In the United States, an increase in the number of births of extremely preterm infants and in their survival potential has occurred over the last decade. Determining the survival prognosis for the infant of a pregnancy with threatened preterm delivery between 22 and 25 completed weeks of gestation remains problematic. Many physicians and families encounter the difficulty of making decisions regarding the institution and continuation of life support for an infant born within this threshold period. This report addresses the process of counseling, assisting, and supporting families faced with the dilemma of an extremely preterm delivery.