Table 2 Major themes and subthemes

1. Neonatologists are confronted with moral uncertainty (which in turn causes moral distress)

2. Neonatologists prioritize their traditional (Hippocratic) role as healers

3. Neonatologists seek third-party support for their decisions to reduce their decision uncertainty

4. Multiple predisposing factors foster and facilitate neonatologists’ moral distress

4.1. Previous experience is important to mitigate neonatologist’s moral distress

4.2. The lack of clear and adequate clinical practice guidelines/recommendations/protocols

4.3. The scarcity of health care resources

4.4. The fact that in the context of neonatology, the best interest and quality of life of the infant are difficult to determine

4.5. Making decisions in a short time frame

5. Multiple predisposing factors are sometimes associated with neonatologists’ constraint distress and sometimes associated with their uncertainty distress

5.1. NICU directors

5.2. Colleagues working in the same NICU

5.3. Parents’ attitudes

6. Neonatologists become more resistant to moral distress over time