OBJECTIVE The objective of this study was to compare rates of survival and special health care needs (SHCN) from discharge to 18 months' corrected age between infants who were born between 22 and 24 weeks and 25 and 27 weeks and to determine predictors and persistence of SHCN. METHODS Data were collected on 508 infants who were born between 22 and 27 weeks from January 1, 1998, to December 31, 2002 at Women and Infants Hospital. SHCN was defined as need for home oxygen, medication, monitor, gastrostomy tube, or ventriculoperitoneal shunt. chi(2) was used to compare rates of survival and SHCN between groups. Regression analyses explored predictors of SHCN and their persistence. RESULTS Survival at 22 to 24 weeks was 53% vs 90% at 25 to 27 weeks. There were no 22-week survivors. Survivors at 23 to 24 weeks were more likely to be discharged on oxygen, a monitor, or medications; remain on oxygen or a monitor or require tube feeds at 18 months; and have a SHCN at any time than survivors who were born at 25 to 27 weeks. The strongest predictor of SHCN at discharge was chronic lung disease and at 18 months was public health insurance. CONCLUSIONS Rates of SHCN were high for infants who were born at the limits of viability. Although rates decreased with increasing age, 40% had persistent SCHN at 18 months. The association of public health insurance with persistent SHCN indicates a need for comprehensive health care and support services for infants with combined biological and environmental risks.