Neonatal intensive care for extremely-low-birth-weight (ELBW, 500-999 g) infants must be evaluated to determine that it is effective, efficient, and available to those who need it. From the late 1970s until the late 1990s in the state of Victoria, Australia, neonatal intensive care has been increasingly effective, with large increases in the long-term survival rate from 25% in 1979-1980 to 73% in 1997, and in the quality-adjusted survival rate from 19% to 59% over the same time. Its efficiency has been relatively high and stable over time, comparing favourably with many other health-care programmes. It is increasingly available, with fewer than 10% of ELBW infants born outside level III perinatal centres in the latest era, and proportionally more ELBW infants being offered intensive care over time. Neonatal intensive care should be re-evaluated at intervals in the future to ensure that its effectiveness, efficiency and availability are maintained.