Objective: To determine the survival rates and neurosensory outcomes of infants born at gestational age 22-27 weeks in the state of Victoria in 2005 and compare theses data with those for similar infants born in the 1990s. Study design: This was a population-based study of all extremely preterm (22-27 weeks' gestational age) live births in Victoria in 2005 free of lethal anomalies and randomly selected term controls. Survival and quality-adjusted survival rates at age 2 years were determined relative to the controls, and results were compared with regional extremely preterm cohorts born in 1991-92 and 1997. Results: Of 270 very preterm live births in 2005, 172 (63.7%) survived to 2 years, not significantly different from the survival rate of 69.6% for those born in 1997. Rates of severe developmental delay and severe disability were lower than in the very preterm survivors born in 1997. Quality-adjusted survival rates in the extremely preterm cohorts rose from 42.1% in 1991-92 to 55.1% in 1997, but did not increase in 2005 (53.4%). Conclusions: Survival rates for infants born at 22-27 weeks' gestational age have not increased since the late 1990s, but the neurosensory outcome in survivors has improved.