To the Editor: I read with interest your article, on establishing a national lower limit of viability.1 Two important problems are evident: 1) the lower limit of gestational age and the birthweight of the neonate should be assigned. This will determine whether to resuscitate and admit the neonate in the neonatal intensive care unit (NICU) or not. There is a need to have a uniform national guideline for such neonates. At present different centers have different criteria for admitting such extreme low birthweight neonates (ELBW) to the NICU. Outcome as regards to mortality and morbidity of these neonates is high as compared to term neonates as is evident from recent studies. Khan et al2 observed that in infants <33 weeks gestational age who were serially assessed, of the 159 enrolled children, 65% survived, 16% died and 19% were lost to follow-up. Those who survived were followed up for neurodevelopment by physicians and developmental psychologists. At a mean age of 31 months, the developmental status of 85 children followed-up for 12 months was normal in 32%, while 45% had mild and 23% had serious neurodevelopmental impairments.2Unlimited population growth is a result of increased birth rate, including preterm neonates. Most of the preterm neonates get admitted to the NICU. Prematurity is a major factor for neonatal mortality.3 In Ministry of Health hospitals there is shortage of NICU beds. Shortage of beds and over admission of neonates results in overcrowding. This is one of the major contributing factors for neonatal sepsis. Preterm neonates are prone to infection in view of their immunological status. The other side of the coin is the acute shortage of trained medical staff (doctors and nurses). The ELBW neonate needs a highly skilled and qualified staff for better outcome. The Ministry of Health is doing its best by opening new hospitals with NICU units and upgrading the existing NICU.The retirement age limit of neonatologists has been raised to 65 years and in the private medical sector it is more than 65 years, a step in the right direction. Most of the NICUs are lacking neonatal surgical facilities, and under these circumstances the surgical neonates have to be transported to higher centers where the surgical facilities are available for surgical intervention. Transport of the sick neonate requires a special qualified trained team and a vehicle with modern equipment for surface and air transport from one hospital to the other. There is a need to update and expand the present neonatal transport system. I agree with the author that there are limited reports on neonatal admission, neonatal, perinatal mortality, and long-term outcome of neonates who get admitted to NICUs in this country. Arafa and Al Shehri from the Southern region (Abha) of Saudi Arabia have reported a high neonatal mortality rate.4 In another study from Madina Al Munawara, the neonatal mortality rate was 6% as reported by Nabi and Karim.5 There is a need to publish sufficient data on neonates who get admitted in the hospital and their outcome. This will give us an idea about the magnitude of the problem and will help to frame the national neonatal policy.