The Incubator

Send us Fan Mail This week we are replaying one of our most listened-to episodes, which sits right at the heart of our special series on non-invasive ventilation recorded ahead of Hot Topics in Neonatology. Dr. Cindy McEvoy, Professor of Pediatrics and Director of Neonatal Research at OHSU, joins Ben and Daphna to discuss her work on extended CPAP in preterm infants. CPAP has long been a cornerstone of neonatal care, but how long should stable infants remain on support? Dr. McEvoy shares find...

Send us Fan Mail Dr. Brett Manley joins Ben for the opening episode of The Incubator’s special series on non-invasive ventilation, recorded ahead of Hot Topics in Neonatology. They work through the full arc of non-invasive support, from the delivery room to the convalescent phase and beyond. What actually counts as nasal high flow, and when should it come off? Why did HIPSTER and HUNTER move clinicians back toward CPAP as primary support? Is the benefit of NIPPV about synchronization or simpl...

Send us Fan Mail During a code, who is making sure the chest compressions are actually high quality? Recording live at the CHNC Symposium, Daphna sits down with Gina Klein, a simulation education consultant, and Sherry Casey, a NICU nurse and simulation coordinator, both from Cincinnati Children’s, to discuss their poster on implementing the CPR coach. Gina explains how video review in the emergency department revealed the microbehaviors that make feedback effective, like giving one piece of ...

Send us Fan Mail When a baby with congenital heart disease decompensates in the delivery room, do we still follow NRP? Recording live at the CHNC Symposium, Daphna sits down with Dr. Noorjahan Ali of Children’s Health Dallas, Dr. Henry Lee of UC San Diego and Rady Children’s, and Dr. Anne Ades of the Children’s Hospital of Philadelphia. Dr. Ali explains a green, yellow, and red light approach to resuscitating heart babies, and why common things are still common. Dr. Lee reviews recent NRP upd...

Send us Fan Mail If a preterm infant’s PDA needs closing, does timing matter? Recording live at the CHNC Symposium, Daphna sits down with the CHNC’s mentored fellows, Dr. Meriam Avades of Phoenix Children’s and Dr. Shannon Vitone of Arkansas Children’s, to hear their projects ahead of their presentations. Dr. Vitone shares a mixed methods study of about 1,300 neonates receiving renal replacement therapy since 2011, where mortality rose over time despite growing use, and interviews with 21 pro...

Send us Fan Mail What happens when most level IV NICUs are missing four to five advanced practice providers? Recording live at the CHNC Symposium, Daphna sits down with Sarah Shedler of Children’s Wisconsin and Chandler Williams, from Children's National, both members of the CHNC’s new APP Focus Group. They explain why APPs, caught between nursing and physician initiatives, needed a group of their own, and share results from their survey of member institutions: roles that vary widely from uni...

Send us Fan Mail Why does first-attempt intubation success in the NICU still hover around 40 to 56%? Recording live at the CHNC Symposium, Daphna sits down with Dr. Somi Singh, a second-year neonatology fellow at the University of Wisconsin–Madison, to discuss her poster on standardizing neonatal intubation practices. Dr. Singh walks through her team’s QI project: a checklist with a time-out and video laryngoscopy, a standardized premedication order set, and a pocket-card workflow built aroun...

Send us Fan Mail When a nurse makes an error with 20 things happening at once, is it really a personal slip, or a system that pushed her past capacity? Recording from the CHNC Symposium, Daphna sits down with Dr. James Wan, director of the Human Factors and Systems Design team at the Children’s Hospital of Philadelphia, an engineer and pastor who keynoted on “Human Factors Empathy Science.” He explains the limited capacity model, why most clinicians live with almost no spare capacity, and why...

Send us Fan Mail How often have you searched for a parent handout on a fetal diagnosis and found nothing, or something too cold and branded to share? Recording live at the CHNC Symposium, Daphna sits down with Dr. Namrita Odackal of The Ohio State University and Nationwide Children’s Hospital, a neonatologist, fellowship program director, and medical illustrator, to celebrate the launch of the Atlas of Fetal Pathologies at fetalatlas.org. She explains how fellows and faculty mentors write eac...

Send us Fan Mail Why does one difficult case sometimes feel heavier than it should? Recording at the CHNC Symposium, Daphna sits down with Dr. Jennifer Kett, division head for bioethics and palliative care at Seattle Children’s, ahead of her keynote on secondary trauma in the NICU. Dr. Kett unpacks the overlapping concepts of primary and secondary trauma, vicarious trauma, compassion fatigue, moral distress, the moral residue crescendo, and institutional betrayal, using the metaphor of a pitc...

Send us Fan Mail What if the baby with complex gastroschisis never needed months in the NICU? Recording live at the CHNC Symposium, Daphna sits down with Dr. Sundeep Keswani, associate surgeon-in-chief at Texas Children’s Hospital, after his keynote on fetoscopic in utero repair of gastroschisis. He explains how fetoscopy has made the risk-benefit balance possible, how intra-abdominal bowel dilation identifies babies at risk, and why a fetal Botox injection to relax the abdominal wall changed...

Send us Fan Mail When a baby with a congenital kidney anomaly develops pulmonary hypoplasia and pulmonary hypertension, should ECMO be on the table? Recording live at the CHNC Symposium, Daphna sits down with Dr. Abhishek Makkar and Dr. Saeed Ahmed of Children’s Health in Dallas to discuss CAKUT, congenital anomalies of the kidney and urinary tract. They share findings from their multicenter survey of CHNC and pediatric ECMO centers, which found that only about 10% of centers have guidelines,...

