In the mid 1980's, when the reported incidence of intraventricular hemorrhage (IVH) was as high as 40%, it became our routine to obtain HUS between days 3 & 7 of life for all infants with birth weights < 1500g. If IVH was diagnosed, weekly HUS were obtained until the IVH was“stable”. Even if IVH was not diagnosed, all infants received an additional HUS at 30 days to rule out periventricular leukomalacia (PVL). In this retrospective study, we reviewed 4 years experience (10/91 to 10/95) with HUS screening, aware of the recent reports of declining incidence of IVH in this population, as well as the demands by “managed care” to reduce costs yet maintain quality of care. 217 infants (209 or 96% inborn) were admitted during this period with a birth weight of < 1500g. Initial HUS were done at a mean of 5.9 ± 2.7 (SD) days of life. A total of 512 HUS were performed at a cost of $157,696 (average cost $725/infant). There were 35 cases of IVH (incidence of 16.1%, cost $4505/diagnosis) and 4 diagnoses of PVL (incidence 1.8%). 17/35 IVH were Gr I (Papile), 5/35 Gr II, 8/35 Gr III, and 5/35 Gr IV. Thus, 204 (94%) of the infants screened had either Gr I/II or no IVH. In reviewing this data, our aim was to develop criteria to decrease the number of routine HUS obtained with negative or insignificant clinical results. Of the 8 infants who expired with IVH, 4 had only a single HUS. In 29/31 of the remaining cases where a diagnosis of IVH was made on the initial HUS and followup HUS were obtained, the grading of the IVH did not change on any subsequent HUS on the same infant. In 2 infants, however, where HUS was negative on days 3 & 6, Gr III and Gr II IVH respectively were diagnosed at 30 days. Three infants (GR III IVH with progressive hydrocephalus) required neurosurgical intervention. 2/5 infants with Grade IV IVH survived. If during this period, HUS had been performed only on infants with birthweight of < 1250 g, the population screened would have decreased to 143 infants. 4 patients with Gr I and one with Gr II IVH would have been missed. (4/5 of these patients were ventilated and 2/5 had significant hypotension.) However, no cases of Gr III/IV IVH or PVL would have gone undiagnosed. By limiting routine HUS screening to infants < 1250g at birth, following up cases of GrI/II IVH only at 30 days, and repeating HUS on GrIII/IV IVH only every 2 weeks, the number of HUS obtained during this period would have been decreased from 512 to 206 (50% decrease). This would have saved $78,848 and lowered the cost per diagnosis of IVH from $4505 to $2719($12130 to $6065 for GrIII/ IV IVH) for infants less < 1500g at birth without reducing quality of care.