Delivery room (DR-) management has a great potential to optimise quality of long term outcome in extremely preterm infants. However, a new conceptual framework that focuses on an individualised 'support of transition' rather than on 'resuscitation' is necessary.Video-recordings of DR-management represent a valuable tool to improve care. Recording combined with a structured feed-back should be introduced in step-wise approach in clinical routine.To describe the postnatal condition of groups of infants or to compare interventions in a research setting, a numerical score - representing the sum of several objective findings - is required. The conventional Apgar-Score has severe limitations that restrict its applicability. The Specified-Apgar allows an assessment of infant's condition independent of interventions and regardless of gestational age. The Expanded-Apgar quantifies the interventions needed to achieve the condition described by the Specified-Apgar.In summary, beside a new conceptual framework an individualised monitoring and an objective assessment of DR-management are required.