Enhanced survival of very premature infants may be regarded as the most striking demonstration of the major improvements in perinatal medicine during the last two decades. This article discusses recent perinatal interventions in the context of the pathogenesis and know risk factors for intraventricular hemorrhage (IVH). In addition, controversies related to the evolution and management of posthemorrhagic hyrdocephalus (PHH) are examined, and current concepts concerning potential brain injury to PHH are reviewed.