of current diuretic practice patterns.

OBJECTIVE:To examine racial and ethnic variation in outpatient respiratory outcomes among children with bronchopulmonary dysplasia (BPD) cared for in multidisciplinary clinics. STUDY DESIGN:Subjects born <32 weeks' gestation with subsequent BPD were recruited through the BPD Collaborative Registry. Data were collected via questionnaire. Associations between outpatient respiratory outcomes and race and ethnicity were assessed using multivariable regression. RESULTS:Among 1564 subjects across 15 BPD clinics, 30.6% were caregiver-identified as Black/African American and 12.1% as Hispanic, which were higher proportions than observed in preterm populations of the respective states where the clinics were located. Compared with non-Hispanic White subjects, Black/African American and Hispanic subjects had younger gestational ages, lower birth weights, and longer initial hospitalizations and were more likely to be insured by Medicaid. Both Black/African American and Hispanic subjects were significantly more likely to be seen in the emergency department or readmitted for respiratory reasons than non-Hispanic White subjects (aORs 1.54, P = .001 and 1.99, P < .001, respectively). Hispanic subjects were also more likely to have sick visits (aOR: 1.52, P = .016). CONCLUSIONS:Both Black/African American and Hispanic children are disproportionately represented in BPD clinics and have a higher likelihood of acute care use, compared with non-Hispanic White children. To optimize respiratory health outcomes of all children with BPD, further research is needed to identify factors that drive observed racial and ethnic differences.

OBJECTIVE:To evaluate whether antenatal betamethasone affects childhood respiratory impairment.METHODS:This was a prospective follow-up study of children aged 6 years and older from parents in the ALPS (Antenatal Late Preterm Steroids) trial randomized to betamethasone or placebo from 34 0/7 to 36 6/7 weeks of gestation. Primary outcome composite included the following: 1) abnormal spirometry, forced expiratory volume in 1 second (FEV1) below the lower limit of normal, FEV1/forced vital capacity (FVC) below the lower limit of normal, or FVC below the lower limit of normal, defined as below the 5th percentile by the Global Lung Initiative; 2) physician-diagnosed asthma and daily asthma medication; or 3) daily asthma medication use in the past year. Children whose parents were enrolled in a concurrent trial were recruited to provide a term reference cohort for lung function. Adjusted analyses were performed controlling for confounders.RESULTS:Of 2,831 ALPS children, 1,218 enrolled, and 1,194 (98.0%) completed spirometry. There were no differences in the primary outcome (35.3% betamethasone, 35.8% placebo; adjusted relative risk [RR] 1.02, 95% CI, 0.87-1.18) or its individual components, although ever-noting wheezing or whistling in the chest was less common (40.7% betamethasone, 45.5% placebo, adjusted RR 0.88, 95% CI, 0.77-0.996). Compared with 432 children from the term reference cohort, ALPS children had more wheezing with exercise in the past year (7.2% betamethasone vs 4.4% term control group, adjusted RR 1.77, 95% CI, 1.03-3.06; 8.8% placebo vs term control group, adjusted RR 2.09, 95% CI, 1.25-3.48).CONCLUSION:Among children aged 6 years or older, late preterm antenatal exposure to betamethasone was associated with lower rates of wheezing or whistling in the chest but no differences in other respiratory outcomes.

