Relevance: The ever growing population of extremely preterm born individuals, representing approximately 27,000 Canadians less than 18 years old, of whom approximately 40% have BPD, is at risk of development of early COPD-like emphysematous changes. Thus, neonatal conditions may be at the origin of a substantial and disproportionately high burden of adult lung disease, associated with significant morbidity and mortality. Prematurity and BPD, in addition to smoking, is one of the strongest predictors of obstructive airways disease in later life. In order to promote lung health and reduce the global burden of chronic lung disease, it is necessary to understand the trajectory of lung growth, development and decline across the lifespan in this at-risk population. Use of novel imaging strategies, more sensitive than PFT or respiratory symptoms to quantify early changes in the lung, provides new knowledge about the natural history of BPD in this population. Furthermore, MRI changes can quantify improvement associated with therapeutic interventions and can be safely serially evaluated across the lifespan. This is particularly important and exciting, given new therapies on the horizon to treat BPD, including stem cell treatments.