Neonatology: Ethical, Legal, and Medical Considerations in the Specialised Care of Newborns

January 25, 2024
by Kunal Babla, Consultant Neonatologist

Neonatology (also known as neonatal medicine or neonatal intensive care) is a paediatric sub-speciality that centres around the care of newborn babies who are very sick or premature. Neonatologists provide care for a range of babies, from those who have minor problems, to those who require comprehensive support on intensive care units.

Broadly, neonatal intensive care covers:

  • The care of term babies who have conditions that developed during the pregnancy and are born with (congenital), or that develop during the birth or afterward.
  • Premature babies born from 22 weeks gestation and upwards (a normal pregnancy lasts about 37-40 weeks)


In the UK, intensive care can be considered for some babies born from 22 weeks gestation onwards. From 24 weeks gestation onwards, most babies will receive intensive care. Decisions around offering resuscitation and intensive care can be extremely difficult and require a sound understanding of ethical and legal frameworks, each individual baby’s circumstances and excellent communication with families at a distressing time.

Babies born early, particularly before 28 weeks, can be extremely fragile and critically unwell, often with significant respiratory disease. They require careful all-round care, but can develop complications such as infection, intraventricular haemorrhage (bleeding within the brain) and significant long-term lung disease. Premature birth and its associated complications can have implications for a child’s long term health and development.

Term deliveries – infection, congenital abnormalities, HIE, PPHN

Sadly, some babies born at or close to their due date can still be unwell and need admission to neonatal intensive care. This can be due to conditions that are due to babies developing in an abnormal way, or due to conditions that arise as a result of complications in the pregnancy or birth.

Babies can develop structural abnormalities in a number of body systems including, but not limited to:

  • Brain and spinal cord (such as spina bifida)
  • Lung and heart (such as small volume lungs or heart abnormalities)
  • Abdomen (such as diaphragmatic hernia or intestinal abnormalities)
  • Genito-urinary conditions.

Each will require specific or specialist input to ensure each baby receives the care and treatment they need.

Other babies born at term may need admission as a result of infections, neurological conditions as a result of poor oxygen supply around the time of birth (hypoxic ischaemic encephalopathy), a difficulty in adapting to newborn life after birth (persistent pulmonary hypertension of the newborn) or difficulty in managing sufficient blood sugar levels (hypoglycaemia). These can all result in longer-term implications for newborns if not correctly identified and treated.

Cardiology and echocardiography

Some babies may need specific input for heart conditions.

These may be due to:

  • abnormal development of the heart (necessitating a close working relationship with cardiologists)
  • prematurity (such as patent ductus arteriosus)
  • complications of other conditions (such as pulmonary hypertension in severe lung disease)

Diagnosis and treatment of these require specialist skills in echocardiography and a sound understanding of the current research literature.