Neonatology pp 347-356 | Cite as

Neonatology and the Law

  • Vittorio FineschiEmail author
  • Francesca Maglietta
  • Emanuela Turillazzi
Reference work entry


Neonatology is one of the areas of medicine that in recent years has received much attention. This interest primarily concerns the constant progress in this field and the inherent ethical and medico legal problems. The extensive debate about some issues reflects both the technical and scientific progresses that have been made in the neonatological field. On the other hand, tightly argued issues such as medical malpractice litigation have reached crisis proportions in the neonatological and pediatric field. Moreover, pediatric claims are very expensive because the damages cover the life of the child and the juries tend to be very sympathetic toward children and their families. Care at the limits of viability and cerebral palsy are some of the more contentious areas of legal medicine on the neonatological field. Since recognizing “red flags” can lessen chances of malpractice claims against neonatologists, this chapter focuses on some issues which have a high vulnerability to claims of medical negligence and on high-risk situations. The principles are primarily the same for any doctor working in any country under any clinical circumstances; of course, subtle differences in the law can appertain to an individual case depending on where it arose and the jurisdiction that applies.


  1. April C, Parker M (2007) End of life decision-making in neonatal care. J Med Ethics 33:126–127CrossRefPubMedCentralGoogle Scholar
  2. Arora C, Savulescu J, Maslen H, Selgelid M, Wilkinson D (2016) The intensive care lifeboat: a survey of lay attitudes to rationing dilemmas in neonatal intensive care. BMC Med Ethics 17(1):69CrossRefPubMedCentralGoogle Scholar
  3. Berglund S, Norman M (2012) Neonatal resuscitation assessment: documentation and early paging must be improved! Arch Dis Child Fetal Neonatal Ed 97(3):F204–F208CrossRefGoogle Scholar
  4. Blackmon LR (2003) Biologic limits of viability: implications for clinical decision-making. NeoReviews 4:e140–e146CrossRefGoogle Scholar
  5. Blair E, Stanley FJ (1997) Issues in the classification and epidemiology of cerebral palsy. Ment Retard Dev Disabil Res Rev 3:184–193CrossRefGoogle Scholar
  6. Brunkhorst J, Weiner J, Lantos J (2014) Infants of borderline viability: the ethics of delivery room care. Semin Fetal Neonatal Med 19(5):290–295CrossRefGoogle Scholar
  7. Chiswick M (2008) Infants of borderline viability: ethical and clinical considerations. Semin Fetal Neonatal Med 13:8–15CrossRefGoogle Scholar
  8. Cohen J, Hoon A, Wilms Floet AM (2013) Providing family guidance in rapidly shifting sand: informed consent for genetic testing. Dev Med Child Neurol 55(8):766–768PubMedGoogle Scholar
  9. Cowan PJ (2005) Litigation. Semin Fetal Neonatal Med 10:11–21CrossRefGoogle Scholar
  10. Donn SM (2005) Medical liability, risk management, and the quality of health care. Semin Fetal Neonatal Med 10:3–9CrossRefGoogle Scholar
  11. Donn SM, Chiswick ML, Whittell P, Anderson S (2003) Medico-legal implications of hypoxic ischemic brain injury. In: Donn SM, Sinha SK, Chiswick ML (eds) Birth asphyxia and the brain: basic science and clinical implications. Futura Publishing, Armonk, pp 379–401Google Scholar
  12. Fanaroff AA (2008) Extremely low birthweight infants – the interplay between outcomes and ethics. Acta Paediatr 97:144–145CrossRefGoogle Scholar
  13. Fanos V, Tagliabue P, Greco L, Agostiniani R, Carbone MT, D’Agostino P, Correra A (2012) Neonatal malpractice claims in Italy: how big is the problem and which are the causes? J Matern Fetal Neonatal Med 25(5):493–497CrossRefGoogle Scholar
  14. Folkerth RD (2007) The neuropathology of acquired pre- and perinatal brain injuries. Semin Diagn Pathol 24:48–57CrossRefGoogle Scholar
  15. Frati P, Fineschi V, Di Sanzo M, La Russa R, Scopetti M, Severi FM, Turillazzi E (2017) Preimplantation and prenatal diagnosis, wrongful birth and wrongful life: a global view of bioethical and legal controversies. Hum Reprod Update 23(3):338–357CrossRefGoogle Scholar
  16. Freeman RK (2008) Medical and legal implications for necessary requirements to diagnose damaging hypoxic-ischemic encephalopathy leading to later cerebral palsy. Am J Obstet Gynecol 199:585–586CrossRefGoogle Scholar
  17. Goldenberg AJ, Sharp RR (2012) The ethical hazards and programmatic challenges of genomic newborn screening. JAMA 1:307(5). Scholar
  18. Graham EM, Ruis KA, Hartman AL et al (2008) A systematic review of the role of intrapartum hypoxia – ischemia in the causation of neonatal encephalopathy. Am J Obstet Gynecol 199:587–595CrossRefGoogle Scholar
  19. Greenwood C, Newman S, Impey L et al (2003) Cerebral palsy and clinical negligence litigation: a cohort study. BJOG 110:6–11CrossRefGoogle Scholar
