Advances in prenatal diagnosis, obstetrical care and neonatal surgery have increased survival of the high-risk newborn. New and more frequent surgical interventions have increased the involvement of the anaesthetist in the perinatal care of the premature and term infant. Providing anaesthetic care for these infants is among the most challenging and stressful endeavours the anaesthetist must face. It is fraught with the obvious difficulties associated with the infant's smaller size, which makes routine technical tasks such as vascular access and securing the airway more difficult. In addition, the differences in the way the neonate handles anaesthetic agents and other drugs adds additional stress to the routine anaesthetic. Lastly, the unique aspects of developmental physiology complicate administration of the routine anaesthetic in this population and enhances the risks of serious complications such as hypoxaemia, hypothermia, as well as fluid and electrolyte abnormalities. Anaesthetic care should be provided to these patients only by those anaesthetists who are fully familiar with these unique aspects of the physiology and pharmacology of the developing neonate and who are prepared for technical challenges and potential complications of neonatal anaesthesia.