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Federal regulations and neonatologists’ views on care of seriously ill infants: changes over time



The Baby Doe Regulations (BDR) regulate provision of life-sustaining treatment to seriously ill neonates. In 2020, the Trump administration expanded upon these through the Executive Order on Protecting Vulnerable Newborn and Infant Children (EO-PVNIC). Neonatologists were surveyed in 1988 to determine their opinions on the regulations. We sought to compare views of neonatologists from 1988 and 2021 in relation to three hypothetical cases and about the impact of the BDR and to evaluate perceptions of the EO-PVNIC.


We modified and distributed the 1988 survey to members of the American Academy of Pediatrics Section on Neonatal Perinatal Medicine. We used Chi-squared tests to compare responses in 1988 to responses in 2021.


We received 445 survey responses. Neonatologists today felt less compelled to provide aggressive care to the hypothetical patients, felt less constrained by the regulations, and were more likely to report that parental wishes would impact their actions.


There have been shifts in neonatologists’ perceptions of the Baby Doe Regulations toward less aggressive medical treatment for seriously ill neonates and more shared decision-making. Further research is required to identify how practices have been impacted over these decades.


  • Neonatologists in the 1980s largely objected to the Baby Doe regulations, fearing the regulations would restrict their ability to provide optimal care to seriously ill neonates.

  • Though still in place, current perceptions of these and newer regulations are unknown.

  • Perspectives on the Baby Doe regulations have changed since their enactment and with the addition of newer, more restrictive regulations.

  • Neonatologists today may favor less aggressive management in the face of poor prognosis.

  • Neonatologists may also favor more shared decision-making now as compared to the past.

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Authors and Affiliations



E.P. conceptualized and designed the study, designed the data collection instruments, collected data, carried out the initial analysis, and drafted the initial manuscript. A.S.W. conceptualized and designed the study, designed the data collection instruments, collected data, carried out the initial analysis, and reviewed and revised the manuscript. K.F.G. conceptualized and designed the study, designed the data collection instruments, collected data, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Katherine F. Guttmann.

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The authors declare no competing interests.

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Polidoro, E., Weintraub, A.S. & Guttmann, K.F. Federal regulations and neonatologists’ views on care of seriously ill infants: changes over time. Pediatr Res (2022).

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