The authors as Canadian trained neonatal nurses have acquired neonatal nurse practitioner training and have been afforded the opportunity to work or provide consultation in countries such as Afghanistan, China, Kenya, Tanzania, Pakistan, and Syria. This study describes the perspectives on neonatal intensive care units in developing countries, which are a culmination of personal experiences reinforced by colleagues with experiences in South Africa, India, Nepal, Uganda, and Vietnam and relate to family decision making and access to care, referral and transport of ill babies, capacity of health care facility, neonatal nursing training and education, and neonatal sepsis, the leading cause of death. The potential impact of the patterns of neonatal mortality are presented. Clinical implications are explored as an attempt to improve the quality of care and improve neonatal morbidity and mortality in developing countries in the absence of material and human resources