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Objective: To identify perinatal risk and protective factors for peri-intraventricular hemorrhage (PIVH) in 214 very low birth weight (VLBW) infants., Method: Perinatal risk and protective factors for PIVH were examined by univariate analysis and by multivariate logistic regression analysis that adjusted simultaneously for the effects of year of birth and perinatal characteristics. Because mode of delivery and antenatal use of steroid represent the only factors, among those considered, that could in most cases be controlled by the clinician, we calculated for each of the four combinations the relative risk of PIVH., Results: By univariate analysis, antenatal steroid administration, cesarean section delivery, increasing birth weight and increasing gestational age were protective perinatal factors. By using logistic regression, significant protective factors against PIVH included a complete course of antenatal steroid therapy and increasing gestational age. Intrauterine growth retardation was associated with an increased risk of PIVH. The relative risk of intraventricular hemorrhage for each of the four combination of mode of delivery and antenatal steroid exposure demonstrate that antenatal steroid exposure and cesarean section delivery are most protective with a relative risk of 14% compared with vaginal delivery and no antenatal steroid exposure., Conclusions: Association of antenatal steroid administration with cesarean section delivery has an important role in lowering the risk of PIVH in VLBW infants.