Improvements in obstetric and neonatal care over the last several decades have lead to a decline in neonatal mortality. This study utilized South Carolina's linked live birth and infant death records from 1975-1992. We analyzed mortality rates at 7 & 28 days by race, gestational age (GA) and birthweight (BW). Neonatal mortality rate decreased from 14.9 to 9.1 (deaths per 1,000) for African-Americans (AA) and from 10.2 to 4.3 for Whites (W). The most dramatic decrease was in 7 day mortality (12.4 to 7.3 for AA; 8.8 to 3.3 for W). Neonatal mortality decreased overtime for both races in each GA category, but the decrease was most dramatic at 26-32 wks GA. The limit of viability (< 50% survival) was lowered from 26 wks in 1975 to 24 wks GA in 1992 for W. For AA, the limit of viability was already 24 wks GA in 1975,& did not change over the time period. Neonatal mortality rates are lower for AA than for W up to 32 wks GA, but by 37 wks GA, W have lower neonatal mortality. There were no appreciable temporal changes for either race in rates of preterm delivery or of infants with BW < 2500g, although AA demonstrated an increase in births with BW < 1500 g (from 1.8/1000 in 1975 to 2.5/1000 in 1992). CONCLUSION: This decline in neonatal mortality over an 18 year period, due primarily to a reduction in GA-specific and 7 day mortality, reflects high risk obstetric and neonatal intensive care efforts. Renewed efforts should be made in devising strategies to change the GA/BW distribution toward term, and to maximize the health and developmental outcome of surviving high risk preterm infants.