Abstract. Objective: The outcome of premature infants is negatively impacted by transport, and in Central Ohio every effort is made to transport the mother prior to preterm delivery. Our neonatal intensive care unit is an all referral unit, thus all babies are transported and the referral hospitals include those without neonatology coverage, and those with neonatology coverage. We tested the hypothesis that the outcomes of extremely premature infants (<27 weeks gestational age) admitted to our NICU would be better when the infant was referred from a hospital with neonatology coverage. Patients and methods: We collected data from 227 patients admitted from December, 2004 to August, 2008; 192 patients were from hospitals with neonatology coverage. Results: The survival rate was greater for those babies referred from hospitals with neonatology coverage than in those referred from hospitals without neonatology coverage (82% vs. 60%, p = 0.007), as was the combined outcome of survival without Grade 3/4 IVH (68% vs. 43%, p < 0.01). When limited to only those patients admitted at <3 days of life, survival was better for infants referred from hospitals with neonatology coverage than those referred from hospitals without it (77% vs. 63%; p < 0.05). Conclusion: These results suggest that for infants born at <27 weeks admitted to an all referral unit delivery in a hospital with neonatology coverage leads to better survival.