The sex, age, and cranial ultrasound (US) findings of 742 premature neonates evaluated over a 3-year period were reviewed retrospectively. Examinations were performed with a mechanical-sector real-time unit using a 5 MHz or 7.5 MHz transducer. The caudothalamic groove was carefully imaged with periventricular/intraventricular hemorrhage diagnosed by previously described criteria. Intracranial hemorrhage occurred in 44% of patients with 20% being Grade 1, 10% Grade 2, 7% Grade 3, and 7% Grade 4. All hemorrhages occurred during the first week of life. Computed tomography is superior to US for demonstrating parenchymal changes and extent of hypoxic damage. Based on our 3-year experience and a review of the literature, we propose an algorithm for cranial imaging of the preterm neonate. This ordered, sequential approach to the premature neonate with possible intracranial hemorrhage permits accurate initial diagnosis as well as appropriate follow-up for potential complications of ventricular dilatation, hydrocephalus, porencephaly, and hypoxic encephalomalacia.