Vacuum extraction significantly reduces perinatal morbidity/mortality. Increased occurrence of intracranial hemorrhage has been associated with vacuum extraction and is multifactorial; a causative effect is not assumed. Long-term developmental outcome data in this specific subpopulation are lacking and may differ from non-vacuum extraction-associated intracranial hemorrhage. Long-term follow-up of children with symptomatic vacuum extraction-associated intracranial hemorrhage was retrospectively analyzed using Bayley Scales of Infant Development. Twenty-five newborns were identified with symptomatic intracranial hemorrhage after vacuum extraction. Motor development was severely impaired in 4 children (16%, Bayley Scale score <55), moderately impaired in 5 children (20%, Bayley Scale score 55-69) and mildly impaired in 2 children (8%, Bayley Scale score 70-84). Mental development was severely impaired in 2 children (8%), moderately impaired in 3 children (12%) and mildly impaired in 5 children (20%). Impaired outcome was associated with parenchymal injury and seems to be a higher reported outcome in non-vacuum extraction-associated intracranial hemorrhage. The high prevalence of impaired development in symptomatic vacuum extraction-associated intracranial hemorrhage necessitates long-term follow-up.