This report highlights the prevalence, risk factors, and outcomes of periviable infants born between 22 0/7 and 23 6/7 weeks’ gestational age. While periviable birth rates have remained relatively stable in recent years, facilities are developing new approaches to ensure the highest possible quality of care and to reduce infant mortality. Findings in this report indicate that lower socioeconomic status is associated with an increased risk of periviable birth. Additional leading risk factors include plural births (twins or higher-order multiples), short pregnancy intervals <12 months, and pre-pregnancy obesity. Despite their extremely low birth weight, averaging just 1.2 pounds, survival rates for periviable infants have steadily improved in recent years. Virginia hospitals have demonstrated a strong interest to better understanding the causes and care practices related to periviable birth, with the goal of developing standardized models of care statewide to improve both survivability and long-term quality of life.