ABSTRACT Objective: To assess the predictive value for adverse neonatal outcome of Doppler ultrasound, angiogenic factors and multi-parametric risk-score models in women with early-onset severe preeclampsia. Design: Prospective cohort study. Setting: Maternity units in two Spanish hospitals. Population: Women with diagnosis of early-onset severe pre-eclampsia. Methods: A multi-parametric risk score model, Doppler ultrasound, and levels of angiogenic factors were measured at admission. The predictive value for adverse neonatal outcome was calculated. Main outcome measures: Composite of adverse neonatal outcome. Results: Of 63 women with early-onset severe preeclampsia, 18 (28.6%) presented an adverse neonatal outcome. PlGF showed the best discrimination between neonatal outcomes among angiogenic factors. Good predictive values for the prediction of neonatal complications were found with the combination of PREP-L score with advanced Doppler (AUC ROC 0.9 95% CI 0.82-0.98]) and with PlGF levels (AUC ROC 0.91 [95% CI 0.84-0.98]). Conclusions:  The combination of maternal risk scoring (PREP-L score) with angiogenic factors or fetal Doppler ultrasound at the time of diagnosis of early-onset preeclampsia with severe features performs well in predicting adverse neonatal outcome. Keywords: Angiogenic factors; Early-onset severe preeclampsia; Hypertension in pregnancy; Neonatal adverse outcome; Doppler ultrasound; Placental growth factor; Soluble fms-like tyrosine kinase 1.