Background and Objective: Periventricular-intraventricular hemorrhage (PIVH) is a common severe brain injury in premature infants that impairs neurological development. This study analyzed the incidence and risk factors of PIVH in extremely preterm infants to provide evidence for clinical prevention and control. Methods: A retrospective study was conducted on 390 extremely preterm infants admitted to the NICU of the Third Affiliated Hospital of Zhengzhou University from 2015 to 2023. They were grouped by PIVH occurrence, with relevant clinical indicators collected. Univariate analysis and logistic regression were used to identify PIVH risk factors. Results: The overall PIVH incidence was 48.5% (189/390), including 15.1% (59/390) severe (grade ? - ? )cases. Infants with gestational age (GA)