The Incubator

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This week on The Incubator Podcast, Ben and Daphna review several recent studies in neonatal care. They start with a JAMA trial comparing expectant versus active PDA management in preterm infants, noting a survival signal favoring expectant care and discussing how this fits within current practice. They then review outcomes of 21-week gestation infants from the University of Iowa, focusing on resuscitation strategies and survival at the limits of viability.

The conversation continues with the ICAF trial, examining whether extending caffeine therapy through 41 weeks postmenstrual age meaningfully reduces intermittent hypoxia and...

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In this episode of Neo News, Ben, Daphna, and Eli tackle the complex and emotionally charged landscape of legal liability in the NICU. Following a recent $32 million settlement involving necrotizing enterocolitis (NEC) and cow's milk-based formula, the team debates the future of informed consent for routine nutritional care. They explore how legal precedents may force neonatologists to replace bedside counseling with transactional forms, potentially eroding trust and complicating evidence-based practice. Join us as we discuss how to balance transparency, parental autonomy, and the reality of risk in the pursuit of better outcomes for...

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In this Journal Club episode, Ben and Daphna review a large national cohort study examining the association between antenatal corticosteroid exposure and survival in extremely preterm infants born between 21 and 24 weeks’ gestation. They discuss biologic plausibility, practice variation, and the challenges of interpreting retrospective data, while focusing on how these findings may inform counseling and shared decision-making at the margins of viability.

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The Effects of Antenatal Corticosteroids on Extremely Premature Neonates Born between 21 and 24 Weeks. Yao R, Tritch N, Vedhanayagam K, Ali N, Reimche-Vu H, Gedestad I, Karageuzian S...

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Ben and Daphna review the ICAF randomized clinical trial evaluating extended caffeine therapy in preterm infants and its impact on intermittent hypoxia through 41 weeks postmenstrual age. They discuss the study design, oximetry outcomes across multiple saturation thresholds, inflammatory biomarkers including TNF-α, and clinically relevant safety signals such as oxygen restart rates, length of stay, and weight gain. The conversation focuses on what intermittent hypoxia may mean for ongoing risk, and whether a targeted subgroup of infants might benefit from extending caffeine beyond traditional stopping points.

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Intermittent hypoxia and c...

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In this Journal Club episode, Ben and Daphna review a salient study from JAMA Network Open examining outcomes of infants born at 21 weeks’ gestation at the University of Iowa. They walk through resuscitation practices, early physiologic challenges, survival trends, and short-term developmental outcomes, while placing the data in the broader context of shifting limits of viability. The discussion highlights both cautious optimism and the many unanswered questions that remain as neonatology continues to push the boundaries of what is possible.

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Outcomes of Infants Born at 21 Weeks' Gestational Age. Hy...

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In this Journal Club episode, Ben and Daphna review a major randomized clinical trial published in JAMA comparing expectant management with active pharmacologic treatment of patent ductus arteriosus in preterm infants. They walk through the trial design, inclusion criteria, and outcomes, highlighting the unexpected survival difference favoring expectant management despite similar rates of bronchopulmonary dysplasia. The discussion explores the implications for bedside decision-making, the limitations of PDA-focused strategies, and the need for a more physiologic, patient-centered approach to ductal management in extremely preterm infants.

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Expectant Management vs Medication...

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In this episode of Beyond the Beeps, Leah MG Jayanetti discusses the unique challenges faced by families in the NICU during the holiday season. Joined by Alena Costume, a two-time NICU mother, they explore the emotional rollercoaster of having a baby in the NICU, the importance of community support, and strategies for coping with stress. Alena shares her personal experiences, highlighting the significance of parental presence and the impact of healthcare staff on the NICU journey. The conversation emphasizes resilience, hope, and the need for better support systems for NICU families. In this...

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As 2025 comes to a close, Ben and Daphna reflect on a year of growth, community, and evolution for The Incubator Podcast. In this end-of-year wrap-up, they preview major changes coming in 2026, including new standalone podcast feeds, expanded journal club content, CME opportunities, and exciting partnerships with organizations like the Vermont Oxford Network and PAS. They also share what’s ahead for the Delphi Conference and offer a candid look at their personal and professional goals for the year ahead. Thank you for being part of this extraordinary neonatal community.

