Changes in both the location of very low birth weight births and in the number of infants selected for transport were chosen for the evaluation of regionalized perinatal care and its effectiveness in the Lowcountry Perinatal catchment area. The four-year period reviewed was characterized by the initiation of a well-defined regionalized perinatal transport program at the Medical University of South Carolina. In conjunction with this increased availability of transport, there was a statistically significant (p less than 0.02) increase in the number of VLBW neonates transported to MUSC after being delivered in community hospitals. This increase was accompanied by an increase in the proportion of infants referred for transport within the first hour of life. Among those neonates referred within the first four hours of life, survival was inversely proportional to the infant's age when the transport team arrived, suggesting that a rapid response by the neonatal transport team was associated with a significantly increased VLBW infant survival. Among all transported infants, in-utero continues to be the most efficacious means of transport for VLBW infants and that delivery of VLBW infants at regional medical centers continues to result in the most optimal survival.