Long-term sequelae of preterm birth have been studied extensively up until the age of 5 to 8 years. However, the cognitive development of adolescents born preterm has received limited attention. The objective of this study is to determine school performance in adolescents born very preterm. We have followed up a cohort of 484 infants born before 32 weeks of gestation in whom cranial ultrasound was routinely and systematically performed. School performance was assessed in the surviving adolescents at 14 years of age. The outcome variable divided the adolescents into three groups: (1) normal, (2) slow learners, and (3) special education. School performance data were obtained from 278 of 304 surviving adolescents; 129 performed normally, while 107 were slow learners, and 42 needed special education. From the unadjusted odds ratios for the need of special education by the various perinatal factors, only the odds ratio for periventricular-intraventricular hemorrhage was significantly associated (2.56, 95% confidence interval 1.17-4.86). Logistic regression analysis revealed that, after correction for possible confounding factors, the odds ratios for special education were significantly higher for adolescents with all grades of periventricular-intraventricular hemorrhage. Less than 50% of adolescents born before 32 weeks gestation perform normally in school. Periventricular- intraventricular hemorrhage, including the lower grades, does have an unfavorable additional effect on school performance. © 2004 Elsevier Inc. All rights reserved.