Send us Fan Mail When a baby crashes in the NICU, how long will it take before someone in the room can pick up a probe and look at the heart? Recording from day two of the CHNC Symposium, Daphna sits down with Dr. Rune Toms of Nicklaus Children’s Health System and Dr. Jae Kim of Cincinnati Children’s to discuss the urgent need to spread basic cardiac POCUS skills. They describe a minimum skill set for acute events, including function, volume, tamponade, and line position, and explain why depe...

Send us Fan Mail Day two of the CHNC Symposium is here! Daphna sets the stage for a full lineup of keynote speakers sharing the latest in care for the most complex babies in level IV NICUs. Stay tuned for all of today’s conversations. Support the show As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @dr...

Send us Fan Mail What happens to a baby with severe BPD when the attending changes every two weeks and every plan starts over? Recording live at the CHNC Symposium, Daphna sits down with Dr. Sushmita Yallapragada, Dr. Riddhi Desai, and Dr. Jonathan Ibrahim of UT Southwestern and Children’s Health in Dallas to talk about BOOST, their Bronchopulmonary Dysplasia Outcomes and Support Team, and the new 12-bed BPD unit within their NICU. They explain how a small core of physicians, APPs, nurses, an...

Send us Fan Mail When five specialists sit across from one frightened family, who responds when a parent starts to cry? Recording live at the CHNC Symposium, Daphna sits down with Dr. Zeynep Salih of Riley Children’s Hospital to talk about interdisciplinary prenatal counseling. Dr. Salih shares findings from interviews with 24 physicians: most prefer counseling together, so everyone is on the same page; nearly all said being a parent helps them empathize; and many deferred emotional moments t...

Send us Fan Mail If your NICU doesn’t offer dialysis, do families still know it’s an option? Recording live at the CHNC Symposium, Daphna sits down with pediatric nephrologist Dr. David Askenazi and nephrology nurse practitioner Kara Short of Children’s of Alabama, and neonatologist Dr. Cara Slagle, ahead of their workshop on practical approaches to neonatal renal replacement therapy. They explain why the most important topics are often the least discussed: medication dosing on dialysis, vasc...

Send us Fan Mail Recording live at the CHNC Symposium, Daphna sits down with two Explore presenters. Dr. Rachel Han of Golisano Children’s Hospital shares a clinical prediction model for UTI in level IV NICUs, built from the CHND, which flags vesicoureteral reflux, urinary tract obstruction, male sex, and aneuploidy as risk factors, and explains why the new AAP guideline’s lower threshold may reveal more infections. Dr. Jeffrey Shenberger of Connecticut Children’s then examines ROP in infants...

Send us Fan Mail What does it take to back up a claim that your NICU delivers the highest quality of care? Recording live at the CHNC Symposium in Denver, Daphna reunites with Dr. Rune Toms, system chief of neonatology at Nicklaus Children’s Hospital and The Incubator’s very first guest. He explains why Nicklaus is joining the Children’s Hospitals Neonatal Consortium, and how its data on complex level IV patients goes beyond what other networks capture. He describes neonatal care as a chain, ...

Send us Fan Mail The Incubator Podcast is coming to you from the Children’s Hospitals Neonatal Consortium (CHNC) Symposium in Denver, Colorado! Daphna sits down with the physicians, nurse practitioners, nurses, and researchers whose focus groups collaborate all year round, across the United States and into Canada, to move research to the bedside sooner for the most complex babies in level IV NICUs. Catch all of these episodes on both our podcast channel and our YouTube channel, wherever you p...

Send us Fan Mail To close out our FANNP Symposium coverage, Daphna and Christa sit down with Patrick McCray, president of FANNP and a neonatal nurse practitioner with AdventHealth in Orlando. Patrick shares the organization’s focus on advocacy, education, growth, and community, and explains why, despite the Florida in its name, FANNP draws NNPs from across the country and beyond. He talks about a record exhibit hall, sold out preconference courses on PICC lines and respiratory care, the on de...

Send us Fan Mail Who will care for the next generation of NICU babies? Daphna and Christa sit down with Colleen Reiley Moss and Jessica Meneses Jones to unpack the neonatal nurse practitioner workforce crisis. With only 37 NNP programs nationwide and clinical placements blocked by red tape, they explore why so few nurses enter the pipeline and why many leave. Christa shares how becoming a clinical site helped her program recruit, and what it truly costs. Together they make the case that NNPs ...

Send us Fan Mail Daphna and Christa sit down with Dr. Alfonso Vargas to preview his journal club. They review the NICHD Neonatal Research Network PDA trial, stopped early for higher mortality with treatment, the UK FEED1 trial on full milk feeds from day one in babies at 30 to 32 weeks, and the PLaNT trial of prophylactic CPAP after cesarean birth in late preterm infants. Dr. Vargas also shares his top takeaways from the 2026 AAP therapeutic hypothermia report and why unit culture, built from...

Send us Fan Mail James Roberts, co-founder and CEO of mOm Incubators, returns to Tech Tuesday almost four years after his first appearance, when the device was still in development. A lot has changed. The mOm Essentials is now CE marked and FDA cleared, in use across eight countries, and has reached roughly 18,500 patients, from NHS maternity wards to air raid shelters in Ukraine. Daphna and James talk through what makes the system different: a bassinet sized footprint, one button operation, ...

Send us Fan Mail How do we safely dose medications when more than 90 percent of NICU drugs are not FDA approved for neonates? Daphna and Christa sit down with Nicole Thompson Bowie, a neonatal nurse practitioner at Nemours Children’s Hospital in Orlando, about her neonatal pharmacology review. Nicole explains why pharmacokinetics is the foundation, why understanding the why behind every drug matters more than any protocol, and how medications given to the mother affect the baby. The conversat...

