This study estimates differentials in survival among very low-birth weight infants according to hospital of birth, and seeks to determine importance of birth at high-technology centers versus birth at other urban or rural hospitals. Data from four states for 1978 and 1979 were used to estimate survival curves for the first 24 hours of life by type of hospital at birth, birth weight, and race. Significant (p less than 0.0001) differences in survival by type of hospital for both races at birth weights of 1000 to 1500 gm were observed. Smaller disparities were seen at birth weights of 750 to 1000 gm. Differentials in survival by hospital setting emerged in the first few hours after birth, underscoring the effectiveness of neonatal intensive care units in reducing infant mortality and the importance of maternal transport. Differentials persisted throughout the neonatal and postneonatal periods, although differences were attenuated. Prenatal assessment and provider and institutional cooperation can contribute to lowered mortality for high-risk infants and mothers.