A review of two previously published studies done at the University Hospital of the West Indies, an unpublished study and annual perinatal statistics was conducted to detect trends in the mortality of very low birthweight infants at the institution over four decades. Mortality decreased from 54% to 38% over the time period, the decrease was greater for infants weighing 1001–1500 g (40%) than those weighing ≤ 1000 g (28%). Despite increased access to mechanical ventilation over time, there was no appreciable decrease in mortality for infants weighing ≤ 750 g. There was a statistically significant decrease in mortality with increasing birthweight for the time period 1987–2002, p < 0.001. The mean ± SD weight of survivors 1.18 ± 0.24 kg was significantly greater than that for non-survivors 0.89 ± 0.21 kg for the same period. Further decrease in mortality of very low birthweight infants will involve measures aimed at decreasing mortality in infants weighing ≤ 750 g and increasing the availability of parenteral nutrition and the accessibility of surfactant.