Although cerebral palsy is the most common neurologic impairment among very low-birth-weight survivors, its etiology remains uncertain. Current research supports the role of both antenatal and neonatal factors in the pathogenesis of cerebral palsy among these extremely premature infants. Important antenatal risk factors include chorioamnionitis and multiple placental lesions. Maternal preeclampsia may provide neuroprotection. The major neonatal risk factors include severe cranial ultrasound abnormalities, chronic lung disease, hyperbilirubinemia, and possibly hypothyroxinemia.