PIP: This study applied a risk-approach strategy involving extra care to at-risk neonates by optimum utilization of existing resources to a cohort of newborns in rural India. Included in the analysis were all births in the study population of 47,000 people in 22 villages in 1981-82. 5 risk factors were identified (low birth weight and small size, preterm birth, feeding problem, illness, and history of prolonged and difficult labor). A management plan was developed for individual risks, and 40 community health workers were trained to implement these plans. During the 2-year study period, 851 newborns (28%) were designated as at-risk and adequate intervention was possible in 412 cases (48%). Neonatal mortality declined from 51.9 to 38.8/1000 live births between 1981 and 1982. The neonatal mortality rate was significantly higher among the infants designated as at-risk and increased with the number of risk factors present simultaneously. Neonatal mortality was highest among infants with feeding problems (439.2/1000) and illness (471.4/1000). 42% of neonatal deaths were related to low birth weight and associated complications; another 20% resulted from neonatal infections and 18% from asphyxia at birth. The neonatal mortality rate for the adequately intervened group (89.8/1000) was significantly lower than that for the group with inadequate intervention (200.5/1000). 92% of neonatal deaths occurred in 28% of the newborns who formed the at-risk groups. It is concluded that this strategy is effective and could be applied in rural areas with similar problems. Continued training of community health workers, greater cooperation with families through health education, and meetings with local leaders and traditional birth attendants are recommended to facilitate identification of at-risk neonates.