The pattern of morbidity and mortality of 103 neonates weighing less than 2500 g referred to a Nigerian University Teaching Hospital over a period of 30 months (March 1989-August 1991) was studied. Fifty seven (55.3%) weighted less than 1500 g, 80 (77.7%) were preterm while 23 (22.3%) were term, small for gestation. Sepsis, hypothermia, respiratory distress syndrome and birth asphyxia were the commonest problems encountered. These were also the predominant associated causes of death. The corrected mortality rate was 65.3%, the rate being higher for babies weighing less than 1500 g (chi 2 = 4.02, p < 0.05) and for small for gestational age babies (chi 2 = 5.17, p < 0.025). The early neonatal problems stemmed from suboptimal conditions of perinatal resuscitation, thermoregulation and transfer. High mortality was also caused by poor state of facilities at the referral centre. Early materno-foetal transfer during preterm labour to hospitals with facilities for optimal perinatal care would reduce morbidity and mortality.