Objective:To study the risk factors of intraventricular hemorrhage in extremely preterm infants. Methods: We retrospectively evaluated 118 extremely preterm infants between 2016 and 2021. The association between risk factors and severe IVH was assessed by univariate and multivariate logistic regression analyses. Results: Univariate analysis revealed the following risk factors were associated with severe IVH in extremely preterm infants: smaller gestation age, lower Apgar score, lack of antenatal steroid administration, catecholamine administration, invasive respiratory support, pulmonary hemorrhage, high grade respiratory distress syndrome (RDS), hypotension, higher frequency of hyperglycemic episodes, multiple tracheal intubations and longer operation duration of venous catheterizations. In a multivariable logistic regression model, hypotension（OR=3.508，P =0.021）, higher frequency of hyperglycemic episodes（OR=5.333，P =0.022）, high grade RDS（OR=5.583，P =0.001）, multiple tracheal intubations（OR=4.566，P=0.006）, longer operation duration of venous catheterization（OR=4.207，P=0.040）remained statistically significantly associated with severe IVH. Conclusion: Hypotension, high grade RDS, multiple tracheal intubations, higher frequency of hyperglycemic episodes and longer operation duration of venous catheterization were strongly associated with higher risk of severe IVH in extremely preterm infants.