Objective: Characterize the relationship between neonatal hyperglycemia and growth and body composition at 4 months corrected age (CA) in very low birth weight (VLBW) preterm infants. Study design: A prospective study of VLBW appropriate-for-gestation infants (N=53). All blood glucose measurements in the first 14 days and nutritional intake and illness markers until discharge were recorded. Standard anthropometrics and body composition via air displacement plethysmography were measured near term CA and 4 months CA. Relationships between hyperglycemia and anthropometrics and body composition were examined using multivariate linear regression. Results: Infants with >5 days of hyperglycemia were lighter (5345 vs 6455 g, P ≤ 0.001), shorter (57.9 vs 60.9 cm, P ≤ 0.01), had smaller occipital-frontal head circumference (39.4 vs 42.0 cm, P ≤ 0.05) and were leaner (percent body fat 15.0 vs 23.8, P ≤ 0.01) at 4 months CA than those who did not have hyperglycemia, including after correcting for nutritional and illness factors. Conclusions: Neonatal hyperglycemia in VLBW infants is associated with decreased body size and lower adiposity at 4 months CA independent of nutritional deficit, insulin use and illness. Downregulation of the growth hormone axis may be responsible. These changes may influence long-term growth and cognitive development.