Remarkable advances in the treatment of neonatal respiratory disorders, such as antenatal glucocorticoid therapy, surfactant replacement therapy and alternative modes of ventilation, have reduced neonatal mortality and acute respiratory morbidity. However, bronchopulmonary dysplasia and chronic lung disease of infancy remain a substantial complication, especially among the most immature infants. The pathogenesis of chronic lung disease is complex and multifactorial. Prevention and treatment will require a comprehensive multiprong approach with specific interventions and practices focused on different levels of the pathways leading to chronic lung changes. Future improvements in care will require a better understanding of lung development and lung repair mechanisms. However, the ultimate and most effective approach should be a relentless pursuit for measures to prevent premature births.