Dutch doctors have reported 22 mercy killings of terminally ill babies since 1997, according to a new study.
The report authors want to encourage reporting of child euthanasia cases
None of the doctors involved were charged, although euthanasia for children is illegal in the Netherlands.
The report, in the Dutch Journal of Medicine, is the first detailed examination of child euthanasia.
The study's authors want to address under-reporting of the practice and encourage doctors to report cases without fear of prosecution.
The cases involved babies with extreme spina bifida, a disabling birth defect.
The study showed that prosecutors had decided not to file charges as long as four unofficial rules were met:
- the child's medical team and independent doctors must agree
- there is no prospect of improvement and the pain cannot be eased
- parents give their consent
- the life must be ended in the correct medical way
A survey has suggested Dutch doctors end the lives of about 15 to 20 disabled newborns a year but most go unreported.
"The babies are there but we were never allowed to talk about them," said paediatrician Eduard Verhagen, of Groningen University Medical Centre, and one of the authors of the study.
"That must change. If we take this awfully difficult decision, it must happen with complete openness," he told De Volkskrant newspaper.
"You are trained to save the life of a child but with these children the suffering can only be stopped by ending their lives. It takes courage to do that."
In 2001, the Netherlands became the first country to legalise euthanasia but doctors must follow strict rules.
The Vatican has criticised the Netherlands over its legalisation of euthanasia.