Aim: To report survival and morbidity until discharge in preterm infants < 50 1 g with life support started immediately after birth. Methods/study design: Coh ort study of all preterm infants with birthweights < 501 g born in three tertiary perinata l centres between 1 January 1998 and 31 December 2001 (gestational age (GA) 25.2 [21.0- 30.7] wk; birthweight 435 [290- 500] g; median [range]). Results: A to tal of 107 infants with birthweights < 501 g were born. Twenty- nine were still born. A prenatal decision to initiate life support immediately after birth was r eached in 9/37 (24% ) infants < 24.0 wk GA and in 39/42 (93% ) infants ≥ 24. 0 wk GA. Survival was 3/37 (8% ) and 26/41 (63% ) in infants < 24 wk GA and ≥ 24.0 wk GA, respectively. Twenty- nine of the 48 infants with immediate life support (60% ) survived (95% CI: 46- 75% ). Forty- two of these 48 (88% ) infants were small for gestational age. No infant without immediate life suppor t survived (0/30). Twenty- three (79% ) survivors developed chronic lung disea se (CLD) and eight (28% ) received photocoagulation for retinopathy of prematur ity (ROP). Conclusion: In this population of extremely low birthweight infants, survival was higher than in previous studies when life support was provided imme diately after birth. Short- term morbidity was similar to other studies. The pr esented data on survival support our concept to offer immediate life support aft er birth in preterm infants with birthweights< 501 g. The long- term outcome of these infants needs to be assessed urgently. Aim: To report survival and morbidity until discharge in preterm infants <50 1 g with life support started immediately after birth. Methods / study design: Cohort study of all preterm infants with birthweights <501 g born in three tertiary perinata l centers between 1 Results: A to tal of 107 infants with birthweights <501 g were born (gestational age (GA) 25.2 [21.0-30.7] wk; birthweight 435 [290-500] g; median [range] A prenatal decision immediately after birth was eached in 9/37 (24%) infants <24.0 wk GA and in 39/42 (93%) infants ≥ 24. 0 wk GA . Survival was 3/37 (8%) and 26/41 (63%) in infants <24 wk GA and ≥ 24.0 wk GA, respectively. Twenty- nine of the 48 infants with immediate life support (60%) survived Forty-two of these 48 (88%) infants were small for gestational age. No infant without immediate life donor survived (0/30). Twenty-three (79%) survivors developed chronic lung disea se (CLD) and eight (28%) received photocoagulation for retinopathy of prematur ity (ROP). Conclusion: In this population of extremely low birthweight infants, survival was higher than previous study when life support was provided imme The prodigious data on survival support our concept to offer immediate life support aft er birth in preterm infants with birthweights <501 g. The long-term outcome of these infants needs to be sure urgently