Physiology-based illness severity scores are proving their value through a wide variety of practical applications. The theoretical disadvantages noted in Table 1 have not turned out to be major problems, whereas the advantages have been quite real. Numerous studies have reported insightful comparisons between treatment groups, between NICUs, between countries, between eras, and over the course of care. Many institutions have implemented routine collection of physiology-based newborn scores. The answer to the question posed in the title is yes; neonatal risk scoring systems can predict some mortality and some morbidity. However, it is clear that this function is much less important than their application as a means of improving quality and cost. Future development will depend on commercially viable applications.