Objective:To determine if metabolite ratios at near-term age predict outcome in very low birth weight preterm infants at 18 to 24 months adjusted age.Study Design:Thirty-six infants (birth weight ⩽1510 g, gestational age ⩽32 weeks) were scanned at a postmenstrual age (PMA) of 35 to 43 weeks from July 2001 to September 2003. Multivoxel proton spectroscopic data were acquired and metabolite ratios were calculated in regions of the thalamus and basal ganglia. Bayley Scales of Infant Development were assessed between 18 and 24 months corrected age.Result:Metabolic ratios showed no significant correlation with developmental outcome. A correlation was seen between N-acetylaspartate (NAA)/choline (Ch) and PMA in thalamus and basal ganglia.Conclusion:Metabolite ratios from near-term proton magnetic resonance spectroscopy (MRS) were not predictive of Bayley scores at 18 to 24 months adjusted age. There was a positive correlation between NAA/Ch and PMA, which supports previous work by others for the importance of developmental changes in the MRS with age.