A retrospective analysis of neonates admitted for ventilatory support to the neonatal intensive care unit at the University Hospital of the West Indies between August 2001 and December 2004 was conducted. One hundred and thirty-eight neonates fulfilled criteria for admission into the study. Ninety-eight (71%) were inborn, 88 (64%) survived and 50 (36%) died. The median age at death was 72 hours and 72% of non-survivors died within one week of life. The main reasons for admission into the unit were respiratory distress syndrome 87(63%), followed by hypoxic ischaemic encephalopathy 15 (11%), surgical indications 13 (9%) and meconium aspiration syndrome 11 (8%). Babies with meconium aspiration syndrome and surgical problems had the best survival 82% and 85% respectively. Survival rates increased with increasing birthweight and gestational age. The most common complication seen was air leaks. The judicious use of neonatal intensive care measures in a developing country can result in a reduction of morbidity and mortality. However to maximize on benefits versus cost in an atmosphere of budgetary constraint evidence based management policies and protocols must be developed and implemented.