Background: Cranial ultrasonography is an easily accessible, well-accepted, first-line imaging modality that is widely used to screen preterm and high-risk infants for brain injury in the neonatal period. The present study was undertaken to determine the frequency of cranial ultrasound abnormalities in neonates in the first week of life and study the association between abnormal cranial ultrasound findings in neonates with perinatal risk factors in regard to the immediate clinical outcome in the form of mortality. Method: A total 150 neonates of both the genders from day 0 to day 28 of life with perinatal risk factors who had undergone cranial USG in first week of life were included in the study. Cranial ultrasound of these neonates was done. The cranial ultrasound findings, other demographic parameters, perinatal risk factors, clinical status and immediate outcome were noted. Results: The frequency of cranial ultrasound abnormalities in neonates in the first week of life was 28%. Among subjects with abnormal findings, all were studied in 24 to 72 hrs. of life. Pregnancy induced hypertension (47.83%) and prelabour rupture of membranes (34.78%) was high among subjects with abnormal cranial findings. Germinal matrix haemorrhage (GMH) was high among subjects with abnormal cranial findings (61.9%) with observed high perinatal risk factor being prematurity with low birth weight (1.5-2kgs) (59.5%). Among 42(28%) abnormal neonates, 35 (83.3%) were recovered and 6(14.28%) were discharged on request/DAMA and 1(2.38%) had mortality. Conclusion: The study concludes that cranial ultrasonography is critical as an investigatory modality in NICU and effectively documents morphology of brain damage.