Aims and objectives: To explore the relationship between perinatal brain injury, visual motor function (VMF) and poor school outcome.Background: Little is known about the status and underlying mechanism of poor school outcome as experienced by low birth weight survivors.Design: This is a secondary data analysis.Methods: The parental study recruited 1,104 low birth weight (LBW) infants weighing below 2,000g from three medical centers of Central New Jersey between 1984 and 1987.Seven hundred and seventy-seven infants survived the neonatal period, andtheir developmental outcomes had been following up regularly until now.The development data of the survivors were used to achieve the research aims.Initial school outcome assessment was carried out in 9-year-old, using the WoodcockJohnson Academic Achievement Scale: The severity and range ofperinatal brain injury was determined by repeated neonatal cranial ultrasound results obtained at 4 hours, 24 hours and 7 days of life.Results: Seventeen and a half percent of the sample experienced poor school performances at age 9 as defined by lower than one standard deviation (SD) of average performance score.Children with the most severe injury, PL/VE, had the lowest mathematics (F =14.54, p =0.000) and reading (ANOVA results: F =11.56, p =0.000) performances.Visual motor function had a significant effect on childrens overall school performance (Hotellings trace value was 0.028, F =3.414, p =0.018),as well as subtest scores for reading (p =0.006) and mathematics (p =0.036).However, visual motor function was not a mediator in the association of perinatal brain injury and school outcome.Conclusions: Perinatal brain injury had a significant long-term effect on school outcome.Relevance to clinical practice: Low birth weight infants with history of perinatal brain injury need be closely monitored to substantially reduce the rates of poor school outcome and other neurodevelopmental disabilities.