Background: Our program of research focuses on thermal and circulatory stability in extremely premature infants. In prior studies, we found that infants have long periods of time in which foot temperature (FT) is higher than central temperature. We thus wanted to determine whether blood flow in the foot is increased when FT is elevated. Perfusion index (PI) can be used as a clinical indicator of peripheral perfusion, but reports on use of PI in premature infants are lacking. We employed exploratory methodology to examine foot perfusion and temperature in very low birth weight infants. Aims: For premature infants after birth: (1) describe foot PI values for the first 2 weeks of life and (2) describe the relationship of longitudinal FT and PI. Study Design: Case study design with longitudinal FT and PI in 17 infants born at <29 weeks’ gestation with birth weight < 1,200 g for 2 weeks after birth. Results: Infants averaged 851 g at birth and were 24–29 weeks’ gestational age. The mean PI across all infants for 14 days was 1.04, SD 1⁄4 0.79. Using a repeated measures multilevel model approach confirmed that FT and PI were positively related in these infants. Conclusions: These findings demonstrate that perfusion is increased in the periphery in extremely premature infants when FT is increased. PI measures can be used as a trend for peripheral perfusion, and these values increase over the first 2 weeks of life in infants weighing more than 750 g.