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Aim: To describe the symptoms characteristic of dying neonates and document the neonatal clinical interventions were offered to dying infants and their families.Background: Despite the great need for quality endof- life care for neonates and their families, there is very little information about either symptomatology of dying neonates as a group, or the medical treatments and nursing interventions provided for dying infants and their families.Design: A retrospective chart review was used in this research. All charts of neonatal inpatients who died in the neonatal intensive care unit (NICU) between 2002 and 2008.Results: Sixty-one charts were evaluated in this research. The major underlying disease was the complications of prematurity (33%). Major physiological distress at the last week of life included respiratory distress (67.2%), bradycardia (36.1%), cyanosis (54.1%), gastro-intestinal bleeding (37.7%) and edema (37.7%). All infants were intubated and received artificial ventilation in the last week of life. Physicians prescribed an analgesic medicine for seven infants and seven infants received comfort interventions to manage the distress symptoms. Forty-one infants had a preexisting Do Not Resuscitate (DNR) order before they died. In 30 cases, both parents were with the infant and most often were holding their infants when death occurred. A quiet and isolated place was provided for these parents and their dying infants.Conclusions: The research findings suggest that the application of the palliative care paradigm and more aggressive comfort care to manage symptoms might be beneficial to dying infants and their families in the NICU.