Finland has about 45,000 to 60,000 annual births and a total of 23 delivery hospitals. High-risk deliveries, including all deliveries below 32 gestational weeks, are centralized to five tertiary-level hospitals. The national, register-based quality surveillance is performed by the Finnish Medical Birth Register, owned by the Finnish Institute for Health and Welfare operating under the Ministry of Social Affairs and Health. Its power is its legal position as a statistical authority: it can mandate public and private hospitals to provide information. This paper describes the development and current form of the Very Preterm Infant Register, which is imbedded in the Finnish Medical Birth Register. The Very Preterm Infant Register was preceded by national research projects. Today, it serves as a quality improvement tool as well as a data source for research. The register is a reliable source of information as all pregnancies and deliveries in Finland are reported in this register as mandated by law. One important strength of this register is its continuum throughout the pregnancy including maternal health data and fetal data including fetal deaths. It is also routinely linked to other national registers, such as the Cause of Death Register, which adds to its reliability and value. The valuable information is utilized in national and international research projects including the iNeo research collaboration comparing care performances across different networks internationally and determinates for adverse outcomes.