Objectives: To determine risk factors associated with adverse developmental outcome at 5 years in extremely low birth weight infants or extremely premature infants (<28 weeks) with normal neonatal cranial ultrasounds. Design/methods: Data were collected prospectively on 152 infants with gestation <28 weeks or birth-weight <1000 g. Infants were grouped into those with normal development, mild-to-moderate impairment (IQ 70 to 84, or hearing loss 30 to 89 dB, visual acuity 6/18 to 6/60, or mild /moderate cerebral palsy (CP)) and severe impairment (IQ <70. hearing, loss ≥90 dB, visual acuity <6/60, or severe CP). Results: Five-year outcomes were available for 144/152 children (95%). In all, 89 (62%) infants had normal development, 39 (27%) had mild-moderate impairment and 16 (11%) had severe impairment. On multivariate logistic regression analysis, factors associated with developmental impairment were serum bilirubin ≥200 μmol/l (odds ratio (OR) - 4.06, p=0.003) and retinopathy of prematurity (ROP) (OR- 1.6, p = 0.03). Conclusions: A serum bilirubin ≥200 μmol/l and presence of ROP are postnatal risk factors associated with an adverse developmental outcome in infants with normal cranial ultrasounds.