This retrospective study compares the cost and quality outcomes of two matched groups of infants; one of which received neonatal care provided by neonatal nurse practitioners (NNPs), the other delivered by the medical house staff in one hospital's NICU. Parameters evaluated for both groups included LOS, days on ventilator, days on oxygen, mortality, morbidity, and costs. The infants in the study were matched by place of birth, gestational age, birth weight, sex, race, and Apgar scores. This study showed that in the 35 cases cared for by NNPs, in collaboration with neonatoologists, neonates received care equal in quality to the 35 matched cases cared for by medical house staff at lower cost with greater continuity and consistency. Cost effectiveness of the NNP group was documented as $18,240 less per infant than those managed by medical house staff. Differences were seen as chiefly attributable to the NNP's unique blend of knowledge, communication skills, and continuous presence plus early identification of service coordination needs.