Objective: To compare the neonatal outcomes of previable preterm births according to the delivery indication and to determine the obstetric risk factors affecting adverse outcomes. Methods: A retrospective study was performed in pregnancies delivered between 22+0 to 26+6 weeks in Seoul National University Bundang Hospital from April 2013 to September 2021. Stillbirths and elective termination of pregnancy were excluded. Patients were classified into two groups according to the delivery indication: 1) spontaneous preterm birth (sPTB) due to premature rupture of membranes (PPROM), preterm labor, or acute cervical insufficiency and 2) indicated preterm birth (iPTB). Obstetric and neonatal outcomes were reviewed and compared between two groups. Results: Among 162 live births, the rate of sPTB was 72% (116/162). In neonatal outcomes, bronchopulmonary dysplasia (BPD) was significantly higher in the sPTB group than the iPTB group (53% vs. 26%, p=0.003). The proportions of transfusion, retinopathy of prematurity (ROP), and home oxygen demand at discharge were all significantly higher in the sPTB group than the iPTB group, however survival at discharge was significantly lower in the iPTB group (all p-value < 0.05). In the multivariate analysis after adjustment of confounding factors, the sPTB group was significantly associated with higher rate of BPD (odds ratio 2.95, 95% confidence interval 1.13-7.71, p-value=0.028). and at the same time, higher rate of survival at discharge (odds ratio 2.98, 95% confidence interval 1.07-8.34, p-value=0.037). One year follow-up showed the rates of cerebral palsy and developmental delay were all higher in the iPTB group than the sPTB group, however the difference did not reach statistical significance (32% vs. 14% and 24% vs. 10%, respectively, both p-value >0.05). Conclusion: In previable preterm births, sPTB was associated with higher incidence of BPD, however had better neonatal survival rate overall.