Purpose : The present trial was designed to determine whether fewer position changes during surfactant instillation may reduce the risk of intraventricular hemorrhage (IVH) in very low birth weight infants (VLBWI). Methods : The medical records of VLBWI who were treated with surfactant from 2009 to 2011 at the Neonatal Intensive Care Units of Seoul St. Mary’s hospital was reviewed. The patients were grouped by the how many position they took during surfactant administration; 5 positions or 3 positions. Results : The baseline characteristics and respiratory status were similar in both groups. The incidence of severe IVH within 7 days after birth was 26.9% in 5 positions and 6.5% in 3 positions group ( P=0.040). Logistic regression analysis demonstrated surfactant position was an independent predictor of severe IVH within 7 days after birth ( P=0.043; odds ratio 5.778; 95% confidence interval 1.055-31.662). The rate of bronchopulmonary dysplasia (56.2% vs. 82.9%, P=0.013) and patant ductus arteriosus (51.6% vs. 785.0%, P=0.023) were higher in the 3 positions group, but logistic regression analysis showed no statistical significance. Conclusion : Three rather than 5 position changes during surfactant treatment may reduce the risk of severe IVH days within a few days after birth.