BACKGROUND:To assess whether human milk consumption after neonatal intensive care unit (NICU) discharge is associated with outpatient respiratory outcomes in infants and children with bronchopulmonary dysplasia (BPD). METHODS:We conducted a retrospective longitudinal cohort study of children under 2 years followed in outpatient BPD clinics. Participants were categorized by post-NICU human milk exposure (any vs. none). Caregiver questionnaires assessed the presence and frequency of chronic respiratory symptoms and acute care usage. Baseline characteristics were compared descriptively, and logistic regression with clustering by subject evaluated associations between human milk intake and outcomes. RESULTS:Among 1731 children, 445 (25.7%) received human milk after NICU discharge, and 1286 (74.3%) did not. After adjusting for potential confounders, human milk consumption was associated with lower odds of sick (OR: 0.65, p = 0.006) and emergency department visits (OR: 0.66, p = 0.015), antibiotic (OR: 0.58, p = 0.005) and steroid prescriptions (OR: 0.46, p < 0.001), and beta-agonist use in the prior 3 months (OR: 0.69, p = 0.008). CONCLUSIONS:In our multicenter cohort of children with BPD, post-NICU human milk consumption was associated with decreased parent-reported acute healthcare utilization and chronic respiratory symptoms, supporting its role as a modifiable risk factor that may improve respiratory outcomes in children with BPD. IMPACT:Human milk has been shown to decrease the incidence of bronchopulmonary dysplasia (BPD); however, limited data exist on the role of human milk intake after NICU discharge and its effect on long-term outpatient respiratory outcomes. Our findings demonstrate that post-NICU human milk intake is associated with decreased acute care usage and chronic respiratory symptoms in children with BPD, suggesting that human milk consumption is potentially a modifiable risk factor to improve outcomes. Further investigation using quantitative time-adjusted analyses, evaluating long-term respiratory consequences, and addressing barriers to use is needed to better define the role of human milk in this population.

RATIONALE:Despite CFTR modulators transforming cystic fibrosis (CF) care, patients still show wide variability in pulmonary outcomes. The contribution of ambient fine particulate matter (PM2.5) exposure to this variability in the modulator era is unknown. OBJECTIVES:To quantify the effects of PM2.5 on pulmonary outcomes in people with CF and to assess whether CFTR modulator use modifies these effects. METHODS:In a retrospective cohort of 5,661 from the Cystic Fibrosis Foundation Registry, ZIP codes were linked to daily PM2.5. Long-term exposure was defined as the fraction of days ≥ 12 µg/m3 from birth to spirometry. Linear mixed-effects models assessed lung function, negative binomial regression estimated exacerbation counts, and Cox proportional hazards models evaluated time to pathogen acquisition. Interaction terms tested modification by CFTR modulator use. RESULTS:Each 10 percentage-point increase fraction of long-term days ≥ 12 µg/m3 (range 0% to 88%) was associated with an 0.82-point decrease in precent predicted FEV1 (95% CI -1.07 to -0.56; P < .0001) and a 0.97-point decrease in FVC % predicted (95% CI -1.20 to -0.73; P < .0001). Similarly, pulmonary exacerbation rates increased by 6.7% (95% CI 2.55-11.1; P = .0014). Higher PM2.5 also predicted earlier P. aeruginosa and MRSA positivity. CFTR modulators significantly attenuated PM2.5-related decrements in lung function but no significant interactions regarding pulmonary exacerbations were identified. CONCLUSIONS:Long-term PM2.5 exposure remains a strong predictor of lung function, pulmonary exacerbations, and bacterial pathogen acquisition. While CFTR modulators appeared to mitigate the association between PM2.5 exposure and lung function, no such mitigation was identified in relationship to pulmonary exacerbations.

We evaluated whether gestational age is associated with outpatient respiratory outcomes among infants born at extreme limits of viability. Among infants born extremely preterm who presented to a BPD clinic after hospital discharge, those born at gestational ages of 22 to 23 6/7 weeks did not experience worse respiratory outcomes during the first 3 years of life compared with those born at gestational ages of 24 to 25 6/7 weeks.