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Transitioning from fellowship to your first attending job? You're probably not prepared for the business side of medicine—and that's exactly the problem Dr. Tung Giep addresses in this episode. Dr. Giep, a neonatologist with over 30 years of experience, shares hard-earned lessons from building and selling a private practice in Houston, navigating toxic work environments, and eventually finding his place in telemedicine. His new book, The Business of Medicine: The Definitive Guide to Help New Physicians Start Their Career on the Right Path and Avoid Costly Mistakes, tackles what medical training ignores: contract ne...

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In this Journal Club episode, Ben and Daphna review five recent studies with practical implications for neonatal care. The FEED1 trial examines whether starting full milk feeds from day one is safe in 30-32 week preterm infants, finding no difference in length of stay compared to gradual feeding but fewer central line days. A brief communication from UAB explores high-volume feeding strategies (≥170 ml/kg/day) and their impact on body composition in very preterm infants.

The hosts discuss a mannequin study from Italy measuring forces applied during intubation with different laryngoscope ty...

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Maternal Psychological Distress Before and After Childbirth and Neurodevelopmental Delay in Toddlers.

Matsumura K, Tanaka T, Kuroda M, Tsuchida A, Hatakeyama T, Kasamatsu H, Inadera H; Japan Environment and Children’s Study Group.JAMA Netw Open. 2025 Oct 1;8(10):e2540907. doi: 10.1001/jamanetworkopen.2025.40907.PMID: 41171271 Free PMC article.

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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...

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Full exclusively enteral fluids from day 1 versus gradual feeding in preterm infants (FEED1): a open-label, parallel-group, multicentre, randomised, superiority trial.

Ojha S, Mitchell EJ, Johnson MJ, Gale C, McGuire W, Oddie S, Hall SS, Meakin G, Anderson J, Partlet C, Su Y, Johnson S, Walker KF, Ogollah R, Mistry H, Naghdi S, Montgomery A, Dorling J; FEED1 collaborative.Lancet Child Adolesc Health. 2025 Dec;9(12):827-836. doi: 10.1016/S2352-4642(25)00271-8. Epub 2025 Oct 17.PMID: 41115446 Free article. Clinical Trial.

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Early body composition outcomes of infants born very preterm and receiving high volume, human milk feedings (≥170 ml/kg/day) before postnatal day 14.

Gunawan E, Molleti M, Salas AA.J Perinatol. 2025 Oct 31. doi: 10.1038/s41372-025-02469-w. Online ahead of print.PMID: 41174086 No abstract available.

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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: @drnicu and @do...

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Applied forces during neonatal intubation with direct and video laryngoscopy at different bed elevations: a randomized crossover manikin study.

Cavallin F, Pasquali G, Maglio S, Villani PE, Menciassi A, Tognarelli S, Trevisanuto D.Eur J Pediatr. 2025 Nov 5;184(12):732. doi: 10.1007/s00431-025-06524-8.PMID: 41191125 Free PMC article. Clinical Trial.

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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...

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Treatment of Hypotension of Prematurity: a randomised trial.

Alderliesten T, Arasteh E, van Alphen A, Groenendaal F, Dudink J, Benders MJ, van Bel F, Lemmers P. Arch Dis Child Fetal Neonatal Ed. 2025 Dec 15;111(1):F60-F66. doi: 10.1136/archdischild-2024-328253.PMID: 40413017 Clinical Trial.

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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: @drnicu and @doctordaphnamd. The papers...

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Antenatal Prediction of Early Cord Clamping among Infants Born Extremely Preterm.

Katheria A, Dorner RA, Grobman W, Rysavy MA, Koo J, Wyckoff MH, Sandoval G, DeMauro SB, Das A, Lee HC, Cotten M, Calvo L, Saha S; Eunice Kennedy Schriver National Institute of Child Health and Human Development Neonatal Research Network.J Pediatr. 2025 Oct 31:114878. doi: 10.1016/j.jpeds.2025.114878. Online ahead of print.PMID: 41177398

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As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the...

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In this episode of the Incubator, Betsy Crouch and David McCulley interview Dr. Wendy Chung, a leader in clinical genetics and child health research. They discuss her journey into genomics, the challenges faced in her career as a physician scientist, the importance of early mentorship, and her research interests, particularly in congenital diaphragmatic hernia (CDH). Dr. Chung shares insights on the complexities of genetic disorders and the need for innovative approaches in treatment and diagnosis. She discusses her experiences with newborn screening and the evolution of genetic screening for rare diseases, emphasizing the...

