A case-control study design was used to assess long-term educational outcomes of verty low birth weight preterm infants treated with surfactant and/or maternal betamethasone in relation to gestation. Cases comprised all singleton infants ≤28 weeks gestation who were born at one regional neonatal intensive care unit between 1983 and 1986 (N=132) participating in surfactant maternal betamethasone clinical trials. Mean Birth Weight was 895 g, Mean Gestational Age was 26.4 weeks with 42% minority, 34% on medicaid, 20% with maternal education less than high school and 62% with low SES. Controls comprised full-term infants (≥37 weeks gestation, N=219) matched by DOB, zip code, and health insurance status. Educational outcomes at ages 8-10 years included grade repetition, special education, and resource room services. Standardized interview and assessments included health and neurologic status, academic standing and psycho-educational evaluation. Unconditional logistic regression analyses (N=303) were performed to assess the relation between extreme prematurity (≤28 weeks gestation) and educational outcomes excluding 26 children with cerebral palsy, mental retardation, blindness, and/or deafness. Extremely premature infants had a significant increase in risk of grade repetition (OR=2.2, 95% CI=1.1-4.4), special education (OR=2.0; 95% CI=0.7-5.6) and school resource room (OR=3.1; 95% CI = 1.2-7.8). Nonwhite race (OR=2.6) and male gender (OR=2.0) were both significant risk factors for grade repetition (OR=2.6 and OR=2.0, respectively). We conclude that infants≤28 weeks gestation born in the surfactant-maternal corticosteroid era remain at risk for academic underachievement even when free of major disabilities. However, the magnitide of the biomedical risk is similar to social risk in predicting long term academic achievement.