In the six-year period from 1975 through 1980, acquired subglottic stenosis was recognized in eight patients during the first year of life who survived intubated mechanical ventilation as newborn infants. Seven of eight cases occurred in infants who weighed less than 1,500 g at birth. This complication was not seen in the first three years of the review, when only nasotracheal intubation was practiced. In the second three years, orotracheal intubation was the predominant practice. Seven infants required tracheostomy and the outcome was poor: none has undergone decannulation and three have died. Recognition of this disorder as a cause of inability to extubate the very-low-birth-weight infant is stressed.