Background <p>Every year, millions of infants are born prematurly, many of whom develop serious complications like bronchopulmonary dysplasia and necrotizing enterocolitis. Despite improvements in neonatal care, there are few therapies that actively promote healing or prevent long-term damage. In recent years, secretions from mesenchymal stem cells, rich in reparative proteins and tiny extracellular particles have shown promise as a safe and effective way to support tissue repair without the risks of live-cell therapy.</p> Methods <p>This review brings together findings from animal studies and early-stage clinical trials to explore how these stem cell-derived secretions work and how they might be used in the clinic. We examine how different sources of mesenchymal stem cells, such as bone marrow or umbilical cord affect the quality and function of their secretions. We also look at key biological pathways they influence, including inflammation control, blood vessel growth, and tissue regeneration. In parallel, we assess the designs and outcomes of current clinical trials involving preterm infants.</p> Results <p>In animal models, these secretions have repeatedly shown the ability to reduce lung and gut injury, calm inflammation, and boost repair mechanisms. Products from umbilical cord tissue appear especially potent, delivering high levels of protective molecules while being low in immunogenic risk. Several small clinical studies report that the approach is safe and well-tolerated in preterm infants, with some signs of benefit. However, clinical use is still limited by variability in production methods and the lack of standardized dosing.</p> Conclusions <p>Mesenchymal stem cell secretions could offer a powerful new way to treat fragile preterm infants, providing regenerative support without the risks of cell transplantation. But before they become part of routine care, we need clearer guidance on how to manufacture, measure, and safely deliver these therapies in newborns.</p>