There is a small body of literature documenting the outcome of premature infants surviving neonatal resuscitation much of which is pessimistic. We investigated the outcome of very low birth weight infants who had chest compressions (CC) in the delivery room compared to infants of similar characteristics who did not require that level of initial intervention. Methods: A search of the computerised Newborn Follow Up database identified all infants meeting the following criteria: born at the Health Sciences Centre in 1992-94, birth weight < 1250g; no evidence of congenital anomalies or maternal substance abuse likely to affect neurodevelopmental outcome; a minimum of 12 months follow up. Chest compressions were initiated following established guidelines for neonatal resuscitation. The study group consisted of survivors of CC in the delivery room. The control group consisted of all other infants meeting the above criteria. The data base contains antenatal and perinatal data extracted from the hospital chart and follow up data collected prospectively. Results: Of the 163 infants born weighing <1250g in the study time period 36(22%) required CC in the delivery room. Mortality for this group was higher(53% vs 24%, p<0.001). The 17 survivors in the CC group were compared to 63 survivors in the non CC group who met the inclusion criteria. There were no differences in birth weight (881±179g vs 962 ±186g) or days of mechanical ventilation(21±13 vs 15 ±22) between the two groups although the CC group was born at a more premature gestation (27.2±1.6 vs 28.1±2.5, p< 0.04) and stayed longer in hospital (99±25 vs 80±39, p<0.01). There were no significant differences in the rates or severity of intraventricular hemorrhage, seizures, hearing loss or clinical diagnosis of cerebral palsy between the two groups. The CC group had a significant increase in retinopathy of prematurity of grade 3 or 4 (37% vs 17%, p<0.03). The gross motor, fine motor, adaptive and language developmental quotients as assessed using the Gessel Scales showed no significant differences between the two groups. Conclusion: In contrast to previous literature our data suggest that infants that require cardiac compressions at birth, although having a higher mortality have a comparable neurodevelopmental outcome to those that do not.