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Introduction: Survival in extreme prematurity has improved dramatically over the years, enabling better outcomes in difficult pregnancies. Aim and Objectives: To evaluate the outcomes in extreme prematurity (less than 28 weeks) over 12 years (2012-2023) at Surya Hospital and also assess long term morbidity. Material and Methods: Neonatal outcomes were assessed over 12 years from 2012 to 2023 at Surya Hospital. Long term outcomes were assessed as per BSID scales (Bayley Scales of Infant and Toddler Development) Results: 997 neonates (28 weeks or less) were admitted in NICU from 2012 to 2023. The overall survival was 72.3%. Of these 337 neonates had a gestational age of 23 to 25 weeks. At 23, 24, 25 weeks the survival was 11%, 41% and 50% respectively in the years 2012 to 2017 which improved to 42%, 63% and 78% at 23, 24, 25 weeks respectively in 2018 to 2023. The long term outcomes with BSID scales will also be presented. Conclusion: Excellent tertiary care NICU management optimizes outcomes in high risk pregnancies. By Counselling families about outcomes guides couples in their decision-making.