Send us Fan Mail What happens inside a feeding tube left in place for days at a time? Daphna and Christa reunite with Dr. Leslie Parker of the University of Florida. Dr. Parker shares not yet published findings from her study comparing feeding tube changes every two days versus every seven days, with less biofilm and bacterial contamination in more frequently changed tubes. She then turns to her work as a legal consultant, explaining why thorough documentation of what you saw, what you did, a...

Send us Fan Mail What do we lose when NICU babies don’t see a therapist until they’re close to going home? Daphna talks with Diane Delgado Allen, an occupational therapist and certified neonatal therapist, following her lecture on optimizing developmental care for the long-term NICU infant. Diane explains the difference between neuroprotective and neuropromotive care, why early sensory experiences shape brain wiring, and how missed opportunities show up as sensory processing disorders, autism...

Send us Fan Mail Recording live at the FANNP National Neonatal Nurse Practitioner Symposium, Daphna and Christa sit down with Dr. Jacqui Hoffman, associate professor in the DNP NNP track at Rush University and the symposium’s speaker coordinator. She shares what keeps the conference fresh, from on-demand sessions to hands-on PICC and ventilator workshops, and why she finds the work fulfilling rather than thankless. The conversation then turns to the neonatal workforce: declining NNP enrollmen...

Send us Fan Mail Recording live at the FANNP National Neonatal Nurse Practitioner Symposium, Daphna and Christa sit down with Dr. Debbie Shirey, Associate Dean for Graduate Education at Baylor University, to revisit the morning’s opening talk. At 23, Debbie was a journalist and weekend DJ when she delivered her son at 27 weeks and spent four months commuting 130 miles to the NICU. A primary nurse named Liz taught her to place feeding tubes, called her every shift, and planted a question that ...

Send us Fan Mail When a NICU mother comes back from surgery, do you know what she was told about pumping? Recording live at the FANNP National Neonatal Nurse Practitioner Symposium, Daphna sits down with Dr. Michele Savin, NNP program director at Thomas Jefferson University. She shares how a group of CRNA doctoral students challenged the outdated “pump and dump” advice, showing that most anesthetic agents fall well below a 10% relative infant dose and that codeine is the main drug to avoid. T...

Send us Fan Mail This week on The Incubator Podcast, Ben and Daphna dig into four studies testing what simple, evidence-based care looks like at the bedside. They open with a Swedish national cohort of nearly 4,700 very preterm infants, where a three-strain probiotic was linked to a 72% lower risk of death or NEC and near elimination of surgical NEC. Daphna then presents a study of banana puree as a natural thickener for NICU dysphagia, with oral intake reaching full volume within a week. Ben...

Send us Fan Mail What do you reach for when you're called to a delivery at 2 a.m. and the NRP algorithm feels just out of reach? In this episode, Ben sits down with Lily Bachelor, a neonatal nurse practitioner from Colorado who turned her own new grad anxiety into a practical bedside tool. Together with her husband, a graphic designer specializing in signage and wayfinding, Lily created badge-sized neonatal resuscitation reference cards, now updated to the ninth edition of the Neonatal Resusc...

Send us Fan Mail How long should you treat a UTI in an 8-day-old, and when do you really need a VCUG? On this Journal Club, Daphna breaks down the brand-new AAP clinical practice guideline for urinary tract infection in children from 8 days to 5 years, the first update since 2011 and the first to include infants under two months. She walks through the key action statements: a lower culture threshold of 10,000 CFU with evidence of inflammation, age-specific urinalysis criteria, shorter antibio...

Send us Fan Mail What FiO2 should you start at for a 34-week preterm infant who needs help breathing at birth? On this Journal Club, Ben reviews the AIROPLANE trial, a cluster randomized crossover study across 26 Australian maternity hospitals comparing initial FiO2 of 30% versus 21% in 1,818 infants born at 32 to 35 weeks. Ongoing respiratory support leaving the delivery room was nearly identical between groups, but infants started at 30% needed less escalation in the delivery room and less ...

Send us Fan Mail Are you still waiting for a creatinine of 1.5 before calling it acute kidney injury? Recording live from the FANNP National Neonatal Nurse Practitioner Symposium, Daphna sits down with Dr. Terri Marin, NNP and nurse scientist at Augusta University and Children’s Hospital of Georgia, and the first NNP member of the Neonatal Kidney Collaborative. She explains why preterm infants are born mid nephrogenesis, why nearly half of babies under 29 weeks develop AKI, and why KDIGO crit...

Send us Fan Mail What if the sedative you added to spare opioids is the reason your patient is still on them? Recording live from the 2026 National Neonatal Nurse Practitioner Symposium in Clearwater, Florida, Daphna sits down with Dr. Khorshid Mohammad, neonatal neurocritical care expert from the University of Calgary, to preview his three talks. He shares how one small change in rounding language opened up NICU families, why true parent partnership means understanding rather than judging, a...

Send us Fan Mail The Incubator Podcast is coming to you from the sold-out National Neonatal Nurse Practitioner Symposium in sunny Clearwater, Florida! Daphna is joined by her co-host for the week, Dr. Christa Matrone, as they sit down with the speakers, educators, and nurse practitioners shaping the future of neonatal care. From neurodevelopment and pain management to kidney health, breastfeeding, and NNP education, there is so much to learn, and every member of the NICU team has a seat ...

