Teleradiology was utilized to link an offsite, high-risk nursery to the Department of Pediatric Radiology of Children's Hospital of Michigan. Interpretations via teleradiology were made in 4200 examinations and taken as the final reading. There was no expansion of either professional or technical personnel at either hospital to accomplish these ends. During the initial 3 months of the study, 40% of the teleradiographic images were double-read to evaluate the accuracy of the technique. During the subsequent 9 months, 17% of the cases were double-read, for an overall double-reading of 23%. There was a 98% agreement between the interpretations made using teleradiology and those made using hard copy. In no instances of the 2% (20 cases) in which there was disagreement between readings did the difference have clinical significance. Our results indicate that teleradiology linkage for interpreting neonatal examinations serves as a valuable tool for expansion of subspecialty expertise, allows more expedient recognition of abnormalities in the neonate, and facilitates faster transport to the appropriate tertiary care center.