A recent appeal by a group of Italian obstetricians and neonatologists, advocating full resuscitation of extremely preterm infants independently from parental opinion, raised a debate on the rationale and consequences of such proposal. Whether or not the appeal will modify practices, there is no doubt that careful assessment of outcome for these very special infants is called for. However, this is currently impossible at national level in Italy. Following a change in legislation, the time-honoured system of births monitoring by the Italian National Institute of Statistics (ISTAT) was dismantled in 1998 and later rebuilt entrusting it to the Ministry of Health, while ISTAT remains in charge of deaths registry. Both are public institutions; yet for privacy protection the transfer of birth certificates from the Ministry to ISTAT is only permitted after deletion of personal identifiers. Thus, the individual matching of birth certificates, containing crucial information such as birthweight, gestational age and vitality, to the corresponding infant death data (if any) becomes more difficult. Results of an attempt of statistical record linkage performed on the 2003 birth cohort are shown in Table 1. Variables used as keys to record linkage were infant’s gender, plurality, date and place of delivery and maternal date of birth. Overall, only 598 of the 1539 deaths (38.9%) could be successfully linked, and proportions decreased from 56.6% in the North to 32% in the Centre and South, to only 15% in the Islands. Both missing birth certificates and records incompleteness on linkage variables contributed to these results. The lower proportion of valid death records determined linking difficulties in Central Italy, while missing birth certificates were the main issue in the South and especially Islands. At the light of the North-to-South trend of neonatal and infant mortality traditionally reported in Italy, lack of information from the Southern regions is particularly troubling. As stated by the Europeristat project, neonatal and infant mortality stratified by birthweight and gestational age are ‘core’ indicators to be recorded by all European Union countries to assess the quality of perinatal care and monitor the effects of policy changes. Voluntary collection of data by Neonatal Intensive Care Units, as developing today in Italy and other countries for benchmarking purposes, is a useful but inadequate substitute, being based on the selected subgroup of neonates surviving to admission to tertiary Centres. Solutions are urgently needed to reconcile privacy protection with timely population-based monitoring of neonatal and infant outcomes stratified by birthweight and gestational age.