[Speaking about life and death in neonatology: How can communication with families be optimized?]

Technological progress and improved clinical knowledge have increased survival of neonates who would previously have died. Survival is sometimes accompanied by a risk of short- or long-term adverse outcomes, which may lead to complex decisions about withholding or withdrawing life-sustaining interventions. These decisions are among the most difficult decisions in pediatric practice. They also involve communicating with parents and are emotionally charged. Many articles examining end-of-life decisions in neonatology state the need for healthcare providers to be caring, compassionate, and human without offering clear, practical advice. In this article, the way in which neonates die and the ethical decision-making surrounding these decisions will be reviewed. Guidelines to reflect on the life trajectories of neonates will be offered, as well as recommendations to optimize communication with families during these difficult moments.