Previously (AAP 1995, 1996), we reported on the use of a novel“discrete speech” voice to text dictation system (VoiceType Dictation by IBM™) using a specialized neonatal vocabulary. Increased efficiency and ergonomic improvements were noted when compared to conventional dictation systems (microcassette to transcription service). In the following study we evaluate the enhanced efficiency gained by using a continuous speech engine(ViaVoice Dictation by IBM™). To evaluate the improvements gained by the new dictation engine, we have evaluated a usage model encompassing typical utilization of a dictation service as well as user based ergonomics. For this model, a specialized neonatal vocabulary was constructed from an entire year's dictated notes and placed into clinical use. While conventional dictation may be comparable in speed relative to ViaVoice dictation, this relationship does not carry over when compared to accuracy, training of transcriptionists, significant delays and cost associated with conventional dictation. Facilitation of the natural cadence and quality of continuous speech in computer based dictation is a significant step towards deployment of the “paperless” medical record. The potential for utilization of a dictation engine to accelerate entry into commercial or novel neonatal database applications provides additional advantage over key based entry systems. Additionally, the elimination of pen and keyboard based entry and data retrieval is vital to optimizing user efficiency in this high acuity environment. We propose the Neonatal vocabulary for ViaVoice dictation as a significant improvement over existing dictation modalities and recognize its potential for improving the quality of the medical record in the NICU.