Inclusion Criteria:  Newborns with very low birth weight (≤1500 g) or ≤ 32 weeks gestation who were admitted to neonatal intensive care unit in the first day of life.  Exclusion Criteria:  Newborns (more than 32 weeks of gestation Newborns with birth weight more than 1500 g. Newborns with congenital heart diseases excluding (patent ductus arteriosus and patent foramen ovale) Newborns with major congenital malformations. Newborns with birth trauma especially basal skull/temporal bone fractures that require hospitalization