Transfontanelle ultrasound scans were performed on 93 very low birth weight neonates admitted at the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria, between January 1992 and April 1994, to ascertain the pattern and determinants of intraventricular haemorrhage and periventricular leukomalacia. Forty-seven percent of the infants had normal ultrasound; 22% had mild intraventricular haemorrhage (IVH), 7.5% had moderate to severe IVH and 23% had periventricular leukomalacia (PVL) and a 3.5 fold increase in IVH. Infants with apgar scores < or = 3 at 5 minutes had a 6-fold increase in IVH and 2-fold increase in PVL. There was no association with birth weight, gestational age, respiratory distress and place of delivery. Our study suggests that antepartum events proximate to delivery and the immediate post partum events play significant roles in the development of IVH and PVL in this population. Improvement in antenatal, labour and delivery, and immediate newborn care; including provision of basic resuscitation equipment and skills to midwives in the rural maternity centers will reduce the incidence and severity of IVH and PVL.