Background: Extra Uterine Growth Restriction (EUGR) is an important problem in preterm infants because their developmental and metabolic processes are not fully developed. EUGR which is failure to grow appropriately after birth is associated with such later adverse consequences as developmental impairments and health problems. Objectives: This study is to identify the incidence of EUGR in premature infants and determining the risk factors that lead to it based on assessment done after 4 weeks of follow up at the Neonatology Unit of CMH Rawalpindi. Study design: A prospective study. Palace and duration of study: Department of Neonatology CMH Rawalpindi from March 2024 to Jan 2024 Methods: Out on 150 preterm infants of gestational age of less than 37 weeks in CMH Rawalpindi. Growth parameters were taken at birth and thereafter at 2 and 4 weeks of age. EUGR was defined as weight below tenth percentile for corrected gestational age at four weeks. Regression analysis was then performed in order to determine the variables affecting EUGR. Results: Among 150 preterm infants, 52 (34. 7%) infants were observed to have EUGR at 4 weeks of post birth. The incidence of bronchopulmonary dysplasia in premature babies was higher than in full-term babies, and was significantly higher in infants with low birth weight (< 1500g) (p = 0. 02, SD = 2. 8). Sepsis was also found to predict EUGR with the probability of 0. 03. Exclusive breast feeding was found to have a lower rate of EUGR compared to infants fed with formulas with the difference being statistically significant at p = 0. 04.