Send us Fan Mail What do you do when a feeder-grower has tried every bottle, nipple, and pacing strategy and still can’t finish a feed? On this Journal Club, Daphna brings a palate cleanser after yesterday’s deep dive on probiotics: a retrospective study from Rainbow Babies & Children’s Hospital testing banana puree as a natural thickener for NICU infants with dysphagia. Among 43 mature preterm infants who had failed standard interventions, oral intake rose from about half of feeds to ful...

Send us Fan Mail Has the evidence on probiotics finally reached a tipping point? On this Journal Club, Ben, fresh off a night shift, opens with two announcements: a follow-up on the ABP’s fellowship length decision and a new partnership with Pediatrix that may finally bring CME to the platform. Daphna highlights the Neonatal Insights conference in Houston. Ben then reviews a Swedish national cohort of nearly 4,700 infants born at 28 to 31 weeks, where a three-strain probiotic was linked to a ...

Send us Fan Mail The American Board of Pediatrics has reversed course. After months of pushback from the neonatology community, the ABP has excluded neonatal-perinatal medicine from the two year fellowship waivers it is now granting to seven other pediatric subspecialties. Neonatology fellowship stays at three years. Ben is joined by Dr. Patrick Myers, past chair of ONTPD and fellowship director at Northwestern, and Dr. Brooke Vergales, ONTPD co-chair, to break down how this happened. They de...

Send us Fan Mail This week on The Incubator Podcast, Ben and Daphna dig into four studies testing what the evidence supports at the bedside. They open with the 24-month BeNeDuctus follow-up, where expectant management and early ibuprofen for PDA yield identical survival without neurodevelopmental impairment. Daphna then presents the Nourish trial, finding individually targeted milk fortification did not improve growth, body composition, or brain MRI outcomes. Next, a Dutch study links probiot...

Send us Fan Mail Does Tylenol in pregnancy cause autism or ADHD? In this edition of Neo News, Ben and Eli break down a major JAMA Internal Medicine study from Hong Kong that followed hundreds of thousands of mother-child pairs and used a sibling-matched design to answer the question. The verdict: no association between prenatal acetaminophen exposure and autism spectrum disorder or ADHD, regardless of timing, pattern, or dose. But data alone doesn't win hearts. The conversation turns to the b...

Send us Fan Mail In this Journal Club episode, Daphna reviews the first national estimate of potential neonatal organ donors, a Pediatrics cohort study from 23 Australian NICUs, along with its companion commentary. Of 1,760 infants who died in the NICU between 2012 and 2022 at 35 weeks corrected age or later, about one in three met conservative eligibility criteria. Most would have donated after circulatory death, and a smaller group with severe HIE could potentially have donated after neurol...

Send us Fan Mail In this Journal Club episode, Ben reviews a JAMA Network Open study from two Dutch Level IV NICUs. It examined NEC before and after routine implementation of a three-strain probiotic in 1,413 infants born before 30 weeks or under 1,000 grams. NEC fell from 11.9% to 5.3%, and late-onset sepsis also declined. But non-NEC mortality rose after implementation. NEC also dropped in an unexposed reference cohort, and one infant died of B. infantis sepsis. Ben and Daphna discuss how b...

Send us Fan Mail In this Journal Club episode, Daphna presents a JAMA Pediatrics randomized trial led by Mandy Belfort and Terrie Inder. It tested whether point-of-care human milk analysis, used to individually target protein and fat fortification, improves outcomes in infants born at 24 to 30 weeks. Milk was analyzed every weekday with the Miris analyzer. Fortification in the intervention group was adjusted to meet protein and energy targets. Growth, body composition by air displacement plet...

Send us Fan Mail In this Journal Club episode, Ben and Daphna review the 24-month follow-up of the BeNeDuctus trial, which compared expectant management with early ibuprofen for PDA in infants born before 28 weeks. Survival without neurodevelopmental impairment was identical in both groups, at 49%. Ben places the findings alongside Baby-OSCAR, the PDA trial, TRIOCAPI, and SMART-PDA, and explains why a neutral result does not mean no PDA should ever be treated. The conversation then turns to h...

Send us Fan Mail Feeding in the NICU is rarely one person's job, yet the language around it changes from nurse to therapist to physician to parent. In this Tech Tuesday episode, Ben and Daphna sit down with Lisa Kleinz and Erin Lesage of Dr. Brown's Medical to unpack feeding together, a philosophy built on team approach, family at the center, and feeding that begins on day one rather than at first bottle. They discuss what separates cue-based feeding from a truly standardized Infant-Driven Fe...

Send us Fan Mail Ben sits down with Dr. Shetal Shah and AAP federal advocacy director Stephanie Glier to unpack HR1, the sweeping reconciliation bill that could cut $1.15 trillion in federal Medicaid spending over the next decade. With 40% of US births and up to 65% of NICU graduates covered by Medicaid, the stakes for neonatology are enormous. Shetal and Stephanie break down state directed payments, provider taxes, shortened retroactive coverage windows, and new work requirements, explaining...

Send us Fan Mail This week on The Incubator Podcast, Ben and Daphna dig into four studies reshaping bedside decisions. They open questioning whether routine DAT screening for ABO and RhD incompatibility still earns its place, finding transcutaneous bilirubin alone predicts phototherapy need just as well. Next, a Swedish national registry of over two million births links missed intramuscular vitamin K, and rising oral substitution, to a near-doubling of bleeding and intracranial hemorrhage ris...

