Background: About 45% of deaths among under-fives occur during the neonatal period with a high contribution from preterm infant deaths. Regular evaluation of preterm deaths is important as patterns and therefore intervention may vary at different times and places. Objectives: To determine the common causes of illness and death among preterm infants admitted to the Special Care Baby Unit (SCBU) of the University of Port Harcourt Teaching Hospital (UPTH), over a 5 year period. Methods: This was a retrospective review of data of preterm babies admitted to the SCBU from 2012 – 2016. Information obtained included biodata, nature of illness, duration of admission and outcomes. Data were collated and analyzed using SPSS v20 for windows.  Results: 3,071 babies were admitted in SCBU over the period, of which 683 (22.2%) were preterms. Of these, 421 (61.6%) were in-born while 262 (38.4%) were out-born. The male: female ratio was 0.9:1. Morbidity patterns varied with birth asphyxia (20%) ranking highest among in-borns while sepsis (21%) and neonatal jaundice (15%) were more prominent in out-borns. The overall preterm mortality rate was 24.6 % with rates being significantly higher in out-born 30.5% versus in-born 20.9% (p=0.004). Mortality was highest among low birth weight preterms. Admission rates decreased steadily over the period. Conclusion: Birth asphyxia and sepsis were the main morbidities recorded. Mortality rates were higher among outborns. Low birth weight preterms were most affected because they were in the majority. There was a steady decline in admission rates. Improving obstetric care, neonatal resuscitation, infrastructure and subsidizing healthcare services for preterms is needful.