Much of the decline in childhood mortality over the past two decades is attributable to improvements in neonatal intensive care for very-low-birthweight infants. Yet large and persistent disparities persist in the quality of neonatal intensive care across hospitals. Improving care for infants now served by hospitals with poor outcomes can greatly reduce infant mortality, particularly among minority infants who are more likely to be very low birthweight and cared for by hospitals with poor outcomes. Referral of high-risk births to hospitals with the best outcomes is another promising strategy.