Discharge day in the neonatal intensive care unit, or NICU, should feel like a finish line. After weeks or months of monitors, alarms, oxygen, feeding tubes, blood tests and waiting, a family can finally take their baby home.

As a neonatologist, I know how much work it takes to get that baby there. Their lungs have grown stronger. Their feeding has improved. Their medications have been adjusted and readjusted. The car seat test has been passed.

But every time we prepare to discharge a preterm infant, I find myself thinking about something that is not listed in the NICU discharge summary: What is the air like in the home and neighborhood where this child lives?

That question has animated my clinical and research life. Before I was a neonatologist, I worked in a toxicology lab studying fine particulate matter, or PM2.5. These are tiny particles produced by sources such as vehicle exhaust, power plants and industrial emissions. They are small enough to be inhaled deep into the lungs and may enter the bloodstream. In the lab, we studied how early-life exposure to polluted air could affect the developing heart and lungs.

Years later, caring for preterm infants in Philadelphia, I am confronted by the same question. Not in a dish or an animal model, but in the lives of my patients – whose lungs are still developing when they leave the hospital – and their parents.

Preterm infants face double exposure

Before my patients are born, their pregnant parent is already breathing the air in the place they call home, whether........

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