The quality of life for infants born at term who suffer undesired perinatal events is directly related to the presence and severity of neurologic and developmental abnormalities. However, there are no accurate tools to predict early which infants with low Apgar score will have what degree of long term abnormalities. Therefore it is unclear which infants need to be closely followed in specialized infant's progress clinics in order to detect abnormalities early while at the same time specialized resources are used optimally. In our Section of Neurological Development we performed a longitudinal, prospective and multidisciplinary study to answer this question. All term infants born between 1/1989 and 12/1991 with Apgar score <7 at five minutes were entered to the study at the time of birth. Soon after birth all 86 infants had a detailed neurological exam, an electro-encephalogram(EEG) and a head ultrasound. Detailed neurological exam was repeated at the end of the first week of life. All infants have now been followed for 6 years at regular intervals after discharge. In each visit a detailed neurological exam is performed together with developmental assessment using appropriate tools for different postnatal ages. Brain stem and visual evoked potentials are performed in all infants at least on two occasions and repeated as clinically indicated. In 55% of the infants there are persisting mild neuro-developmental abnormalities, 11.6% have moderate to severe abnormalities and 33.4% are normal. Of the infants who did not show hypoxic-ischemic encephalopathy (HIE) at birth, 44% are normal, compared to 24% of the infants who did show clinical signs of HIE. Moderate to severe abnormalities occurred much more frequently (21%) in children who had clinical HIE at birth than in those with no HIE (2%). Neurological exam at the end of the first week of life and EEG findings had similar predictive values. The best sensitivity for long term abnormalities was provided by initial neurological exam. The highest specificity and best positive predictive value was achieved by the combination of HIE, neuroexam at one week and EEG. The negative predictive value was low for all of the factors evaluated whether they were considered independently or in combination. The absence of HIE at birth, independent of how low was the Apgar score, predicts good long term outcome and would suggest no need for close follow-up in specialized “Infant Progress Clinics” unless the exam at 7 days of age and EEG are abnormal. In these infants, close follow up should be provided at least until school age.