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Three third-year fellows present diverse research at Hot Topics. Juhi from University of Illinois in Chicago demonstrates lung ultrasound's potential to predict respiratory support duration in 30+ week infants, with first six-hour exams showing strongest correlation—suggesting possible replacement for admission chest x-rays. Tanima from Boston Children's applies large language models to extract IVH prognostic variables from AI literature, identifying critical gaps including absence of resolution prediction studies. Hailey conducts qualitative research on physician experiences with NICU mortality/morbidity, identifying three impactful loss categories: outcome-expectation mismatches, meaningful relationships, and weight of responsibilities. Their work ex...

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Dr. Jeffrey Gould and Dr. David Stevenson recount founding California Perinatal Quality Care Collaborative (CPQCC) in the mid-1990s, transforming California's fragmented perinatal care system. Initial success required organizational development expertise—not just databases—to transform stakeholders into partners by identifying mutual value. They created California Association of Neonatology, secured Packard Foundation support, and unified competing academic centers and private practitioners. CPQCC's disciplined approach—pods meeting biweekly, shared data, non-hierarchical teams—contributed to California achieving the nation's lowest maternal mortality while national rates climb. Gould emphasizes quality improvement as structural intervention building relationships and impr...

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Dr. Elizabeth Foglia, University of Pennsylvania/Children's Hospital of Philadelphia and scientific PI for AAP's DRIVE (Delivery Room Intervention and Evaluation) Network, discusses building a 3,000-hospital US collaboration to understand real-world delivery room practices. Despite robust evidence supporting supraglottic airways for PPV in infants 34+ weeks, surveys show minimal provider use—representing a significant evidence-to-practice gap. The SUGAR trial compares implementation strategies to increase adoption using hybrid effectiveness-implementation design. DRIVE currently includes 50 hospitals with diverse delivery room configurations, providing infrastructure for pragmatic trials, quality improvement, and benchmarking. First network-wide meeting launches multi-center QI project in...

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 In this episode of The Incubator Podcast, recorded live at Hot Topics in Neonatology in Washington, DC, we sit down with Dr. Daniele De Luca, Chief of Pediatric and Neonatal Critical Care at AP-HP Paris-Saclay University and leader of one of Europe's largest NICUs. Dr. De Luca discusses the groundbreaking Lancet Child & Adolescent Health Commission on the Future of Neonatology, a three-year initiative involving over 100 global key opinion leaders addressing the critical innovation gap in our specialty. He explores why neonatal medicine has experienced a slowdown in therapeutic advances since the 1990s, despite t...

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Dr. Matthew Laughon, Professor at University of North Carolina and NICHD Neonatal Research Network investigator, presents the landmark PDA Management Trial comparing expectant management versus active medical treatment (indomethacin, ibuprofen, or acetaminophen). The trial stopped early due to futility and safety concerns—mortality exceeded 10% in the treatment group versus 4% with expectant management, with more infection-related deaths among treated infants. Secondary outcomes (BPD, NEC, ROP) showed no differences. The study included infants with symptomatic PDAs but excluded those with severe cardiopulmonary compromise. Findings support expectant management for symptomatic PDAs through 21 days of life, aligning wi...

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Nicole and Maureen from Lactalogics present innovative donor human milk processing using gentle ultra-high temperature pasteurization—exposing milk to heat for only 10 seconds versus 30-40 minutes with traditional methods. Their tube-in-tube system (milk and steam traveling opposite directions) maintains safety by eliminating pathogens while better preserving inherent nutrients. Products launching April 2026 include shelf-stable options for term infants (20 cal, 1.1g protein/100mL) and preterm infants (20 cal, 1.6g protein/100mL), plus a human milk fortifier reaching 24 calories. Donor moms require rigorous screening and 500+ ounce surplus. The shelf-stable format supports both in-hospital use and post-discharge bridging wh...

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Dr. Michael Narvey, neonatologist and Vice President of Canadian Pediatric Society, challenges the validity of pre-discharge car seat testing. After leading Canadian work resulting in nationwide abandonment of the test in 2016, he argues the test doesn't represent real-world conditions (potholes, movement) and lacks evidence demonstrating it saves lives from apnea or desaturations. Based on 50 years of autopsy data, rare car seat-related deaths result from unsupervised asphyxiation when infants slide down onto straps—not from events in moving vehicles. Narvey distinguishes between eliminating the test versus maintaining essential car seat safety education, emphasizing proper po...

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Dr. Elaine Boyle, Professor of Neonatal Medicine at University of Leicester, presents the SURFON trial evaluating early surfactant versus expectant management in 34-38 week infants with respiratory distress. This pragmatic trial enrolled infants requiring 30-45% oxygen or non-invasive support. Primary outcomes showed no difference in hospital length of stay or progression to severe respiratory disease. Early surfactant reduced NICU duration and non-invasive support by less than one day each, with borderline pneumothorax increase requiring treatment of 80+ infants to prevent one case. Findings suggest watch-and-wait approaches remain safe and reasonable for this population, though...

