Since the initial description of bronchopulmonary dysplasia (BPD) 40 years ago, advances in perinatal care have allowed the survival of infants that are more immature. The disease has not disappeared, but it now affects infants with undeveloped distal airspaces, resulting in an arrest of alveolar development. The histological changes that occur during normal lung development are well described, but little is known about the signaling mechanisms that regulate saccular and alveolar development. Understanding how alveoli and the underlying capillary network develop and how these mechanisms are disrupted in preterm infants with BPD is critical to develop efficient and effective therapies for lung diseases characterized by alveolar damage. This brief review focuses on the recently recognized role of angiogenic growth factors during normal alveolar development, injury and repair with a particular emphasis on the vascular endothelial growth factor. Copyright (c) 2007 S. Karger AG, Basel.