During a 14-month period, 112 consecutively born neonates with a birth weight between 1,501 and 2,000 g were screened by cranial ultrasonography. Nineteen patients (17%) had abnormal scans. Of these abnormalities, 14 (13%) were germinal matrix hemorrhage and/or intraventricular hemorrhage. Although the incidence of hemorrhage in these larger premature neonates is less than that which has been described in neonates with a birth weight less than 1,500 g, the severity of the hemorrhage, mortality (21%), morbidity, and outcome were similar to those seen in smaller neonates. More than half of the hemorrhages identified were severe, ie, grades III and IV. The clinical picture in these neonates was striking in that each suffered severe birth asphyxia and/or required ventilation shortly after birth. Therefore, screening all larger premature neonates is probably not warranted and selective screening will be adequate to identify those neonates who need intervention or would benefit from developmental follow-up.