We have previously reported on outcome at 6, 12, 24 and 40 months as part of a longitudinal study of High Risk VLBW infants with chronic lung disease and/or Grade 3 or 4 IVH (HR)(N=42), Low Risk VLBW infants with acute respiratory disease and/or Grade 1 or 2 IVH (LR)(N=73) and Full Term controls(FT)(N=71). These results have shown HR failed to catch up as they show a slower rate of change in development compared to FT and LR and that LR have deficits in specific areas compared to FT. These results at 54 months further compare the groups to determine if these findings persist at an age which is more predictive of long term outcome as there are more sophisticated assessments with more demanding tasks. Measures used included the Standard Binet Intelligence Scale, the Vineland Adaptive Behavior Scale and measures of executive processing skills which demonstrate ability to formulate a strategy for problem solving. Group comparisons using ANOVAs with Tukey's Studentized Range Tests for Follow Up showed significance (p<0.05) for all Subtests of the Stanford Binet with the FT scoring higher than either HR or LR, LR scoring in the low normal range and HR scoring below the mean and significantly lower than the LR except in the Memory Subtest where HR and LR were both in the low normal range and did not differ. Daily Living Skills as measured by the Vineland showed a significant group effect (p<0.05) with FT functioning higher than either HR or LR and HR and LR differing from each other. The measures of executive processing skills showed FT different from HR, but not LR, and LR different from HR (p<0.05). These findings demonstrate the support the need to continue follow up even in the apparently low risk VLBW infant. This will become increasingly important as these children approach school age.(Funded by NICHD RO1-HD 25128)