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Background: The addition of budesonide to surfactant in very-low-birth-weight infants with less severe RDS decreased bronchopulmonary dysplasia (BPD) severity. Long-term neurodevelopmental follow-up was needed to monitor for systemic effects of budesonide. Methods: Infants ≤1250 g who received intratracheal budesonide (0.25 mg/kg) with surfactant (n= 173) were compared to a historical cohort who received surfactant alone (n= 294). Peabody Developmental Motor Scales II at 4–6 months corrected age and Bayley Scales of Infant & Toddler Development III at 18–22 months corrected age were compared. Results: There were no differences in muscle tone or motor skills by Peabody exam. There were no differences in the cognitive, language, or motor domains between cohorts on Bayley III. Conclusions: In a cohort of infants treated with budesonide mixed with surfactant, there were no differences in developmental outcomes at 4–6 months or 18–22 months corrected age.