Eighty-one very low birth weight (VLBW) infants were followed for 3 years to assess the relative impact of intrauterine growth retardation on growth and development; 27 small for gestational age (SGA) infants were compared with 27 gestation-matched infants with appropriate size for gestational age (AGA) and 27 birth weight-matched AGA infants. It was hypothesized that growth and neurodevelopmental outcomes in SGA VLBW infants are poorer than those of AGA gestation-matched (AGA-GA) infants but do not differ from those of birth weight-matched (AGA-BW) control infants. Gestational ages of the SGA, AGA-GA, and AGA-BW infants were 29 +/- 2, 29 +/- 1, 26 +/- 2 weeks, and birth weights were 821 +/- 178, 1124 +/- 85, and 848 +/- 141 gm, respectively. The SGA infants did not differ from the AGA infants in neonatal course, but AGA weight-matched infants had lower Apgar scores and more days of assisted ventilation, and an increased incidence of bronchopulmonary dysplasia, intraventricular hemorrhage, and seizures. At 3 years of age the SGA VLBW infants had lower weight and height than both comparison groups (p < 0.05). Neurologic outcome in SGA infants did not differ from that in AGA-GA infants. The AGA-BW infants had an increased incidence of suspect or abnormal neurologic findings at 2 and 3 years of age (p < 0.05). The SGA infants scored lower on developmental tests at 1, 2, and 3 years than AGA-GA infants but had scores similar to those of the AGA-BW group. We conclude that intrauterine growth retardation in VLBW infants has a significant long-term impact on growth. Although 3-year development of SGA infants is significantly lower than that of gestation-matched control infants, it does not differ from that of weight-matched control infants.