This case presents the challenges faced in managing a premature infant with multiple unexplained neuromuscular symptoms. The discussion focuses on the ethical dilemmas surrounding the initiation of palliative care in the absence of a clear diagnosis. Key ethical questions include the appropriateness of continuing intensive care when the prognosis is uncertain, and the role of parental autonomy in making informed decisions. This case underscores the importance of ongoing ethical deliberation and sensitive communication in neonatal end-of-life care.