The value of the autopsy in the practice of clinical medicine continues to be debated. While the yield of the autopsy in adults is well documented, similar studies in infants and children are lacking. To understand how frequently the neonatal autopsy provides useful information, we studied all deaths in a level III neonatal Intensive care unit over a three-year period. Clinically active problems at the time of death were tabulated and compared with the final diagnoses obtained from the autopsy report. During the three-year study period, there were 113 deaths with autopsies performed in 71 (63%) of the cases. Significant findings were noted in 39% of patients. These included congenital anomalies (16 patients), Infections (nine patients), unsuspected iatrogenic complications (five patients), and others (11 patients). In 16% of the cases, the autopsy provided the definitive explanation for the cause of death by substantiating an unproved or unsuspected diagnosis. In an additional 18.3% of the cases, the autopsy findings influenced genetic counseling or were important in monitoring patient care. The gross examination was the most useful component of the autopsy, providing 63% of the significant findings. This high rate of return supports a continued high rate of neonatal autopsy.