Institution-based studies from perinatal centers are reporting encouraging survival and developmental outcome in extremely preterm infants, but population-based studies of all such births within a geographical-defined region are necessary to examine the impact of perinatal-neonatal care on the entire community. We have reported that their perinatal mortality and severe disability rate were significantly lower in those born within perinatal centers compared with those born elsewhere. Promotion of "in utero transfer" is associated with a significant improvement in their survival and developmental outcome. Postnatal surfactant therapy, which began a decade ago, saw a doubling of the survival rate for infants born as early as 24-26 weeks, while their severe disability rate remains below 10%. Although surfactant and mechanical ventilation are expensive therapies, the resulting improvement in outcome was responsible for a reduction in the cost per additional quality-adjusted life-year gained.