Send us Fan Mail Ben and Eli dig into a Journal of Perinatology study that asks a deceptively simple question: can we trust birth certificate data to tell us how many babies actually need NICU care? The answer, it turns out, is no. Nearly 40% of NICU admissions are missing from birth certificates, with the biggest gaps among full-term and late-preterm infants, and troubling racial disparities in which admissions get missed. Ben and Eli unpack what this means for how states and hospitals alloc...

Send us Fan Mail Ben and Daphna dig into a large, population-based study linking IVF conception to VACTERL association, a rare but serious pattern of congenital anomalies spanning the vertebral, anal, cardiac, tracheoesophageal, renal, and limb systems. Drawing on over 1.5 million births across four US states and linked SART registry data, the study finds IVF-conceived infants face significantly higher odds of VACTERL and related multiple anomaly syndromes compared to naturally conceive...

Send us Fan Mail Ben and Daphna dig into a pilot RCT that asks a deceptively simple delivery-room question: should very preterm infants start on CPAP of 5 or CPAP of 8 cmH2O? The PHILODENDRON trial, out of Milan's Buzzi Children's Hospital, randomized 56 babies born between 26 and 29 weeks to find out — testing feasibility, safety, and early physiological adaptation before committing to a larger multicenter trial. No major safety signals emerged, but babies on lower CPAP reached surfactant th...

Send us Fan Mail Is the newborn vitamin K shot really being skipped more often these days, and does that actually matter clinically? This week on Journal Club, Ben and Daphna review a nationwide Swedish cohort study of over two million births, published in JAMA Pediatrics, examining trends in non-receipt of intramuscular vitamin K and its link to bleeding in infancy. Non-receipt nearly doubled between 2006 and 2021, and infants without intramuscular vitamin K had significantly higher odds of ...

Send us Fan Mail Do we really need a DAT on every baby born to a group O or Rh-negative mother? This week on Journal Club, Ben and Daphna dig into a new Pediatrics study questioning routine Direct Antiglobulin Testing (DAT) in low-risk neonates with ABO or RhD incompatibility. Using data from over 1,300 infants, the authors found that transcutaneous bilirubin alone predicted the need for phototherapy just as well as DAT in ABO-incompatible babies, and that passive anti-D from RhoGAM rarely ca...

Send us Fan Mail In this episode of From the Heart, Drs. Nim Goldshtrom and Adrianne Bischoff talk with Dr. Kristin Elgersma, a nurse-researcher whose path into neonatal nutrition began at her son's bedside in a cardiac ICU. A former concert pianist turned nurse-researcher, Kristin asked a question no one had: does human milk change outcomes for babies with congenital heart disease? Her multicenter PC4 study of day-by-day data from over 800 infants across 25 centers found no link between huma...

Send us Fan Mail In this episode of From the Heart, Dr. Nim Goldshtrom and Dr. Adrianne Bischoff dissect a hemodynamics consult that changes shape twice in 48 hours. A 30-week recipient twin from twin-to-twin transfusion syndrome presents with biventricular dysfunction and suprasystemic pulmonary hypertension, starts on epinephrine and milrinone, and stabilizes. Then overnight, everything falls apart: hypotension, rising lactate, falling urine output. Only on repeat echo does the real diagnos...

Send us Fan Mail Disclosure: Dr. Wanda Barfield appeared on this episode in her personal capacity. The views she expresses are her own and do not represent the official positions of the Centers for Disease Control and Prevention, the Department of Health and Human Services, or the United States government. The American Academy of Pediatrics has never had a neonatologist as president. This September, that could change. In this special episode, Ben sits down with Dr. Wanda Barfield, neonatologi...

Send us Fan Mail This week's Journal Club. Monday, nasal CPAP versus NIPPV as the bridge to minimally invasive surfactant in infants born before 30 weeks, first author Dr. Hui Zhang. Tuesday, the PAEAN trial on high-dose erythropoietin for neonatal HIE, led by Dr. Helen Liley. Wednesday, extended infusion versus bolus feeding for weight gain in extremely-low-birth-weight infants, from Dr. Haribalakrishna Balasubramanian's team in India. Thursday, the DROP-ROP trial, testing dexamethasone eye ...

Send us Fan Mail A medical student on The Pitt finishes her shift, is asked to stay, and tells her supervisor to learn some boundaries. The internet did not let it go. Ben and Eli use that moment to work through what boundary setting actually looks like in a NICU, why a tired clinician makes different decisions at three in the morning than at three in the afternoon, and where duty hours collide with the fact that patients do not arrive on a curriculum. Also, why handing a resident your pager ...

Send us Fan Mail Steroids again? This time in the eye. Daphna brings the DROP-ROP trial from JAMA Pediatrics, a double-masked randomized study across fourteen Swedish centers asking whether topical dexamethasone can stop pre-threshold ROP from progressing to type one disease. One hundred infants, born under 30 weeks, dosed for up to twelve weeks, some still getting drops at home. Twenty percent needed laser or anti-VEGF in the dexamethasone arm versus thirty-eight percent on placebo, a relati...

Send us Fan Mail Every unit has a bolus camp and a continuous camp, and both are usually dug in. Ben brings a single center non-inferiority trial from India, published in the Journal of Pediatrics, randomizing 132 infants born before 29 weeks and under a thousand grams to extended infusion feeding or two hourly bolus feeds. Weight gain at discharge was essentially identical at 15.3 versus 15.7 grams per kilo per day, but the infusion group lost two fewer days to interrupted feeds. Ben and Dap...

Send us Fan Mail We already had HEAL, so why run this trial at all? Daphna brings PAEAN from JAMA Pediatrics, a phase three trial across 24 units in Australia, New Zealand, and Singapore that gave high dose erythropoietin to 313 late preterm and term infants already receiving therapeutic hypothermia for HIE. Same drug, same dosing, nearly the same eligibility criteria as HEAL, by design. Death or moderate to severe developmental deficit at two years was 34 percent with EPO versus 29 percent w...

