Background. Preterm very low birthweight (VLBW) infants remain a challenge worldwide. Local information on factors associated with mortality of VLBW infant is lacking. Objective. To identify the factors associated with the mortality of preterm VLBW infants at a tertiary hospital in Limpopo Province, South Africa. Methods. A retrospective study was undertaken between January and July 2015 at the neonatal intensive care unit (NICU). The medical records of mothers and their babies were retrieved and reviewed. Maternal data used were age, parity, use of antenatal corticosteroids, HIV status, mode of delivery and maternal morbidity. Neonatal data included gender, birthweight, gestational age, Apgar score, resuscitation in delivery, length of stay in NICU, morbidity and treatment. Data obtained were analysed using STATA version 10.0. Results. A total of 252 preterm VLBW infant-and-mother pairs were included in the study. The VLBW infant survival rate was 77.4%. Use of antenatal corticosteroids, spontaneous preterm labour, birthweight and gestational age, Apgar score <6 at 1 minute, resuscitation in delivery room, length of stay in the NICU, prematurity-related problems, sepsis, pulmonary haemorrhage, hypothermia, jaundice, and nasal continuous positive airway pressure (NCPAP) with surfactant and mechanical ventilation with or without surfactant were significantly associated with infants’ outcomes. Conclusion. The survival rate of preterm VLBW infants in this rural tertiary hospital was relatively high but could be further increased by prompt administration of surfactant and mechanical ventilation with or without surfactant.