The delivery of a distressed term infant is infrequent but often requires intensive therapy. This study investigates the primary causes for such distress and the period (antepartum intrapartum, neonatal) when each complication was initially recognized. During a 1-year period, 168 term infants (8% of 2,057 term deliveries) required admission to the newborn intensive care unit. The primary disorders were similar to those of 228 infants transported from community hospitals and involved suspected sepsis, metabolic problems, major anomalies, birth asphyxia, and respiratory distress. Only one third (59 cases, 35%) of the subsequently distressed infants was anticipated during the antepartum period. The term infant who requires more than routine nursery care cannot necessarily be predicted until labor or delivery.