• A statewide system for the screening, tracking and referral of high-risk infants has been in operation in Iowa since 1978. During the first five years of the Iowa High-Risk Infant Follow-up Program, pediatric nurse-practitioners have screened 1,440 infants at ages 4, 9, 18, and 30 months. Nineteen percent of the infants failed screening and were referred to developmental centers for further evaluation. Infants meeting criteria related to preterm birth comprised most of the flagged group; the highest failure rates were found for infants who experienced neonatal seizures or who were hypotonic at discharge from the hospital. Most children who failed screening did so by the nine-month checkpoint. A year-by-year comparison of failure rates for high-risk children in Iowa suggests a statistically significant pattern of decreasing developmental morbidity.