Objective To explore the clinical rescue, clinical outcomes and complications in neonates with extremely low birth weight (ELBW, <1 000 g) and very low birth weight (VLBW, <1 500 g) in a single center in Shanghai. Methods Clinical data of neonates with birth weight less than 1 500 g admitted to Shanghai Children's Hospital between Jan. 2008 and Dec. 2017 were retrospectively analyzed. Results A total of 690 neonates were enrolled in this study. The overall survival rate was 72.7% (502/690) and in-hospital mortality rate was 13.9% (96/690). There was 13.3% (92/690) discharge against medical advice and the outcome was uncertain. The survival rate of VLBW neonates in 2013-2017 was significantly lower than that in 2008-2012 (45.2%[33/73] vs 64.7%[11/17], P<0.05). The most common complication was hypothermia, but there was no significant difference in the incidence of hypothermia between the latest 5 years and the first 5 years (81.0%[363/448] vs 82.6%[200/242], P>0.05). In 2013-2017, there was a significant increase in the occurrence of neonatal respiratory distress syndrome (NRDS) (70.1%[314/448] vs 26.9%[65/242], P<0.01), bronchopulmonary dysplasia (BPD) (19.4%[87/448] vs 9.5%[23/242], P<0.01), necrotizing enterocolitis (NEC) (16.3%[73/448] vs 6.2%[15/242], P<0.01) and infection (50.4%[226/448] vs 29.8%[72/242], P<0.01), while asphyxia (36.6%[164/448] vs 41.7%[101/242], P<0.01), retinopathy of prematurity (ROP) (1.3%[6/448] vs 5.0%[12/242], P<0.01) and hypoglycemia (11.2%[50/448] vs 17.8%[43/242], P<0.05) were decreased as compared with those in 2008-2012. Conclusion The overall survival rate is still low in neonates with ELBW and VLBW. Asphyxia and infection are still poorly controlled. The cooperation between institutions of obstetrics and neonatalogy is needed to improve the outcome of neonates with ELBW and VLBW.