The advances in neonatal intensive care in developing nations have been somewhat disproportionate in relation to organized evaluation and follow-up of infants' progress after discharge from NICU's. No information about school performance for very small preterm survivors of NICU in developing countries is available in published reports. We report our data on follow-up to 6 years of age for outborn critically ill very low birth weight infants. Between 1988 and 1991 there were 167 infants, <1500g transferred to our NICU of whom 53(32%) died. Until the present time, 67 (59%) of the 114 survivors have detailed follow up until school age. Their mean birth weight was 1139 grams and mean gestational age 30 weeks. Severe Intra Ventricular Hemorrhage occurred in 22%, severe ROP in 26% and Chronic Lung Disease in 29%. Mean Hospital stay was 92 days (range 40-300 days). Forty of the infants are girls. At 3 years of age developmental assessment could not be performed 7% due to severe neurologic injury; 49% of all infants were normal, 16% had minimal delay, 15% moderate delay and 12% had severe developmental delay. Severe Intra Ventricular Hemorrhage in the neonatal period had a strong association with severe developmental delay at 3 years of age. At school age, 24% of the infants are requiring special education and cannot function in normal schools. Of the infants with normal development at 3 years of age >90% are currently receiving adequate education and attending normal schools. On the contrary, all infants with severe delay at 3 years of age are requiring special education or are not able to receive instruction at all. In developing countries, parents, pediatricians and society as a whole need to be aware of the high risk for educational problems in these critically ill <1500 gram infants, particularly if they had suffered severe intra cranial hemorrhage and are found to be abnormal in earlier developmental assessments. Timely diagnosis and early intervention may improve outcome. As important, special programs need to be made available for all these infants with developmental disabilities that survive due to technological advances in NICU's.