A prospective cohort study of pregnancies delivered at 23 weeks gestation from women admitted to one of sixteen Canadian tertiary perinatal units included 248 women and 287 infants. The rate of Cesarean section was 11%, and 40% of women had a serious complication (chorioamnionitis was the most frequent one). Of liveborn infants with known outcomes, 38% (n=69) were admitted to the NICU. Of these, 64% died. Among survivors at discharge 44% had severe brain injury and 58% had retinopathy of prematurity. All survivors had some form of serious neonatal morbidity.