Provision of intensive care to very-low-birth-weight (VLBW) infants has recently come under intense scrutiny if not actual attack. The breakthroughs made 15 years ago that allow us to care for infants who weigh between 500 to 750 g at birth have not been followed by rapid improvements in their outcomes. Each year 8000 VLBW infants are born in this country. Currently, one third of these infants survive and many of the survivors have pulmonary and central nervous system disabilities that require years of care. The annual cost of their care to the public and private sectors is estimated at $250 million.
Some have written that the knowledge to care for these infants is beyond our grasp. Others believe that the public sector no longer has the financial resources to assume this task and suggest that monies earmarked for VLBW care would have a greater impact on overall child health care if given to preventive pediatrics. These claims are tied to a chilling argument that recipients of health care dollars should have the potential to repay society. Ideas like these have gained a measure of acceptance, in part because physicians, traditional defenders of the concept that health services