Background: Sonography of the brain is an integral part of care in the neonate, particulary among high-risk premature infants. Current ultrasound technology allows for rapid evaluation of infants in the intensive care nursery with virtually no risk.Objective: The aim of this study is to evaluate the need for screening cranial ultrasound and follow up in high risk neonate. Methods: In present Prospective Cohort study we evaluated 60 Egyptian NICU admitted high risk neonates for history taking, examination, laboratory investigation and ultrasound examination. History taking including maternal medical history, consanguinity, gestational age, mode of delivery, jaundice and convulsions. Examination includes general and systemic examinations for: the birth weight, gestational age, neonatal reflexes (e.g. Moro's and suckling reflexes), thorough neurological examination. Laboratory investigation as part of routine work in the unit. Trancranial ultrasound done through the anterior fontanels during the first week of admission and after one month. Results: Significant relationships were detected between gestational age(p value=0.049), neurological findings(p value=0.005) and the routine cranial uitrasound, and between the follow up ultrasound (p value<0.001)with the routine cranial ultrasound findings.Conclusion: Routine cranial ultrasound should be done to all NICU admitted patients and those with abnormal findings should be under close monitoring and follow up.