Although Apgar scores as indicators of physiologic depression in newborns appeared to have limited value in predicting developmental outcome, they remain attractive indicators of risk status because they are obtained routinely in this country. Unfortunately, most follow-up studies of the relationship between Apgar scores and outcome have been generally of short duration. Thus the long-term predictive value of Apgar scores is not completely known. In this study 111 otherwise normal full-term infants with 5 minute Apgar scores of less than 7 were enrolled prospectively in a follow-up program. Approximately 13% died (2) or had significant developmental disabilities (12) identified by 30 months of age. Sixty-seven percent of the children with these poor outcomes had a history of neonatal seizures. The remainder received an extensive developmental evaluation at age 5. The mean performance on psychoeducational tests of children without a history of neonatal seizures did not differ from that of a comparison group, whereas the mean of children who experienced neonatal seizures was significantly lower. Thus, low Apgar scores warrant developmental surveillance during the early years of life but, if unaccompanied by neonatal seizures, do not appear to predict more subtle developmental dysfunction evident at school entry age. However, seizures remain an ominous sign for significant early and late developmental sequelae.