An association between necrotizing enterocolitis (NEC) and poor neurodevelopmental outcome is increasingly recognized. A progression of preexisting intraventricular hemorrhage (IVH) or new IVH during an episode of NEC may be contributory. We investigated the incidence of IVH in infants with NEC. We performed an observational study of 105 infants with acute NEC during a 3-year period. Cranial ultrasound scans were performed on admission, following surgery, and following periods of clinical instability. Median birth weight was 0.92 kg (interquartile range, 0.73 to 1.56), gestational age 27 weeks (interquartile range, 25 to 30), and age at admission 14 days (interquartile range, 6 to 32). Twenty-five infants had an IVH before developing NEC. Eighty-one had Bell stage III disease, and 84 required surgery. Four infants developed a new IVH during the episode of NEC and all four died. IVH during an episode of NEC is rare even in very sick babies but carries a poor prognosis. IVH during an episode of NEC is unlikely to account for the poor neurodevelopmental outcome in this group as a whole.