Background: Birth weight is an important indicator of the health and viability of new-borns. Reducing premature birth rates is one of the major challenges in public health. Worldwide, a growing trend is being observed in premature births. Objective: To analyse the survival and perinatal risk factors of early neonatal death in very low birth weight (VLBW) new-borns (500–1499 g). Materials and methods: A retrospective cohort study (2000–2010) was used to analyse data from the Medical Birth Register. In total, data on 1,460 singletons were analysed. This study examined and compared the perinatal risk factors of two groups: live births and deaths within the neonatal period. Results: Odds of surviving increased from 1.6 in the infants with the extremely low birth weight (ELBW) (≤ 999 g) to 2.5 times in the VLBW infants (≤ 1499 g). The variables significantly associated with new-born mortality were congenital abnormalities (ORadj=7.8), birth weight (ORadj=3.4) and placental abruption (ORadj=2.1) and Apgar score ≤ 6 at 5 min (ORadj=2.1). Conclusion: The neonatal mortality risk was significantly higher in the cases of neonatal birth weight ≤ 1000 g, gestational age up to the 31st GW, Apgar score of 6 points at fifth min, congenital abnormalities and placental abruption.