The influence of breech presentation on neonatal mortality was studied in 77 viable low-birth-weight breech deliveries. Neonates were divided into 3 weight groups: 1000–1499 g, 1500–1999 g, and 2000–2499 g. The antepartum and intrapartum characteristics of the 3 weight groups were detailed. The 17 neonates who died were studied to determine if alternative delivery methods would have prevented their deaths. Survival rates were 45% in the 1000–1499-g group, 76% in the 1500–1999-g group, and 97% in the 2000–2499-g group. Cervical head entrapment and fetal bradycardia were ominous intrapartum complications, but severe prematurity with respiratory distress syndrome and fetal hydrops were the primary causes of neonatal death. From these data, it is concluded that 1) intrapartum management and delivery of the low-birth-weight breech presentation infant should be individualized, and 2) cesarean section for routine delivery is not justified.