Objective <p>To assess the cognitive and behavioral outcomes of very low birth weight (VLBW) as compared to normal birth weight (NBW) neonates in middle childhood.</p> Methods <p>In this observational study, the first 50 VLBW (≤ 1250&#xa0;g) children from an original cohort of 2009–2011, who agreed to participate, and 50 age and sex-matched NBW children were assessed at 6–11&#xa0;years age. Cognitive function, behavior, psychopathology, self-concept, adjustment and memory parameters were assessed by a certified psychologist using Malin's Intelligence Scale for Indian Children (MISIC), Childhood Psychopathology Measurement Schedule, Children’s Self-concept Scale, Preadolescent Adjustment Inventory, and PGI Memory Scale for Children (PGIMC), respectively.</p> Results <p>Compared to NBW, the VLBW children had significantly lower Verbal Intelligence Quotient (IQ) (<i>P</i> = 0.008), Performance IQ (<i>P</i> &lt; 0.001), and Full-Scale IQ (FSIQ) (<i>P</i> &lt; 0.001). VLBW cohort had significantly lower scores in remote memory (<i>P</i> &lt; 0.001), mental balance (<i>P</i> = 0.001), attention (<i>P</i> = 0.005), visual retention (<i>P</i> &lt; 0.001), and recognition (<i>P</i> = 0.003). VLBW cohort exhibited significantly higher scores on psychopathology (<i>P</i> = 0.036), anxiety (<i>P&#xa0;</i>= 0.034), significantly lower self-concept (<i>P</i> &lt; 0.001) and adjustment scores (<i>P</i> &lt; 0.001) than NBW.</p> Conclusions <p>VLBW children have significant cognitive, behavioral and adjustment issues as compared to NBW children.</p>