This study assessed survival and neurodevelopmental outcomes among infants born at 22 to 24 weeks of gestation, as measured at 18 to 22 months of corrected age, and showed that the rate of survival without neurodevelopmental impairment increased between 2000 and 2011. Care of periviable infants remains a great challenge in neonatal and perinatal medicine. 1 Infants born between 22 and 24 weeks of gestation often die or survive with long-term neurodevelopmental impairment. 2 – 4 The approach to resuscitation and management at these early gestational ages varies substantially. 1 , 5 Data reported during the past 5 years indicate that mortality has declined among extremely premature infants. 6 – 9 Investigators at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network (NRN) reported a decrease in mortality over the past two decades, with the greatest gains in survival seen among infants . . .