Send us Fan Mail Most trials comparing CPAP and NIMV leave a lingering doubt about whether surfactant explained the difference. This one does not. Ben brings a multicenter noninferiority trial from JAMA Network Open in infants born between 24 and 29 weeks, randomized to nasal CPAP or NIMV with every baby receiving less invasive surfactant administration. The trial stopped early for futility after 312 infants. Noninvasive ventilation failure within 72 hours was 26 percent on CPAP versus 13 per...

Send us Fan Mail A term newborn looks fine on mom's chest, then crashes within minutes. By the time transport arrives, there's a pH of 6.9, a lactate over 10, and a baby already intubated and on surfactant. Is this pulmonary hypertension, congenital heart disease, or something else entirely? In this episode of From the Heart, It's Complicated, Dr. Adrianne Bischoff and Dr. Nim Goldshtrom work through a real, complex neonatal cardiac case in real time — the kind of case that keeps neonatologis...

Send us Fan Mail Why does reading in the NICU still feel optional when the evidence says otherwise? Daphna sits down with Paige Pedroli, author of the Nic Zoo book and two-time NICU mom, and Dr. Raquel Garcia, a craniofacial and feeding specialist, to unpack why reading to preterm and critically ill infants belongs alongside kangaroo care as neuropromotive, not just neuroprotective. They cover the evidence behind auditory stimulation and language outcomes, why reading gives overwhelmed parent...

Send us Fan Mail Is your EMR actually built for neonatology, or just retrofitted to survive it? Ben sits down with Dr. Lindsey Knake, clinical assistant professor and associate chief health information officer at the University of Iowa, to talk AI in the NICU. They cover the real difference between Epic's homegrown tools and third-party options like Evidently and NABLA, why a six-month hospital stay breaks most chart summarization tools, and how ambient AI is starting to change documentation ...

Send us Fan Mail The full week of Journal Club in one place. Monday, the PLaNT trial of prophylactic CPAP for late preterm infants born by cesarean, with senior author Dr. Edgardo Szyld. Tuesday, whether parental holding during therapeutic hypothermia changes feeding and length of stay. Wednesday, the Connection Study, the first live biotherapeutic product tested under an IND, and what it means for probiotics returning to the NICU. Thursday, a handheld light probe that reads bowel through the...

Send us Fan Mail The respiratory severity score is one multiplication most of us already do in our heads, mean airway pressure times FiO2. This week Dr. Dinushan Kaluarachchi joins Journal Club to walk through three papers built on it, RSS trajectories across gestational age in the PROP cohort, an RSS based grading of BPD at 36 weeks, and RSS after 40 weeks as a predictor of tracheostomy. He also talks about writing that last paper with his son, a high school junior, and why a brief communica...

Send us Fan Mail NEC still tends to announce itself on an X-ray, usually later than we want. This week Daphna reviews the first-in-human study of broadband optical spectroscopy, a handheld transcutaneous probe out of Lurie Children's that reads reflected light from 350 to 2500 nanometers to look at bowel beneath the skin. Just under 100 preterm infants, more than 11,000 scans, and a machine learning model that separated NEC from non-NEC scans with 100% sensitivity and a 100% negative predicti...

Send us Fan Mail Probiotics left US NICUs after the FDA reclassified them, and NEC rates went up. This week Ben reviews the Connection Study, a 2,158 infant phase 3 trial of IBP-9414, a live biotherapeutic product containing Limosilactobacillus reuteri, run under an IND with the regulatory rigor probiotics never had. Neither primary endpoint reached significance, but all cause mortality fell 27%, and surgically confirmed NEC favored treatment after 14 days of dosing. The discussion may be the...

Send us Fan Mail Parents of babies undergoing therapeutic hypothermia often wait days before they can hold their child, and many never get the chance during cooling at all. This week on Journal Club, Daphna reviews a new Journal of Perinatology retrospective cohort from two level IV NICUs, 379 infants with HIE, where 28% were held during cooling. Held infants reached full oral feeds sooner, were more likely to go home on breast milk, and had shorter stays, but they were also less sick to begi...

Send us Fan Mail Late preterm babies born by cesarean fill our NICUs, and most of them are there for respiratory distress that resolves in a day or two. Could 20 minutes of CPAP in the operating room keep them out? This week on Journal Club, Ben and Daphna break down the PLaNT trial, a five center randomized pilot of prophylactic CPAP at 5 to 6 cm of water in spontaneously breathing infants born at 34 to 36 weeks by cesarean. They then sit down with senior author Dr. Edgardo Szyld to talk pne...

Send us Fan Mail When is surfactant "early," and when is it too early, or too late? In this second installment of our two-part series with the Neonatal Resuscitation Symposium, Ben Courchia sits down with Dr. Roger Soll, a leading voice in surfactant research since the 1980s, to trace how our thinking on timing has evolved, from aggressive prophylactic dosing to selective rescue therapy to today's less invasive approaches like LISA and SALSA. Dr. Soll unpacks why head-to-head trials keep favo...

Send us Fan Mail Which babies with critical congenital heart disease face the highest risk of brain injury, and does earlier surgery actually help? Why is infant CHD mortality climbing again after years of decline, and who's most affected? Can a mother's cardiovascular status in preeclampsia predict her newborn's circulatory transition? This week's Journal Club brings together five conversations on CHD, maternal-fetal physiology, and vaccine policy. Nim and Adrianne cover a meta-analysis on b...

