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Background Antenatal and neonatal viral exposure may put the developing brain at risk for abnormal neurodevelopment. A clinical follow-up program was created in the Congenital Infection Program at Children’s National Hospital to follow infants with in utero or early life exposure to SARS-CoV-2. The aim of this study was to determine if infants with early SARS-CoV-2 exposure have abnormal neurodevelopment in infancy. Methods We performed a retrospective review of all infants evaluated in the follow-up program between 3/2020 – 11/2021. Demographic details, SARS-CoV-2 infection/testing data, pregnancy/birth data, and specialty consult and NICU records were extracted from infants’ medical charts. Infants were divided into 3 SARS-CoV-2 exposure groups: 1) antenatal exposure to symptomatic mother, 2) antenatal exposure to asymptomatic mother, 3) neonatal infection. All infants received a neurologic exam and developmental screening with the Ages and Stages Questionnaire (ASQ) in 5 domains (Communication, Gross Motor, Fine Motor, Problem Solving, Personal-Social) during their evaluation. The ASQ accounts for prematurity. Outcomes of interest were an abnormal neurologic exam or ASQ scores close to or below suggested cut-offs. Multivariate analysis was used to study correlations between exposure group and neurodevelopmental outcomes. Results Thirty-five infants were seen for up to 3 outpatient visits. Most infants (83%) were exposed in utero – 16 to symptomatic mothers (Group 1) and 12 to asymptomatic mothers (Group 2); 1 chart did not have symptom data. Six were exposed only as a neonate (Group 3). Group 1 had abnormal neurologic exams at mean (SD) age 112 (24) days (Table 1) and ASQ scores close to or below cut-offs for all domains (Fig. 1) more frequently than Groups 2 or 3. Group 1 was more likely to score below any ASQ cutoff compared to Group 2 (P=.04); of the 5 domains, differences were significant for Fine Motor (P=.01) and Personal-Social (P=.02). Conclusion Early SARS-CoV-2 exposure may impact infant development, especially among those exposed in utero to a symptomatic mother. Vaccination and other precautions to reduce spread and symptoms may protect against early neurodevelopmental delays. Future work should prioritize longitudinal follow-up of children with early SARS-CoV-2 exposure. Disclosures All Authors: No reported disclosures.