Neonatal care has changed significantly over the past decades. Despite increased survival rates in extremely preterm infants, there was no significant improvement with regard to morbidity. Regenerative approaches seem to have a great potential in preventing several diseases associated with impaired fetal organ development. Mesenchymal stromal cells (MSC) play an important role in regulating fetal organ development. Pregnancy-associated diseases or exposure of the fetus to an extrauterine environment leads to severe deterioration in endogenous MSC, which subsequently interferes with fetal organ development. Data from cell and animal experiments suggest that this deterioration is - at least in part - compensated by administration of exogenous MSC. Whereas results of these studies seem to be promising, some of the more recent large trials in human adults failed to prove a benefit. Nevertheless, this therapy still has great potential - not only for neonatal medicine. To use that potential, lessons have to be learned from previous experience. The biggest challenge currently, however, is to translate bench data to bedside as quickly but also as safely as possible.