Advances in perinatal and neonatal management have resulted in a significant increase in the survival of fragile extremely low birth weight (ELBW) infants > 1,000 g at birth. The evaluation and reporting of the outcome of these infants aids in assessing the efficacy of interventions, provides data to aid in policy decisions, and provides critical information for parents and primary care providers. Comprehensive assessment of multiple domains including neurologic/neurosensory, developmental-cognitive, visual perceptual, speech/language, motor, functional skills for daily living, and Kindergarten readiness permit a total view of the child within the context of the family. Survival of VLBW infants < 800 g has steadily improved from 0% (1943 to 1945) to 49% to 70% (1994 to 1995). Rates of cerebral palsy, mental retardation, blindness, and deafness have remained stable in the 1980s and 1990s. There is evidence, however, that the percent of functional limitations may be increasing. A requirement for Special Education Resources among VLBW infants remains high at 44% to 56%. As increasing numbers of infants at the limits of viability survive, the medical community must remain vigilant in its surveillance and advocate both humanistically and scientifically for comprehensive strategies that optimize long-term functional, academic, and family outcomes.