WHAT'S KNOWN ON THIS SUBJECT: Neonatal mortality rate and causes of death have been relatively stable in recent years. Decision-making practices preceding death of sick neonates affect the circumstances of death. These practices vary worldwide according to the team approach and local population background.WHAT THIS STUDY ADDS: Although our population is mostly religious, we observed a decline in maximal intensive care along with increasing redirection of care over a decade. Changes in the team approach and increasing level of parental involvement influence type and duration of treatment.abstract OBJECTIVES: To follow changes in the causes of neonatal deaths in the NICU at Hadassah Medical Center, Jerusalem, Israel, over a decade; to examine trends regarding types of end-of-life-care provided (primary nonintervention, maximal intensive, and redirection of intensive care, including limitation of care and withdrawal of life-sustaining treatment); and to assess the parental role in the decision-making process given that the majority of the population is religious. METHODS:All neonates who died between 2000 and 2009 were identified. The causes and circumstances of death were abstracted from the medical records. Trends in end-of-life decisions were compared between 2 time periods: