Pulmonary haemorrhage (PH) in a sick neonate is a life-threatening complication and is often associated with a high mortality. It is now often seen in extreme preterm and very low birth weight infants who are growth restricted and have received surfactant with significant respiratory distress syndrome. The mainstay of treatment includes ventilation and vigorous resuscitation of a shocked and critically ill infant. This review aims to give an overview of the pathogenesis, aetiology and management of PH in a neonate.