“…[1][2][3] The medical, ethical, and economic implications of providing care for such extremely low birth weight infants have been the subject of much debate. [4][5][6] As infants of increasingly lower birth weight and gestational age have been resuscitated, questions have arisen regarding whether the improved survival rates have been accompanied by increased impairment rates, with a worsened quality of life, for the tiniest survivors. [7][8][9] We sought to compare the rates of survival, neonatal morbidity, and neurodevelopmental impairment at 20 months of corrected age among children of 500-to 999-g birth weight who were born at our perinatal center during 2 periods, ie, 1982-1989 and 1990 -1998; the latter period was associated with increased prenatal steroid therapy, cesarean section delivery, assisted ventilation in the delivery room, surfactant therapy, and postnatal steroid use.…”