Most of us can think of a close friend or family member whose premature infant’s life and health were saved by quality medical care received in a neonatal intensive care unit (NICU). Over the last 3 decades, NICUs have succeeded in saving ever-earlier and tinier premature infants. But some extremely low-birth-weight babies that survive live with devastating neurological and other deficits. This month's issue explores the complex ethical challenges that NICU achievements force physicians, parents-to-be, and society to confront.