The management of neonatal subglottic stenosis by the anterior cricoid split procedure (ACS) has evolved rapidly since this operation was first described by Cotton and Seid in 1980. Recent reports have specified criteria for the evaluation of patients for ACS, and adherence to these guidelines has increased the extubation rate and decreased the mortality rate in these series. Ninety-one patients have undergone anterior cricoid split at Children's Hospital Medical Center (Cincinnati, OH) since 1977. These cases were reviewed, emphasizing the 24 infants treated since January 1, 1988, and not previously reported. In comparison to our most recent report of 70% extubation and 10.4% mortality, 67% of the latest group were extubated, while mortality was reduced to 4.1%. These results were achieved despite some relaxation of strict patient-selection guidelines when this was appropriate in individual patients, emphasizing the need for careful clinical evaluation and close consultation between otolaryngologist and pediatrician in the selection of patients for ACS.