The study was renewed in 1998 to continue follow-up of the cohort of 403 very low birth weight neonatal care survivors, born during August 1988-June1991. The time period of birth includes the approval dates for surfactant therapy. Hence, the first children to be treated with surfactant in general neonatal intensive care units (NICU) are now entering school age, providing an opportunity to evaluate school performance and to assess true chronicity of respiratory limitations. A large NICU and follow-up data base on the cohort contains extensive baseline assessment of respiratory disease, neonatal treatments and diagnoses, as well as functional assessment, health status and health care utilization at ages 4-6. The addition of data up to age 10 will confirm or dispute findings that functional outcome may be lower among children born after surfactant was released for marketing, and that the prevalence of long-term respiratory problems has remained the same. The new outcome data to be collected include school performance from school records and parent and teacher questionnaires, respiratory function by peak flow meters and respiratory symptoms and medications by parent interviews and questionnaires.