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Dr. Shalini Ojha, Professor of Neonatal Medicine at University of Nottingham, presents the Feed One trial examining full enteral feeding (60 mL/kg/day) from day one versus gradual advancement in 30-32 week infants. While the primary outcome of hospital length of stay showed no difference (median 32 days), full feeding significantly reduced parenteral nutrition use, IV cannulations, and associated interventions without increasing necrotizing enterocolitis risk (4 versus 6 cases). This pragmatic trial challenges the unfounded fear that early full feeding causes NEC—demonstrating that moderate preterm infants can safely receive complete enteral nutrition from birth, simplifying ca...

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Three first-year fellows from University of Virginia—Jamie, Megan, and Brianne—share their Hot Topics conference experience. Despite being early in training, they engage deeply with cutting-edge research across diverse interests: POCUS and hemodynamics (Jamie), ENT non-surgical interventions (Brianne), and neurodevelopmental outcomes with Tiny Baby projects (Megan). They value learning from practice variation across institutions, particularly regarding fluid management and humidity protocols. Rather than finding evidence gaps discouraging, they're inspired by opportunities for future research. They plan to share conference insights through journal club upon returning to UVA. The fellows emphasize how accessible and...

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Dr. Pankaj Agrawal, Division Chief of Neonatology at University of Miami, discusses rapid genomic advances—from six-month diagnostic timelines in 2000 to same-day sequencing today. While current practice targets phenotype-based testing for unexplained conditions or dysmorphic features, Agrawal advocates moving toward universal NICU sequencing to identify previously unrecognized conditions. Key barriers include administrative buy-in, cost concerns, consent processes, and result disclosure challenges. Even negative results provide value—offering families reassurance and contributing to research databases. With only 5,000 of 20,000 genes linked to human disease, ongoing gene discovery work continues. Agrawal emphasizes the NICU as ideal for...

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Dr. Kavya Rao from University of Buffalo discusses quality improvement initiatives following completion of her master's in QI. Her team successfully implemented antibiotic stewardship by safely discontinuing antibiotics at 24 hours for early onset sepsis in clinically well infants with negative blood cultures, initially studying all gestational ages with plans for subset analysis. Additional projects include reducing PRBC and platelet transfusions using lower thresholds based on updated guidelines. Rao emphasizes finding QI topics through clinical passion and data-driven identification of performance gaps, using benchmarking with Vermont Oxford Network data. She co-mentors fellows in QI...

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Dr. Ariel Salas, recent R01 recipient, discusses challenging traditional feeding volume targets in preterm infants. His multi-center trial compares 180-200 versus 140-160 mL/kg/day volumes, examining body composition changes rather than weight alone. Salas emphasizes targeting fat-free mass gains over simple weight gain, as this component associates with better long-term neurodevelopmental outcomes. Body composition analysis reveals compartmental changes invisible to daily weights—distinguishing extracellular versus intracellular water shifts. This outcome provides reasonable compromise between immediate intervention effects and long-term results. Salas advocates acknowledging practice variation as opportunity for equipoise and fair testing, ch...

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Julie Raskin, representing Congenital Hyperinsulinism International (CHI), advocates for universal newborn glucose screening following her son's brain injury from undiagnosed hyperinsulinism in 1996. Registry data reveals 28% of affected infants lack traditional risk factors (abnormal birth weight), and even high-risk babies are often discharged inappropriately. CHI's "Glucose is a Vital Sign" campaign promotes screening protocols currently under research, examining glucose plus ketone monitoring during initial days to identify affected infants without over-medicalizing healthy newborns. The organization maintains eight centers of excellence globally and provides international treatment guidelines at congenitalhi.org. Over 30 genes cause this diagnosable...

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Dr. Edgardo Szyld from Indiana University presents the PLANT study evaluating 20 minutes of prophylactic CPAP for late preterm infants (34-36+6 weeks) born via cesarean section. This population represents 70% of US preterm births and experiences five times higher respiratory distress rates with cesarean delivery. The pragmatic pilot enrolled 100 patients, demonstrating reduced NICU admissions without pneumothorax cases—addressing previous safety concerns from observational data. Szyld's team is planning PLANT 2, targeting 35-36 weekers across 11 international centers, which will compare outcomes with and without antenatal steroids. This pragmatic approach addresses a high-volume but understudied population significantly impacting NI...

