Although only a small fraction of all neonates require extensive resuscitation, the large number of births throughout the world ensures that adequate neonatal intensive care facilities remain on the cutting edge of technology. Advancements in monitoring, ventilatory support, vascular access, and maintenance of core body temperature have been paramount in the vast increase in the survival rates of newborns.1 New innovations in size and materials coupled with new routes of vascular access have been paramount for neonatologists with regard to invasive monitoring, ionotropic support, and total parental nutrition. Invasive monitoring includes both continuous blood pressure measurements and the ability to obtain arterial blood for up-to-the-minute blood gas measurements for ventilatory support. Smaller catheter size and peripheral central routes have enabled the neonatologist to maximize the use of blood products, electrolytes, drug delivery, and nutrition, especially in those neonates who are unable to tolerate enteral nutrition for long periods of time. Advances in medical devices and refinement of techniques now allow for smaller and sicker neonates to gain the same advantage that was once only available to larger infants within the intensive care unit.