Abstract. Background: Intraventricular hemorrhage (IVH) is the most common neurological injury in preterm infants; it is a signiﬁcant cause of morbidity and mortality in these neonates. Serum activin A is a growth factor that has been shown to be expressed in the brain, among other places; it is produced by the placenta. Increased concentrations in the umbilical cord are characteristic of certain pregnancy disorders. Objective: To evaluate the use of serum activin A concentration, measured on the ﬁrst day of life, as a predictor for the development of intraventricular hemorrhage in preterm neonates. Methods: This study was conducted on 44 preterm infants with gestational ages less than 34 weeks. A transcranial ultrasound was performed for each preterm within the ﬁrst 48 hours and at one week of life. Neonates who developed IVH were considered the case group and those who did not develop IVH were considered the control group. Serum activin A (g/L) was assessed for all preterm infants within the ﬁrst 24 hours of life. Results: Cases had greater serum activin A concentration (median = 2.8, I.Q=2.55–3.57) compared to control group (median = 0.8, I.Q = 0.5–1.27, p < 0.001). There was a positive correlation between serum activin A concentration and IVH grading (r = 0.08, p < 0.001). There was no signiﬁcant correlation between serum activin A concentration and gestational age or birth weight. Serum activin A cutoff value 2 g/L could differentiate preterm with IVH from preterm without IVH. Conclusion: Serum activin A concentration could be a useful predictor for intraventricular hemorrhage in preterm infants.