Send us Fan Mail In this episode of Neo News, Ben and Eli break down a troubling story in vaccine policy: an unsolicited $1.6 million CDC grant funding a Danish research group's trial in Guinea-Bissau, one designed to withhold or delay the hepatitis B birth dose from thousands of newborns in a country where the disease is highly endemic. They trace the ethical parallels to Tuskegee, the funding irregularities, and the pushback from the Africa CDC that halted the study. They also cover the cli...

Send us Fan Mail In this prospective study, Adrianne and Nim dig into an area with almost no normative pediatric data: right ventricular diastolic function. Comparing 57 infants with RV pressure overload after intervention for pulmonic stenosis or tetralogy of Fallot to 134 healthy controls, the authors found a consistent pattern, reduced beat-to-beat variability, a higher atrial contribution to filling, and an E/A ratio inversion that was nearly universal in the CHD group versus about half o...

Send us Fan Mail In this small prospective pilot study, Adrianne and Nim explore a domain rarely discussed on rounds, how a mother's cardiovascular function in preeclampsia shapes her newborn's circulatory transition. Using maternal echo and neonatal electrical cardiometry across 13 mother-baby dyads, the authors found an inverse relationship: the worse the mother's cardiac function, the higher the neonate's cardiac output, though vascular tone barely budged. It's a compelling hypothesis abou...

Send us Fan Mail In this retrospective national study, Adrianne and Nim look at 25 years of congenital heart disease mortality in the US using CDC WONDER data. Infant mortality remains staggeringly high (54 per 100,000), and after years of steady decline, it has been climbing again since 2014. Disparities run throughout: higher deaths among males, non-Hispanic Black and American Indian/Alaska Native populations, and in rural, Midwestern regions, pointing more to gaps in access and resources t...

Send us Fan Mail In this systematic review and meta-analysis, Nim and Adrianne dig into just how common brain injury really is in neonates with critical congenital heart disease. Pooling 31 studies spanning two decades, the authors found that nearly 70% of these babies show some form of ischemic brain injury, split roughly between pre-operative and post-operative timing. Counter to what most clinicians would predict, kids who went to surgery earlier (days 4-6) had higher rates of white matter...

Send us Fan Mail What if communication were treated as a procedure, something we train for and get feedback on, just like an intubation? In this episode of Neo News, Eli Cahan talks with Dr. Jessica Fry of Northwestern University and Lurie Children's Hospital about her NeoReviews piece, "Recognizing Communication as a Procedural Skill in Neonatology." Dr. Fry shares the personal loss that shaped her career, the ethical stakes of getting family communication right, and how trauma-informe...

Send us Fan Mail How far has delivery room ventilation really come? In this special episode, recorded in collaboration with the Neonatal Resuscitation Symposium, Ben sits down with Dr. Charles Roehr, professor of neonatology and perinatal medicine at the University of Bristol, clinical trialist at the University of Oxford, and member of ILCOR. Together they trace the evolution of respiratory support at birth, from the era of fixed inflation breaths to today's focus on physiologic stability an...

Send us Fan Mail Which PDAs actually need treatment? Can maternal voice and scent shape language outcomes? Should we cool at 35 weeks? And did stepping away from probiotics come at a cost? This week’s Journal Club takes on five papers that push back on standard practice. Ben reviews the SMART-PDA trial and a comparative study of PDA pharmacotherapy, Daphna covers the MIND trial on multisensory maternal interventions and a Pediatrix database study on NEC after the FDA probiotic warning, and Be...

Send us Fan Mail Vitamin K refusal has crossed 5%. That's one in twenty babies, and the curve is bending the wrong way. Ben and Eli work through a new Pediatrics case review that opens with a warning shot, that hemorrhagic presentation in an infant should no longer be a diagnostic mystery, alongside a JAMA letter tracking refusal from 2.9% in 2017 to 5.2% in 2024. Eighty-one times the risk. Intracranial hemorrhage in most late-onset cases. Twenty percent mortality. They talk about the halo ef...

Send us Fan Mail When the FDA warning landed in late 2023, probiotic use in high-use NICUs collapsed from 86% to under 7% almost overnight. What happened to NEC? This week Daphna brings Tolia and Patel's new Journal of Perinatology analysis of the Pediatrix Clinical Data Warehouse, a natural experiment across 347 NICUs and more than 10,000 extremely preterm infants. Centers that stopped saw NEC climb from 2.7% to 4.4%. Centers that never used probiotics saw nothing change. Ben and Daphna work...

Send us Fan Mail Cooling works at 36 weeks. At 35 weeks, nobody is sure. Ben brings a new Journal of Perinatology analysis of the National Inpatient Sample, covering 1.4 million infants from 2016 to 2022, asking what happens when therapeutic hypothermia is offered just below the evidence line. Cooled 35-weekers died at higher rates than cooled 36-weekers, but within the 35-week group, cooling changed nothing either way. Coagulopathy rose with cooling. Mediation analysis says it wasn't the cau...

Send us Fan Mail In this Journal Club, Daphna takes the reins with the MIND randomized controlled trial from Nathalie Maitre and colleagues in The Journal of Pediatrics. Can a multisensory bundle, combining infant-directed voice, a parent's scent, holding, and gentle containment, do more for a preterm baby's developing brain than recorded voice alone? Using event-related potentials to track how infants tell speech sounds apart, the team followed language outcomes all the way to age two. Daphn...

