In recent years, survival of the extremely low birthweight infant has dramatically improved. Morbidity, both short- and long-term, however, remains very high Costs in the currency of pain and suffering for the newborn, stress and financial burdens for the family, and dollars for society are extensive. The controversial questions that are discussed include: How small is too small? How much is too much? How far should we go? How much can we afford? Who should decide? What strategies should be followed to ensure such decisions are just?