BACKGROUND: The aim of this study was to better understand the relationship between intraventricular hemorrhage and the risk of development of early lung disease in extremely low birth weight infants. We hypothesize that infants with severe intraventricular hemorrhage have higher respiratory severity scores than infants with mild/no intraventricular hemorrhage within the first 7 days of life. METHODS: This was a single center retrospective study conducted on subjects born between 01/01/2018 and 06/30/2021 at the University of Kentucky Children's Hospital NICU. We enrolled preterm infants with gestational age of less than 30 weeks and birth weight of less than 1000 grams who were placed on mechanical ventilation on admission. RESULTS: We found a clinically significant increasing trend of respiratory severity scores within the first week of life in the group of infants with severe intraventricular hemorrhage. CONCLUSION: This study is first to show that severe intraventricular hemorrhage is associated with higher respiratory severity scores predicting early lung injury in the extremely low birth weight infants placed on a mechanical ventilator within the first 7 days of life.