Neonatology on the Web

Spitzer’s Laws of Neonatology

Spitzer’s Laws of Neonatology

Gentle Reader:

Spitzer’s Laws have been handed down to us from the very dawn of Neonatology, or perhaps one should say from the meconium-stained birth of our fine specialty. In those days, giants walked the earth, computers were the size of moving vans, and neonatology fellows were on call every other night but still found time for basic research on prostaglandins in fetal sheep. The subtler interpretations and corollaries of these laws have been lost in the mists of time, but they still contain useful kernels of truth for the post-modern pediatric house officer.

— Webmaster, November, 1994

Addendum 30 years later:

Spitzer’s Laws, first published in Clinical Pediatrics in the early 1980’s, were well known to neonatologists and fellows in the 90’s and posted on the wall in many NICUs. They were originally added to the Neonatology on the Web site as one of several diversions and “humorous” papers found in the literature at that time. In today’s “woke” world, some of them may strike you as politically incorrect, but they are reproduced here unchanged in the interest of historical accuracy.

You can find further discussion of Spitzer’s Laws in the following two articles:

“Spitzer’s Laws of Neonatology — it’s about time somebody took a critical look at this foolishness,” by Alarn R. Spitzer, Journal of Perinatology (2013) 33, 830. doi:10.1038/jp.2013.106

“Time for a relook at Spitzer’s laws of neonatology?” by P. Gou and C. A. Ryan, Journal of Perinatology (20130 33, 827-829. doi:10.1038/jp.2013.103

— Webmaster, March 2024.

Spitzer’s Laws of Neonatology

1. The more stable a baby appears to be, the more likely he will “crump” that day.

2. The distance that you have to go for a transport is directly proportional to the degree of illness of the baby.

3. The incidence of transport calls is inversely proportional to the number of available beds.

4. The nicer the parents, the sicker the baby.

5. The incidence of neonatal problems increases dramatically if either parent is a physician or a nurse.

6. Endotracheal tubes are designed to fall out (or become plugged, etc.) at the most critical moment.

7. The milder the RDS, the sooner the infant will find himself on 100% oxygen and maximal ventilatory support.

8. The likelihood of BPD is directly proportional to the number of physicians involved in the care of the baby.

9. The longer a patient is discussed on rounds, the more certain it is that no one has the faintest idea what’s going on or what to do.

10. The patient who is glossed over quickly on rounds is the most likely to crump that day.

11. The sickest infant in the nursery can always be discerned by the fact that he is being cared for by the newest, most inexperienced nursing orientee.

12. The surest way to have an infant linger interminably is to inform the parents that death is imminent.

13. The more miraculous the “save,” the more likely that you’ll be sued for something totally inconsequential.

14. The probability of infection is directly proportional to the number of antibiotics that the infant is already receiving.

15. If it ain’t CHD, it’s PFC (or vice versa).

16. If they’re not breathin’, they may be seizin’.

17. Lasix (Vitamin L) will squeeze urine out of bricks. Unfortunately, it doesn’t always work as well in babies.

18. Antibiotics should always be continued for — days (fill in the blank with any number from 1 to 21).

19. If you can’t figure out what’s going on with a baby, call the surgeons. They won’t figure it out either, but they’ll sure as hell do something about it.

20. The month you are on service always has three times as many days as any other month on the calendar.

From: Alan Spitzer
Sent: Saturday, January 18, 1997 1:09
Subject: Spitzer’s Law of Neonatology


I was both surprised and pleased to find my laws of neonatology on your extremely well-done web site. And while I am getting on in years (50 in 2 weeks!), I don’t know that these laws were created at the “dawn of neonatology.” It makes me sound like I brought them down from the mountain with Moses and his Top 10. In any event, though, I appreciate the PR, although it gets tougher and tougher for me to admit that with over 150 publications and a big fat textbook to my credit, the laws are my number one citation! I’m glad, though, that people have enjoyed them over the years. Thanks again for posting them.

Alan Spitzer

Created 11/27/94 / Last modified 1/18/97
Neonatology on the Web /