To determine the incidence and to identify factors associated with the development of CVH, 84 infants delivered at the Hospital of the Univ. of PA. from 7/81-12/82 of birth weights between 500-1250 gms and who lived for at least 24 hrs were evaluated for CVH using a linear-array real-time ultra sound scanner. Twenty-four infants (28%) were identified as having CVH. Mild hemorrhage (Gr I or II) was noted in 17/84 infants while 7/84 infants had a Gr III or IV bleed so that 29% of bleeds were significant. The relation of CVH to gestational age & birth weight was examined: 15/40 (37%) infants of 25-28 wks gestation and 10/44 (23%) infants 29-32 wks gestation had CVH (p=NS); 13/39 (33%) infants 500-1000 gms and 11/45 (26%) infants 1001-1250 gms had CVH (p=NS). Perinatal factors such as PROM, antenatal dexamethasone, Apgar score, or mode of delivery did not affect the incidence of bleeding. However, 20/24 infants with CVH had premature labor (PML) while 29/60 infants without bleed had PML (p =<0.01). Postnatal factors such as severity of RDS, pneumothorax, hypernatremia, hypoxia, hypercarbia, or admission pH were not significantly different in the infants with CVH. In summary, the overall incidence of Gr III or IV CVH among inborn very low birth (VLBW) infants was 8% with the only significant association being with PML. In contrast to outborn VLBW infants where the incidence of CVH is as high as 60%, in the inborn VLBW infants, PML and intrapartum stress seem to be more important factors in the genesis of CVH because the availability of immediate neonatal resuscitation minimizes postnatal factors which may also be involved in the development of CVH.