Background: The incidence of cerebral white matter damage reported to the Aust ralian and New Zealand Neonatal Network (ANZNN) varies between neonatal intensiv e care units (NICUs). Hypothesis: Differences in the capture, storage, and inter pretation of the cerebral ultrasound scans could account for some of this variation. Methods: A total of 255 infants of birth weight < 1500 g and gestation < 32 weeks born between 1997 and 2002 and drawn equally from each of the six NICUs i n New Zealand were randomly selected from the ANZNN database. Half had early cerebral ultrasound scans previously reported to ANZNN as normal, and half had scan s reported as abnormal. The original scans were copied, anonymised, and independ ently read by a panel of three experts using a standardised method of reviewing and reporting. Results: There was considerable variation between NICUs in method s of image capture, quality, and completeness of the scans. There was only moder ate agreement between the reviewers’reports and the original reports to the ANZ NN (κ0.45-0.51) and between the reviewers (κ0.54-0.64). The reviewers report ed three to six times more white matter damage than had been reported to the ANZ NN. Conclusion: Some of the reported variation in white matter damage between NI CUs may be due to differences in capture and interpretation of cerebral ultrasou nd scans. Background: The incidence of cerebral white matter damage reported to the Australian and New Zealand Neonatal Network (ANZNN) varies between neonatal intensiv e care units (NICUs). Hypothesis: Differences in the capture, storage, and inter pretation of the cerebral ultrasound scans Methods: A total of 255 infants of birth weight <1500 g and gestation <32 weeks born between 1997 and 2002 and drawn equally from each of the six NICUs in New Zealand were randomly selected from the ANZNN database Half had early cerebral ultrasound scans previously reported to ANZNN as normal, and half had scan s reported as abnormal. Results: There was variations variation between NICUs in method s of image capture, quality, and completeness of the scans. There was only moder ate agreement between the reviewer s’reports and the original reports to the ANZ NN (κ0.45-0.51) and between the reviewers (κ0.54-0.64). The reviewers report ed three to six times more white matter damage than had been reported to the ANZ NN . Conclusion: Some of the reported variation in white matter damage between NI CUs may be due to differences in capture and interpretation of cerebral ultrasou nd scans.