Advances in perinatal technology have led to a preponderance of ethical dilemmas regarding the resuscitation of extremely preterm infants weighing between 500 and 750 grams. Although a review of the literature indicates poor outcomes in many of these infants, an equal number of studies documenting positive outcomes has been reported. A point/counterpoint format is used to discuss the issues related to the borderline viable infant. Strategies for resolution are formulated based on the issues of concern. Prevention of preterm birth, discussion of the resuscitation plan before delivery and initial resuscitation with the option to withdraw treatment are critical solutions to consider. Additional strategies include the establishment of definitive care guidelines and a standardized definition of quality of life. Other options worthy of consideration are discussed.