The National Heart, Lung, and Blood Institute-sponsored workshop, "Maternal and Perinatal Nutritional Programming of Lung Health and Disease in Childhood and Early Adulthood: Research Gaps and Opportunities," was convened (October 24-25, 2024) to explore how nutrition before, during, and after pregnancy influences lung development and respiratory health across the lifespan. The workshop focused on identifying critical knowledge gaps, mechanistic pathways, and intervention opportunities. Presentations spanned maternal dietary patterns, specific nutrient supplementation, gestational weight gain, and the role of maternal obesity in offspring wheeze and asthma. The role of early postnatal nutrition, particularly human milk for preterm infants at risk for bronchopulmonary dysplasia, was emphasized. Emerging areas included circadian rhythms and the maternal and infant microbiome, metabolome, and epigenome in mediating nutrition-related respiratory outcomes. Research needs included randomized trials of dietary interventions, mechanistic studies to elucidate biological pathways, and implementation strategies to integrate nutritional interventions into practice. Vulnerable populations were emphasized, including preterm infants and families experiencing food insecurity. Participants emphasized the need for a coordinated research agenda to inform future interventions that could improve outcomes across generations.

RATIONALE:Extremely preterm infants are at highest risk for developing bronchopulmonary dysplasia (BPD). This study aimed to examine the relationship between gestational age and respiratory outcomes in children with BPD in the outpatient setting. METHODS:Data were collected from 1025 preterm children with BPD recruited from outpatient bronchopulmonary (BPD) clinics at Johns Hopkins and Children's Hospital of Philadelphia (CHOP). Extremely preterm children (22-24 and 25-27 weeks gestation) were compared to a reference group of very preterm children (28-32 weeks gestation). Data were analyzed using Χ2 tests, t-tests, and ANOVA tests. RESULTS:Infants born at < 25 weeks gestation were more likely to have severe BPD (71.9%), be discharged on supplemental oxygen (50.7%), have public insurance, and self-report as Black (60.4%) compared to those born > 25 weeks. In the outpatient setting, extremely preterm children (22-24 weeks gestation) had a higher likelihood of activity limitation (OR 1.72) compared to very preterm infants. Hispanic children, regardless of gestational age, were more likely to have sick visits (OR 2.09) and a hospital admission (OR 2.15) compared to non-Hispanic children. Children with public insurance had a higher likelihood of ED visits (OR 1.48), hospital admissions (OR 1.49), systemic steroid use (OR 1.39), nighttime respiratory symptoms (OR 1.66), and activity limitations (OR 1.61) compared to privately insured children. CONCLUSIONS:After initial hospital discharge, extremely preterm children (22-24 weeks gestation) have a higher likelihood of activity limitation. However, other factors including race/ethnicity and public insurance are more likely driving outpatient respiratory outcomes regardless of gestational age.

OBJECTIVES:To characterize an observational cohort of ventilator-dependent infants and children with bronchopulmonary dysplasia (BPD) with or without tracheobronchomalacia (TBM) and determine the impact of TBM on the need for ventilator support, liberation from the ventilator and tracheostomy decannulation. METHODS:Demographics and clinical outcomes were obtained by retrospective review from 12 centers participating in the outpatient BPD Collaborative registry. The cohort consisted of infants born between 2016 and 2021 who were dependent on invasive mechanical ventilation at home. The respiratory outcomes of those infants with TBM were compared to those who did not have TBM. RESULTS:There were 154 subjects included and about half (48.7%) had documented TBM. Both the TBM and non-TBM groups had similar demographic characteristics and respiratory outcomes. However, the non-TBM were found to have lower mean birth weight (673 vs. 832 grams; p = 0.006), higher likelihood of having Nissen fundoplication (34.2% vs. 12.2%; p = 0.006) and higher use of diuretics (59.2% vs. 37.3%; p = 0.007). Both groups were similar in terms of ventilator requirements, timing of liberation from the ventilator, and rate of decannulation. CONCLUSIONS:The presence of TBM in ventilator-dependent infants with BPD did not affect ventilator support needs, liberation from the ventilator and the rate of tracheostomy decannulation. We speculate that the relative contributions of the other components of BPD disease may play critical roles in determining the need for tracheostomy and their ultimate respiratory outcomes. A prospective multicenter study to assess the impact of TBM in severe BPD is urgently needed.

