Top of pageAbstract Little has been published about circulating nucleated red blood cells (NRBC) in very low birth weight (VLBW) infants. We saw marked erythroblastosis (increased NRBC) in several infants with severe IUGR who were also VLBW. Hence, we evaluated the NRBC of all VLBW infants admitted to our intensive care nursery in 1983-86. There were 361 Infants with birthweight <1500 g admitted in the first 24 hours after birth, but 31 died before studies were obtained. Of the remainder 278 were appropriate (AGA) and 52 small for gestational age (SGA). NRBC were significantly* increased in SGA infants compared to AGA infants. In AGA infants, marked increase in NRBC was associated with extreme prematurity and bacterial infection. Findings in SGA infants are consistent with recent observations demonstrating erythroblastosis in blood from fetuses with IUGR (using “cordocentesis”), in whom the severity of hypoxla was correlated with the increase in NRBC. Abnormally increased NRBC at birth in VLBW infants with IUGR may indicate chronic intra-uterine hypoxemia and predict infants at risk of neonatal complications (e.g. NEC).