The incidence of germinal matrix-intraventricular hemorrhages declined from 50% in 1977 to 24% in 1985. Over the last decade intraventricular hemorrhage rates ranging from 8% to 56% were reported, leaving uncertainty as to the direction of recent intraventricular hemorrhage trends. Records of all 1950 neonates weighing 2250 g or less at birth (867 weighing 1500 g or less and 1083 weighing 1501-2250 g) at a university neonatal intensive care unit between 1986 and 1995 were studied. Intraventricular hemorrhage rate declined by 53%, from 11.5% in 1986 to 5.5% in 1995 (P < .01), and was consistent across all birthweight groups: 750 g or less from 36% to 24%, 751-1000 g from 38% to 22%, 1001-1250 g from 19% to 13%, 1251-1500 g from 12% to 2% and 1551-2250 g from 3% to 0.2% (P < .05). Proportionately, severe intraventricular hemorrhage (grades 3 +/- intraparenchymal hemorrhage) declined from 70% of all intraventricular hemorrhages in 1986 to 23% in 1995 (P < .005). Overall mortality declined by 65% between 1986 and 1995 (P < .001), whereas mortality associated with intraventricular hemorrhage declined by 30% (P = .34). Despite dramatic declines in intraventricular hemorrhage rates, 21% of infants weighing less than 1000 g and 12% of those weighing less than 1500 g at birth were affected in 1995.