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Dr. Ravi Patel, Professor at Emory University and Chair of the Georgia Perinatal Quality Collaborative, examines the tension between quality improvement and evidence-based medicine. He argues NICUs should prioritize high-certainty interventions (antenatal steroids, delayed cord clamping) rather than standardizing practices based on low-certainty evidence. Using tools like GRADE to assess evidence certainty helps determine when standardization is appropriate versus when practice variation allows for shared decision-making. Patel advocates re-energizing evidence generation as improvement in common morbidities has stalled. Examples like Eat Sleep Console demonstrate the value of prospective evaluation when adopting new practices...

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Dr. Clara Song, Chair of the AAP Section on Neonatal-Perinatal Medicine, discusses urgent workforce challenges facing neonatology. With average neonatologist age around 50-55 and stable fellowship applications despite growing positions, the field faces potential shortages. The section launched initiatives addressing fair compensation, including a new website comparing negotiated commercial payer rates across states and engaging state chapters for payer advocacy. Song highlights concerning trends where neonatologist productivity increased while compensation decreased as the field became female-dominated. She discusses the section's comprehensive staffing toolkit and proposes restructured training pathways—potentially shortened residency with targeted 2-5...

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Dr. Divya keerthy (New York Presbyterian Queens/Weill Cornell Medicine) and Dr. Katherine Nyman (UCSD/Rady Children's, San Diego) discuss their Hot Topics conference experience. Keerthy presents research on prenatal polycyclic aromatic hydrocarbon exposure measured via backpack monitors and silicone wristbands during the third trimester. Her longitudinal study tracked infant microbiome at three time points over six months, identifying two air pollutants affecting microbiome development. Nyman highlights interest in the Tiny Baby collaborative, particularly PDA management challenges in extremely premature infants. Both emphasize the value of Hot Topics' evidence-based sessions including "green and...

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Dr. Louise Owen from Royal Women's Hospital Melbourne presents the AEROPLANE trial comparing 21% versus 30% oxygen for 32-35 week infants at birth. This understudied cohort represents 80% of preterm births globally. Using cluster randomization with waived consent, the trial captured real-world practice across centers. Infants receiving 30% oxygen required less delivery room intervention including assisted ventilation, intubation, and chest compressions. Three-quarters of infants needing initial support continued requiring respiratory support beyond delivery. Both groups ultimately received average oxygen in the 50s, suggesting moderate preterm infants may behave more like very preterm rather than term babies regarding...

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Dr. Katherine P Callahan, neonatologist and bioethicist at Children's Hospital of Philadelphia, discusses the complexity of genetic testing in neonatal care. While the NICU serves as a launch point for genetic technologies due to high prevalence of genetic disease, genetic information is often ambiguous or uncertain rather than straightforwardly diagnostic. Variants of uncertain significance represent just one challenge—even clearly pathogenic findings may have unclear implications for individual patients, as demonstrated when parents carry the same mutation as their severely affected child. Callahan emphasizes that genetic information poses "informational hazards" requiring careful consideration of...

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In this episode, Dr. Andrew Beverstock discusses his research on urinary sodium and its relationship with growth in preterm neonates. He shares insights into the importance of sodium for neonatal growth, the methodology of his study, and the unexpected results that challenge existing literature. The conversation also touches on his diverse medical training, mentorship experiences, and his involvement in medical education and point-of-care ultrasound (POCUS). Dr. Beverstock emphasizes the significance of careful population selection in research and outlines his future research directions.

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In this episode, Mandy Daly shares her profound journey as a NICU parent and her advocacy work through the Irish Neonatal Health Alliance (INHA). She discusses the emotional challenges faced by parents of preterm infants, the importance of family-centered care, and the need for systemic changes in neonatal healthcare. Mandy emphasizes the significance of building support networks, empowering families through education, and the impact of lived experiences in shaping healthcare policies. The conversation highlights the collaborative efforts required to improve outcomes for families navigating the complexities of neonatal care.

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In this episode, Leah Jayanetti speaks with Keira Sorrells, founder of the NICU Parent Network, about her personal journey through the NICU experience with her triplets and the advocacy work she has undertaken to support NICU families. They discuss the importance of family-centered care, the NICU Babies Bill of Rights, and the emotional challenges faced by parents in the NICU. Kira shares her insights on healing through storytelling and the need for self-care among NICU leaders, emphasizing that hope is an expression of love, regardless of the outcomes.

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