Despite dramatically improved outcomes in prematures generally, the very smallest--those weighing below 750 grams--have a high mortality and a substantial morbidity among survivors. In addition, the cost and resource consumption required for care of these babies is large. Some survivors from this weight group appear to be entirely normal, however. Thus, there is a moral and ethical dilemma whether, for the sake of the potential intact survivors, the entire group should receive drastic life support. Today's neonatologist is caught in a crossfire of conflicting demands from families, referring physicians, federal and state regulations, hospital administrators, cost considerations, and personal ethical beliefs.