Background: Neurosonogram (NSG) has become an essential diagnostic tool in modernneonatology for depicting normal anatomy and pathological changes in neonatal brain.It is easy to perform, non-invasive and can be initiated at a very early stage, even immediately after birth. Any neonate, regardless of birth weight or gestational age, who has a greater than average chance of morbidity or mortality, due to fetal, maternal or placental anomalies or an otherwise compromised pregnancy, especially within the first 28 days of life is categorized as high risk neonate. NSG provides bedside imaging access to the neonatal brain, reliable tool for detecting congenital and acquired abnormalities of the perinatal brain and most frequent patterns of brain injury in preterm and term neonate. Objectives: To find out incidence of NSG abnormalities in high risk neonates, to study various intracranial findings and correlate them with clinical neurological examination, to follow up high risk neonates till 6 months of age for their neurodevelopmental outcome. Materials and Methods: The present one year prospective analytical study was conducted at ASRAM Hospital, Eluru during the period of March 2023 to March 2024 among 60 high risk neonates. After taking the informed written consent from the Parent or Guardian, the relevant information regarding pregnancy, delivery were collected from the parents and the newborn details recorded in a predesigned proforma. A neurological examination is done to detect neurological deficits and tone abnormalities. Tone, reflexes, anthropometry, seizures, feeding difficulties were noted at the time of discharge. These babies were assessed at 3 and 6 months of age in the outpatient department. At each follow-up, tone assessed by Amiel -Tison angles at 3 and 6 months of age, detailed developmental milestones and occipitofrontal circumference (OFC) were assessed, hearing and vision tested clinically, seizures during follow up and use of antiepileptic drugs. Results: In the present study, incidence of NSG abnormalities in high risk neonates is 30% in which the mostcommon finding is Intracranial hemorrhage (ICH) and next common is periventricular hyperechogenecity and Cerebral edema. On regular follow up of these high risk newborns at 3 months and 6 months of age, 8 infants were developmentally delayed out of 60 high risk infants. Interpretation and conclusion: NSG is critical as a investigatory modality in NICU and effectively documents morphology of brain damage and on regular follow ups, we can intervene early and limits the complications.