The incidence, extent, and outcome of germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) were determined with the use of ultrasound and autopsy findings in 100 consecutive infants, with a birth weight of less than 1,500 g. Serial ultrasound examinations once or twice weekly were performed with the use of a portable real-time linear-array scanner. The overall incidence of GMH-IVH was 46%. Twenty infants had grade 1 (GMH), 24 had grade 2 (IVH +/- GMH), and two had grade 3 (IVH +/- GMH with intracerebral hemorrhage) conditions. The mortality in infants with GMH-IVH was 35%, compared with 13% in infants without GMH-IVH. Although 11 (37%) of 30 survivors with GMH-IVH had ventricular dilatation, only two infants required ventriculoperitoneal shunts for progressive hydrocephalus. The incidence of GMH-IVH was increased in outborn infants, in those delivered vaginally, and in those who required mechanical ventilation, bicarbonate therapy, or volume expansion in the first 24 hours. The long-term prognostic significance of the ultrasound findings was unknown and will be determined by follow-up studies.