We report our experience with 345 premature infants weighing less than 1,500 g admitted to the neonatal intensive care unit during 1990-1993. The improved survival of the very-low-birth-weight patients was related mainly to the routine use of surfactant in the treatment of respiratory distress. In addition, as a result of several preventive precautions, early diagnosis, and appropriate antimicrobial therapy, a decrease in neonatal sepsis was observed. The decrease in the ratio between the number of septic episodes to the number of septic patients is another indication of the efficacy of our current preventive and therapeutic protocols.