The delivery of extremely low gestational age newborns and extremely low birth weight infants presents challenging ethical issues for caregivers and parents. Major concerns regard the high mortality and morbidity resulting in long term sequelae, the limit of viability as well as the conflict and difficulty in judgement involving “quality of life” and “sanctity of life” issues. Other paramount ethical concepts include the newborn’s best interest, the decision to initiate or withhold treatment at birth and the decision to withdraw treatment with the consequence that the infant will die. On the basis of the ethical principles of beneficence, autonomy, justice and nonmaleficence we will discuss the best interest standards, the standard for the decision making process and treatment decisions, which should always be governed by the prospect for the individual infant. In this paper we propose that ethical questions should not be regulated by law and the legal system should not interfere in the patient-physician relationship. Continuous improvement in medicine over the last decades led to increased treatment possibilities, which on the other hand also resulted in more ethical dilemmas. Therefore, today more than ever, it is essential that the neonatologist becomes familiar with basic ethical concepts and their application to clinical reality. Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy) · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou