Abstract Abstract Background: Intraventricular haemorrhage and periventricular leukomalacia are associated with poor outcome of very preterm infants, while the role of more subtle cerebral alterations, as detected by cranial ultrasound, is less clear. Aim: In this study, we related periventricular echodensities and signs of brain atrophy to neurodevelopmental outcome at 3 y of age. Patients and methods: All preterm infants born in 1997 in our institution with a gestational age < 32 wk or birthweight < 1500 g were subjected to repeated standardized cranial ultrasound examinations until discharge. Survivors were examined at 3 y of age employing the Bayley Scales of Infant Development II. Results: Eighty-seven infants were enrolled (birthweight 430-2500 g (median 1200 g), gestational age 24-34 wk (median 29 wk)). Periventricular echodensities were detected in 42 infants (48%); in 12 cases persisting < 7 d, in 30 cases > 7 d. At discharge, 18 infants (22%) had signs of brain atrophy. Neurodevelopmental outcome was assessed in 64 infants. Infants with signs of brain atrophy scored significantly lower on MDI (atrophy 91.8, no atrophy 101.9; P = 0.02), PDI (atrophy 91.4, no atrophy 106.5; P = 0.001) and Behaviour Rating Scale (atrophy 41.1, no atrophy 66.4; P = 0.01) than infants without atrophy. Periventricular echodensities were not related to outcome. Conclusion: Our data show that infants with sonographic signs of brain atrophy at discharge achieve lower scores in neurodevelopmental testing at 3 y. Abstract Abstract Background: Intraventricular haemorrhage and periventricular leukomalacia are associated with poor outcome of very preterm infants, while the role of more subtle cerebral alterations, as detected by cranial ultrasound, is less clear. Aim: In this study, we related periventricular echodensities and signs of brain atrophy to neurodevelopmental outcome at 3 y of age. Patients and methods: All preterm infants born in 1997 in our institution with a gestational age <32 wk or birthweight <1500 g were subjected to repeated standardized cranial ultrasound examinations until discharge. Survivors were examined at 3 y of age employing the Bayley Scales of Infant Development II. Results: Eighty-seven infants were enrolled (birthweight 430-2500 g (median 1200 g), gestational age 24-34 wk (median 29 wk)). Periventricular echodensities were detected in 42 infants (48%); in 12 cases persisting <7 d, in 30 cases> 7 d. At discharge, 18 infants (22%) had signs of brain atrophy. Neuro Developmental outcome was assessed in 64 infants. Infants with signs of brain atrophy scored significantly lower on MDI (atrophy 91.8, no atrophy 101.9; P = 0.02), PDI (atrophy 91.4, no atrophy 106.5; Atrophy 41.1, no atrophy 66.4; P = 0.01) than infants without atrophy. Peridytricular echodensities were not related to outcome. Conclusion: Our data show that infants with sonographic signs of brain atrophy at discharge achieve lower scores in neurodevelopmental testing at 3 y.