  20. Greve P (2011) Pediatrics: a unique and volatile risk. J Healthc Risk Manag 31(2):19–29CrossRefGoogle Scholar
  21. Haward MF, Kirshenbaum NW, Campbell DE (2011) Care at the edge of viability: medical and ethical issues. Clin Perinatol 38:471–492CrossRefGoogle Scholar
  22. Janvier A, Bauer KL, Lantos JD (2007) Are newborns morally different from older children? Theor Med Bioeth 28:413–425CrossRefGoogle Scholar
  23. Janvier A, Leblanc I, Barrington KJ (2008) The best-interest standard is not applied for neonatal resuscitation decisions. Pediatrics 121:963–969CrossRefGoogle Scholar
  24. Kadhim H, Evrard P, Kahn A et al (2005) Insights into etiopathogenic mechanisms involved in perinatal cerebral injury: implications for neuroprotection. In: Fong HD (ed) Focus on cerebral palsy research. Nova Science Publishers, Hauppauge, pp 1–26Google Scholar
  25. Liu J, Chen XX, Wang XL (2016) Ethical issues in neonatal intensive care units. J Matern Fetal Neonatal Med 29(14):2322–2326PubMedGoogle Scholar
  26. Lucassen A (2012) Ethical implications of new genetic technologies. Dev Med Child Neurol 54:196CrossRefGoogle Scholar
  27. MacLennan A (1999) A template for defining a causal relation between acute intrapartum events and cerebral palsy: international consensus statement. BMJ 319:1054–1059CrossRefPubMedCentralGoogle Scholar
  28. Nadroo AM (2011) Ethical dilemmas in decision making at limits of neonatal viability. J IMA 43:188–192PubMedGoogle Scholar
  29. Nielsen LF, Schendel D, Grove J et al (2008) Asphyxia-related risk factors and their timing in spastic cerebral palsy. BJOG 115:1518–1528CrossRefGoogle Scholar
  30. Online Mendelian Inheritance in Man. McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University; Baltimore. Accessed 13 July 2012. Available at
  31. Paneth N (2001) Cerebral palsy in term infants–birth or before birth? J Pediatr 138:791–792CrossRefGoogle Scholar
  32. Patel RM (2016) Short- and long-term outcomes for extremely preterm infants. Am J Perinatol 33(3):318–328CrossRefPubMedCentralGoogle Scholar
  33. Pignotti MS, Donzelli G (2008) Perinatal care at the threshold of viability: an international comparison of practical guidelines for the treatment of extremely preterm births. Pediatrics 121:e193–e198CrossRefGoogle Scholar
  34. Pinter AB (2008) End-of-life decision before and after birth: changing ethical considerations. J Pediatr Surg 43:430–436CrossRefGoogle Scholar
  35. Raju TNK, Suresh G, Higgins RD (2011) Patient safety in the context of neonatal intensive care: research and educational opportunities. Pediatr Res 70(1):109–115CrossRefPubMedCentralGoogle Scholar
  36. Riezzo I, Neri M, De Stefano F, Fulcheri E, Ventura F, Pomara C, Turillazzi E, Fineschi V (2010) The timing of perinatal hypoxia/ischemia events in term neonates: HSPs, ORP-150 and COX2 are reliable markers to classify acute, perinatal events. Diagn Pathol 5:49. doi:10.1186/1746-1596-5-49CrossRefPubMedPubMedCentralGoogle Scholar
  37. Savulescu J, Kahane G (2009) The moral obligation to create children with the best chance of the best life. Bioethics 23:274–290CrossRefGoogle Scholar
  38. Seri I, Evans J (2008) Limits of viability: definition of the gray zone. J Perinatol 28:S4–S8CrossRefGoogle Scholar
  39. Sklansky M (2001) Neonatal euthanasia: moral considerations and criminal liability. J Med Ethics 27:5–11CrossRefPubMedCentralGoogle Scholar
  40. Squier W (2002) Pathology of fetal and neonatal brain damage: identifying the timing. In: Squier W (ed) Aquired damage to the developing brain, timing and causation. Arnold, London, pp 110–127Google Scholar
  41. Squier W, Cowan FM (2004) The value of autopsy in determining the cause of failure to respond to resuscitation at birth. Semin Neonatol 9:331–345CrossRefGoogle Scholar
  42. Stark Z, Gillam L, Walker SP, McGillivray G (2013) Ethical controversies in prenatal microarray. Curr Opin Obstet Gynecol 25(2):133–137CrossRefGoogle Scholar
  43. Tucker Edmonds B, McKenzie F, Panoch JE, White DB, Barnato AE (2016) A pilot study of neonatologists’ decision-making roles in delivery room resuscitation counseling for periviable births. AJOB Empir Bioeth 7(3):175–182CrossRefPubMedCentralGoogle Scholar
  44. Turillazzi E, Fineschi V (2009) How old are you? Newborn gestational age discriminates neonatal resuscitation practices in the Italian debate. BMC Med Ethics 12:10–19Google Scholar
  45. Wilkinson DJC, Barnett C, Savulescu J, Newson AJ (2016) Genomic intensive care: should we perform genome testing in critically ill newborns? Arch Dis Child Fetal Neonatal Ed 101(2):F94–F98CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Vittorio Fineschi
    • 1
    Email author
  • Francesca Maglietta
    • 2
  • Emanuela Turillazzi
    • 2
  1. 1.Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Sciences“Sapienza” University of RomeRomeItaly
  2. 2.Department of Legal MedicineUniversity of FoggiaFoggiaItaly

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