Send us Fan Mail In this Journal Club, Ben and Daphna dig into two new papers on PDA management in our smallest patients. First, the SMART-PDA pilot RCT from Souvik Mitra and colleagues, which uses comprehensive hemodynamic screening to selectively treat high-volume shunts in infants born before 26 weeks, and whose striking Bayesian signal for reduced pulmonary hemorrhage and NEC stopped the trial early. Then a companion JAMA Network Open comparative effectiveness study across four pharmacoth...

Send us Fan Mail In this episode, Ben and Daphna sit down with Dr. Scott, pediatrician, neonatologist, and inventor of the Tortle. She shares how a simple observation in her Idaho practice, babies developing flat heads despite diligent parents, sparked a second career in medical device innovation. The conversation covers the evolution from the original corrective beanie to the Midliner and Transportal, the physiologic rationale for midline positioning in IVH prevention, and real-world data fr...

Send us Fan Mail Does the latest Cochrane evidence finally tip the balance in favor of erythropoiesis stimulating agents in preterm infants? In this VON Grand Rounds follow-up episode, Ben sits down with Dr. Roger Soll and Dr. Souvik Mitra to review the 2026 Cochrane systematic review on early ESA use in preterm newborns. Across 37 trials and over 6,000 infants, early ESAs consistently reduce the need for red blood cell transfusion. The review also confirms with high certainty that ESAs do no...

Send us Fan Mail Neonatal sepsis physiology, steroids, vasopressors, and moms.gov. A full week on The Incubator Journal Club. Adrianne and Nim open with a retrospective study from Toronto challenging the assumption that hypoxemic respiratory failure in septic preterm infants is driven by elevated pulmonary vascular resistance. The data points instead to left ventricular dysfunction as a key contributor, raising questions about the reflex to reach for nitric oxide first. Nim then reviews a dou...

Send us Fan Mail In this episode of Neo News, Ben and Eli discuss the federal government's Mother's Day press conference and the launch of moms.gov, a new website aimed at supporting new and expecting mothers. They examine what the administration got right, including the real barriers families face in accessing maternal care and the economic challenges of having children in America today. They also dig into what the website links to, including Option Line, run by Heartbeat International, an o...

Send us Fan Mail In this double-blind randomized controlled trial, Adrianne and Nim examine whether norepinephrine outperforms dopamine as a first-line vasoactive agent in neonates with fluid-refractory septic shock. The primary outcome, shock reversal at 30 minutes, was not significantly different between groups, at 32 percent for norepinephrine and 46 percent for dopamine. Secondary outcomes including mortality, IVH, NEC, and need for additional vasoactive support were also similar. The epi...

Send us Fan Mail In this double-blind randomized controlled trial from northern India, Nim and Adrianne review whether early hydrocortisone reduces 14-day all-cause mortality in preterm infants with fluid-refractory shock. The primary outcome showed no statistically significant difference between groups, though an 11 percent absolute reduction in mortality in the hydrocortisone group raised clinical interest. A major limitation was the high rate of open-label steroid crossover, with over 70 p...

Send us Fan Mail In this retrospective single-center study from Toronto, Adrianne and Nim explore the echo findings of preterm infants with septic shock and hypoxemic respiratory failure. Contrary to the common assumption that elevated pulmonary vascular resistance drives hypoxemia in sepsis, the data points to left ventricular dysfunction as a key contributor. Babies with hypoxemic respiratory failure showed lower LV systolic and diastolic performance, while pulmonary pressures were similar ...

Send us Fan Mail What would it really mean to shorten neonatology fellowship training to two years? In this episode, Ben and co-host Dr. Shetal Shah sit down with three division heads, Dr. Jill Maron (Brown), Dr. Patrick McNamara (University of Iowa), and Dr. Sarah Taylor (Yale), to examine the ABP's proposed changes from the perspective of those who run major academic NICUs. From the operational and financial strain of losing an entire class of third-year fellows, to the erosion of scholarly...

Send us Fan Mail What does it mean to truly improve outcomes for very low birth weight infants, and are we actually doing it? In this episode, Daphna sits down with Dr. Joseph Kaempf, neonatologist and Medical Director of Value Research and Innovation at Providence Health System in Oregon, to examine some uncomfortable truths about neonatal quality improvement. Dr. Kaempf shares findings from a study spanning 16 NICUs over 14 years showing that composite morbidity outcomes have remained flat ...

Send us Fan Mail Phototherapy duration, jaundice and UTIs, extended CPAP, and The Pitt. A full week on the Incubator Journal Club. Ben opens with a nationwide Swedish cohort study from JAMA Network Open examining phototherapy duration in nearly 5,000 very preterm infants. Longer phototherapy was not significantly associated with late neonatal mortality, but six to seven days was associated with significantly higher rates of severe neonatal morbidity. With 95% of the cohort receiving photother...

Send us Fan Mail In this episode of Neo News, Ben and Eli discuss the cultural phenomenon of HBO Max’s new hit medical drama, The Pitt. Sparked by an insightful critique in The New Yorker by Dr. Dhruv Khullar, they dive into why this Noah Wyle-led series is capturing the attention of millions of Americans, including healthcare workers and patients alike. They explore how the show’s unflinching portrayal of systemic failures, from ER overcrowding to uninsured patients leaving against medical a...

Send us Fan Mail Is five days of antibiotics enough to treat a urinary tract infection in a NICU infant? In this Journal Club episode, Ben and Daphna review a single-center study from Nationwide Children's Hospital examining adherence and safety of a five-day antibiotic treatment guideline for culture and urinalysis-proven UTIs in the NICU. Among 77 infants with 93 bacterial UTIs, the five-day course was associated with a 1% failure rate, defined as reinitiation of antibiotics within seven da...