Bronchopulmonary dysplasia (BPD) is the second most common pediatric chronic respiratory disorder after asthma. Infants and children with BPD can have markedly different long-term respiratory outcomes despite being born at similar gestational ages, which is partially attributable to environmental exposures. Furthermore, these early life exposures can have lifelong consequences for the respiratory system, including decrements in lung function. In this review, we discuss what is known about the effects of environmental pollutants on respiratory outcomes for individuals born prematurely, and more specifically, those with BPD where data exist. Ultimately, targeting individuals with modifiable risk factors, such as preventable exposures, may improve long-term health outcomes for this vulnerable group.

OBJECTIVES:Bronchopulmonary dysplasia (BPD) is the most common complication of preterm birth, which can have life-long effects. Commonly used definitions of BPD severity are based on respiratory support at 36 weeks post-menstrual age. The utility of these definitions for tertiary referral centers outside the initial birth hospitalization is unclear. STUDY DESIGN:Retrospective cohort study of infants born < 34 weeks gestation in the BPD Collaborative registry using three common definitions of BPD severity at 36 weeks post menstrual age and associated their severity with outpatient respiratory outcomes during the first 3 years of life. RESULTS:BPD severity by all three definitions was applied to 608 patients. Although the definitions had different distributions of BPD severity for the cohort, a majority of participants (75.7%) had moderate/Grade 2 or severe/Grade 3 BPD irrespective of the definition. Using clustered logistic regression models, we found no association between any of the definitions of BPD and outpatient acute care use or the BPD control score. CONCLUSIONS:In this multi-center cohort study, we did not observe a significant association between BPD definitions and respiratory morbidity following the initial birth hospitalization. Alternative risk-based BPD definitions that can be integrated into the care of preterm infants following discharge need to be developed.

Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability globally. While genetic and environmental risk factors are known, these insights have not yet resulted in individualized prevention strategies. Polygenic scores (PS) have enhanced our understanding of genetic risk and early-life lung function differences, but their applicability across diverse populations remains unclear. As such, we aimed evaluate whether a COPD PS captures population-wide risk or disproportionately affects sub-populations defined by ancestry or sex. This observational study assessed the association between a previously validated COPD PS and lung function in children with asthma, using spirometry results from children with asthma in the Center of Applied Genomics biorepository. Mixed-effects linear regression models were used to examine the relationship between PS and spirometry measures (FEV1 and FEV1/FVC), with stratified analyses by sex and ancestry. 25,477 spirometry results from 6336 patients were included. Population-wide, children in the high PS group had significantly lower FEV1/FVC z-scores compared to the low PS group (P = 0.0037, beta = - 0.11, 95% confidence interval [CI] - 0.18 to - 0.036). When stratified by sex, high PS was associated with lower FEV1/FVC z-scores in males (P = 0.0088, beta = - 0.14, 95% CI - 0.24 to - 0.035), but no significant effect was found in females. Ancestry-specific analysis revealed that males of European (EUR) ancestry with high PS had significantly lower FEV1 (P = 0.0035, beta = - 0.37, 95% CI - 0.63 to - 0.12) and FEV1/FVC z-scores (P = 0.00076, beta = - 0.35, 95% CI - 0.55 to - 0.15). No significant associations were observed in females with EUR ancestry or in African ancestry groups. Logistic regression analysis showed that high PS in males of EUR ancestry increased the odds of having an FEV1/FVC ratio below 0.7, a marker for COPD (P = 0.0074, OR = 2.01, 95% CI 1.19 to 3.31). This study demonstrates sex-specific effects of a COPD PS in pediatric asthma patients, with males of EUR ancestry at highest risk. The findings underscore the need to include diverse populations in genomic studies to improve the generalizability of PS for COPD prevention.

