The infant mortality rate, considered an important proxy for societal health, has been recently rising in Delaware. In fact, in 2001, Delaware's infant mortality rate (10.1/1,000 births) was the highest in the country. In this review, potential factors leading to increasing infant mortality in Delaware are discussed. Evidence for increasing illness severity in infants with birth weights less than 1,500 grams and an increasing number of live, yet previable, births is presented.