A reduction in newborn (NB) mortality is contingent on efforts of NB stabilization. The authors attempted to quantify stabilization into a score, the neonatal stabilization score (NSS) that correlates with outcome. The population for the study comprised 192 transported NBs who weighed less than 1,000 g at birth moved from level 1 hospitals in New York City during 5 years, 1977-1981. The NSS score was based on five components: vital signs, laboratory investigations, respiratory support, I.V. fluid administration, and specific managements. Each was rated 0, 1, or 2. A maximum score of 10 indicated excellent stabilization. Analyses for the validity and reliability of the NSS included the Mantel-Haenszel test (which controlled for birth weight and Apgar) and measurement of interrater agreement "&OV0445;" (kappa statistic). Mortality rates were lower in those with higher NSS and odds of death were 2.39 times greater in NB with low NSS (X2= 5.16;P< 0.025). The calculated index of agreement &OV0445; on 16 charts represented an excellent agreement beyond chance (&OV0445; = 0.76,P< 0.01).