Infancy represents a unique period of immune vulnerability. This study investigated age-specific immune dynamics associated with differential health outcomes in the immature lung. Single-cell RNA sequencing (scRNA-seq) and bulk RNA sequencing were employed to comprehensively map the transcriptional landscapes of lung-resident cells. Marked differences in gene expression and cell-type distributions were observed between neonates and juveniles. Acute inflammatory responses in neonatal lungs were associated with decreased alveolar epithelial type 2 (AT2) cell proliferation, as well as a transient disruption of ligand-receptor interactions (Fgf1 and Fgfr4) between AT2 cells and secondary crest myofibroblasts. In contrast, juvenile immune and lung-resident cells were transcriptionally poised to respond to lung injury, dampening the acute inflammatory effects of E. coli on the lung. This study highlighted how early-life immune ontogeny impacts disease susceptibility, opening avenues for future research to identify therapeutic targets to enhance resistance to respiratory infections for the most vulnerable populations.

Objective To assess the clinical utility and predictive ability of three commonly used definitions of bronchopulmonary dysplasia (BPD) (2001 NHLBI, 2018 NICHD, 2019 NRN) in forecasting lung function outcomes in children with a history of prematurity and BPD.Study Design A retrospective chart review of 138 children with a history of prematurity and BPD who were recruited from two outpatient clinics at large tertiary medical centers was performed. Each subject's lung disease was classified based on the three definitions of BPD. Regression analyses were performed to assess the association between lung function (FEV1%predicted, FVC %predicted) and BPD status, defined dichotomously and by severity. Additional analyses compared lung function outcomes by need for supplemental oxygen at hospital discharge and history of pulmonary hypertension.Results None of the three definitions evaluated met the criteria for an ideal definition that can both identify individuals at risk for long-term pulmonary impairment and stratify disease severity in a clinically meaningful way. In dichotomized analysis (BPD vs. no BPD), both the 2018 NICHD and 2019 NRN definitions identified preterm-born individuals with significantly lower lung function parameters compared to preterm-born individuals without BPD whereas the 2001 NHLBI definition failed to distinguish between affected and unaffected individuals. A clear gradient of worsening lung function with increasing BPD severity was appreciated using the 2001 NHLBI criteria, highlighting an aspect of the definition's relative strength in stratifying long-term risk.Conclusions Newer definitions of BPD (2018 NICHD, 2019 NRN) more effectively identify children at risk for impaired pulmonary function than the older NHLBI definition. The association of supplemental oxygen requirement and diagnosis of pulmonary hypertension with lung function parameters suggests that there may be clinical indicators that are more predictive of long-term respiratory outcomes than the currently available definitions. There continues to be a need for significant refinement in the definition of BPD to improve its predictive value and guide long-term management strategies.

OBJECTIVE:Bronchopulmonary dysplasia (BPD) is the most common cause of chronic lung disease in infancy. Caregivers often experience significant challenges in caring for these medically complex children. The purpose of this study was to determine feasibility of administering an electronic social determinants of health (SDoH) screening tool and to determine if caregiver social needs correlate with respiratory outcomes in children with BPD. STUDY DESIGN:An SDoH screening tool was completed by caregivers of children seen in BPD pulmonary clinics at the Children's Hospital of Philadelphia (2022-2025). Subject characteristics and respiratory health outcomes were obtained by chart review and questionnaires. RESULTS:Approximately 1/3 of caregivers (34.7%) endorsed a social need, with difficulty paying utility bills the most expressed need. Children of caregivers who endorsed at least one social need were more likely to have lower birth weights, earlier gestational ages, and caregivers who self-report as Nonwhite. For every social need identified, there was a 32% increased risk of an emergency department visit and a 38% increased risk of rehospitalization (unadjusted). When analyzed by self-reported race, children of White but not Nonwhite caregivers, had twice the likelihood of an ED visit/rehospitalization with each social need endorsed. CONCLUSION:Social need endorsement is high in caregivers of children with BPD. An association between social need endorsement and ED visits/re-hospitalizations was found in children of self-reported White but not Nonwhite caregivers, suggesting that other systemic issues not identified by the SDoH tool account for the high acute care events in children of Nonwhite caregivers.