Background: Neurodevelopmental outcome at school age has not been compared previously in premature infants with and without chronic lung disease (CLD) who received surfactant. Objective: To determine if CLD is a risk factor for abnormal neurodevelopment. Methods: A multicenter randomized trial comparing prophylactic to rescue surfactant in infants <30 wks gestation by dates was performed in 1985-1987 (Kendig et al, NEJM, 1991). 148/154 (96%) of survivors from our center were tested at 5-7 years of age by a pediatric psychologist and a pediatric neurologist. The McCarthy Scales of Children's Abilities intelligence scale, the Child Behavior checklist, and a neurological examination were performed. Teacher reports defined academic achievement and educational requirements including consultative services. The Hollingshead scale was used as an estimate of socioeconomic status (SES). Statistical Analysis: Infants requiring supplemental oxygen at 36 wks postmenstrual age (CLD36w) were compared to controls using two separate analyses. A case-control analysis matching for grade of IVH, gestational age (GA), birthweight, and SES was performed using paired Student t, chi square, and McNemar's tests. A second analysis used linear and logistic regression on the entire cohort testing independent variables of gender, GA, grade of IVH, SES, and CLD36w. p<0.05 was considered statistically significant. Results: Infants with CLD36w were more likely than controls to have an abnormal neurologic exam (45% vs. 20%), to have a General Cognitive Index <70 (30% vs. 15%) and to require formal Special Education (35% vs. 25%); however, no differences were statistically significant. Conclusion: CLD or bronchopulmonary dysplasia, defined as a supplemental oxygen requirement at 36 weeks postmenstrual age, is associated with a somewhat, but not dramatically, poorer neurodevelopmental outcome. CLD36w as a risk factor is greatly overshadowed by the more important risk factors of lower GA, higher grade of IVH and SES.