Objective To investigate the expression of regional cerebral oxygen saturation （rSO₂） in preterm infants with brain injury （BIPI） and its relationship with amplitude-integrated electroencephalogram （aEEG） parameters and neurodevelopment. Methods Retrospectively， 116 cases of BIPI （Bilateral Intra-ventricular Perforation） born in the hospital between February 2022 and February 2023 were selected as the study subjects. According to the Expert Consensus on the Diagnosis and Prevention of Premature Infant Brain Injury， these cases were categorized into mild， moderate， and severe groups， with 59，35， and 22 cases， respectively. The study compared the general characteristics of premature infants with different brain injury levels. Regression analysis was conducted to identify the factors affecting brain injury in premature infants， and correlation analyses were performed on aEEG scores， rSO₂， and GMS scores. ROC curve analysis was used to evaluate the value of combining brain oxygen saturation monitoring with aEEG in predicting abnormal whole-body motor quality assessment. Results On the 3rd and 7th days after birth， severe brain-injured premature infants had significantly lower rSO₂ and aEEG scores compared to those with mild and moderate brain injuries （P < 0.05）. At 7 days， these infants also had lower scores for graph continuity， sleep-wake cycles， lower boundary amplitude， bandwidth， total score， rSO₂， gestational age， and birth weight， and a higher proportion of abnormal developmental outcomes （PR+CS） （P < 0.05）. Multivariate logistic regression analysis revealed that the 3-day aEEG total score （OR = 0.448，95%CI：0.094~0.890），7-day aEEG total score （OR = 0.384，95%CI：0.058~0.726），3-day rSO₂ （OR = 0.574，95%CI：0.398~0.750）， and 7-day rSO₂ （OR = 0.431，95%CI：0.115~0.777） were all protective factors for brain injury in premature infants， P < 0.05. Correlation analysis showed that brain oxygen saturation was negatively correlated with aEEG scores and overall motor quality. The prediction value for abnormal overall motor quality using 7-day rSO₂， aEEG， and the combination of 7-day rSO₂ and 7-day aEEG scores was as follows： the positive predictive value for rSO₂ was 86.46%， the negative predictive value was 96.85%， the sensitivity was 92.31%， the specificity was 92.21%， and the cut-off value was 0.845； The positive predictive value （PPV） of aEEG was 78.26%， the negative predictive value （NPV） was 96.86%， the sensitivity was 89.74%， and the specificity was 92.21%， with a cut-off value of 0.820. The positive predictive value （PPV） of 7-day rSO2 combined with 7-day aEEG score was 89.04%， the NPV was 96.88%， the sensitivity was 94.90%， and the specificity was 93.51%， with a cut-off value of 0.884， P < 0.05. ROC curve analysis showed that the AUC of 7-day rSO₂ + 7-day aEEG score was 0.895， De-long test P < 0.005， indicating high predictive value for overall exercise quality. Conclusion Combined with rSO₂ and EEG， the prediction of overall motor quality is better， which may have clinical value for excluding high-risk children.