Over the most recent 10 years there have been no significant further improvements in survival or morbidity rates of preterm infants, mostly the extremely-low-gestational-age-neonates (ELGANs, defined as less than or equal to 28 weeks' gestation).The incidence of some of the major morbidities associated with extreme prematurity, such as BPD, could potentially be affected by management in the first minutes of life; it may be necessary to apply the principles of care that occur in the neonatal intensive care unit in the delivery room to achieve a further improvements in short and long-term outcome of these neonates. Up to now, the care of the smallest preterm infants in the delivery room has received little attention: few resuscitation protocols addressed to these newborns, not advanced equipment used and subjective monitoring based on clinical examination. Therefore, it may be useful to incorporate an intensive care environment into the delivery room to enhance survival rates and reduce morbidity of the extremely preterm infants. New approaches in the first minutes of life using more gentle parameters of intervention are being studied but further evidence is needed to improve resuscitation procedures in these newborns.