The story of neonatal intensive care is a remarkable story of medical progress but also a story of moral controversy. Every year, in NICUs around the world, many babies are saved who would have perished if they had been born 40 years ago. In the United States, roughly 250,000 preterm infants are born each year. Before 1965, many of these babies would have died. Today, most survive without long-term health problems. Neonatology has become the largest subspecialty in pediatrics.

Neonatology is not an unmitigated success. Many survivors are left with lifelong medical problems such as chronic lung disease, visual impairment, seizures or neurodevelopmental problems. These chronic health problems have led some observers to conclude that neonatology is not as successful as it sometimes seems and today in the grey zones of neonatology, parents and clinicians together decide whether life sustaining interventions for certain neonates should be withheld or withdrawn. Priest and bioethicist John Paris wrote, “There comes a point with extremely premature infants… where the risk of mortality and morbidity becomes so significant and the degree of burden and the prospects of benefit so suffused in ambiguity and uncertainty that a decision as to whether to institute or continue medical treatment properly belongs to the parents [1]”. Indeed, a significant proportion of deaths in Neonatal Intensive Care Units (NICUs) follow these difficult end of life considerations. Such debates have surrounding neonatology since its inception.