Thirty patients with neonatal acquired paraplegia without an identified cause were reviewed. The mean gestational age was 33 weeks (range, 25–40 weeks); the mean Apgar scores were 6 and 8 (range, 0–10); the mean weight at birth was 1.739 kg (range, 0.750–4.200 kg). Half of the infants needed neonatal intensive care for a mean period of 42 days. Fourteen (46%) had local or generalized infections, 12 (40%) had respiratory complications, and seven (22%) required mechanical ventilation. Seven (22%) had polycythemia, six (20%) had anemia, six (20%) underwent umbilical artery catheterization, and five (16%) received full exchange transfusion. Two clinical presentations were observed: flaccid (24 patients) and hypertonic (6 patients). The secondary deformities that were found and the orthopedic procedures to correct them are described. A vascular or intravascular change, such as thrombosis/embolism or ischemia/hypoxia by vasospasm or failure of autoregulation of spinal blood perfusion, is the final pathway of many events that may produce paraplegia in preterm and low birthweight neonates.