The Incubator

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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 from a Tennessee children's hospital that cut its IVH rate from 28% to under 6%. She also offers candid advice for clinicians looking to turn...

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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 not increase retinopathy of prematurity. The conversation covers shared decision making, drug selection, dosing, iron supplementation, and which...

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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 double-blind RCT from northern India evaluating early hydrocortisone versus placebo in neonatal fluid-refractory shock. The primary outcome did...

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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 organization with a specific position on abortion, and what that means for the information patients will...

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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 episode critically examines the methodological limitations of the study, including unclear sepsis definitions, absence of echo phenotyping, and unusually high starting doses, and asks whether the field needs better tools before...

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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 percent of both groups ultimately receiving hydrocortisone. The study highlights the difficulty of achieving equipoise when clinicians already believe strongly in a therapy, and raises important questions about study design...

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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 between groups. Mortality was significantly higher in the hypoxemic group. This challenges the reflex to reach for nitric oxide first and asks clinicians to look at the...

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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 development, dwell time, and faculty wellbeing, the conversation makes clear that the costs of this...

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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 while length of stay has increased. He explores why traditional QI tools like driver diagrams and PDSA cycles may no...

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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 phototherapy, Ben and Daphna question how much evidence actually supports the near-universal practice.

Daphna follows with a retrospective study from Istanbul...

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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 advice, mirrors their daily reality in the hospital. Tune in as they discuss whether the shar...

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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 days for the same organism. The episode also explores the potential role of enteral antibiotic therapy and what shorter treatment courses could...

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What happens to intermittent hypoxemia when you keep a stable preterm infant on CPAP for two extra weeks? In this Journal Club episode, Ben and Daphna review a secondary analysis from the Journal of Pediatrics by Mamidi and McEvoy. Among 95 infants randomized to either two additional weeks of bubble CPAP on room air or discontinued CPAP, those in the extended CPAP group experienced significantly fewer intermittent hypoxemia episodes (57.6 versus 151.7), higher baseline saturations, and greater functional residual capacity. The episode also touches on the practical implications for units navigating oral feeding protocols alongside extended...

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In this Journal Club episode, Daphna reviews a retrospective cohort study from Istanbul examining clinical, laboratory, and ultrasound factors associated with UTI in neonates hospitalized for unexplained hyperbilirubinemia. Among 96 term and near-term infants, 31% had culture-proven UTIs, a striking prevalence. Pathological renal ultrasound findings were independently associated with UTI, with affected neonates 4.6 times more likely to have a concurrent infection. Notably, standard laboratory markers including CRP and white blood cell count failed to distinguish UTI-positive from UTI-negative infants. The findings prompt a practical question: should urine culture be part of the routine workup for...

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In this Journal Club episode, Ben and Daphna review a nationwide Swedish cohort study examining the association between phototherapy duration and neonatal outcomes in very preterm infants (22 to 31 weeks). The study’s primary outcome, late neonatal mortality on days 8 to 27, was not significantly associated with phototherapy duration. However, longer phototherapy exposure was associated with increased odds of severe neonatal morbidity, including IVH and BPD, in infants born at 26 to 31 weeks. The findings prompt an important conversation about the near-universal use of phototherapy in preterm neonates and whether current practice warrants reassessment.

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What if closing a PDA could be done at the bedside in under 10 minutes, without transporting a fragile preterm infant to the cath lab? Dr. Shyam Sathanandam, Chief of Cardiovascular Medicine at Nicklaus Children's Heart Institute, joins us to discuss the evolution of transcatheter PDA closure in extremely preterm infants. We cover how bedside procedures protect the most vulnerable neonates, which infants are most likely to benefit from closure, the learning curve and complication profile, and Dr. Sathanandam's vision of eventually training neonatologists to perform this procedure themselves.

Dr. Shyam Sathanandam...

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Opioid withdrawal dosing, intranasal breast milk, human milk fortification in Japan, neonatal dysphagia, and vaccine policy. A full week on the Incubator Journal Club.

Ben opens with the Optimized NOW trial in JAMA: symptom-based dosing reduced time to medical readiness for discharge by nearly two and a half days in NOWS infants managed with Eat Sleep Console, and allowed 65% of pharmacologically treated infants to avoid scheduled opioids entirely.

Daphna reviews a small RCT out of Turkey showing improved cerebral oxygenation and favorable vital sign trends after intranasal breast milk...

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In this fast-paced episode of Neo News, Eli and Ben tackle the rapidly shifting landscape of vaccine regulation and economics in the US. They discuss recent political maneuvers surrounding the Vaccine Injury Compensation Program (VICP) and how expanding liability could quietly push manufacturers out of the market entirely. The hosts also examine the FDA's recent hesitation to review Moderna’s new mRNA flu vaccine, highlighting how these administrative roadblocks threaten the financial viability of developing novel vaccines—including critical immunizations for pediatric and neonatal populations. Tune in for a sharp analysis of how top...

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How often are we missing dysphagia in our most vulnerable NICU patients? In this episode of Journal Club, Daphna reviews a retrospective cohort study from the Journal of Perinatology examining the incidence and risk factors of dysphagia confirmed by flexible endoscopic evaluation of swallowing (FEES) in very preterm and very low birth weight infants. Among infants showing persistent feeding difficulties at 38 weeks post-menstrual age, laryngeal penetration was detected in all infants who underwent FEES, and tracheal aspiration in nearly 60%. Ben and Daphna discuss whether we are naming dysphagia for what it is, whether...

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What does it take to turn a single struggling baby into a national standard of care? In this episode, Ben sits down with Professor Katsumi Mizuno (Showa Medical University) and Dr. Melinda Elliott (Chief Medical Officer, Prolacta Bioscience) to discuss the landmark Jasmine Trial, the first randomized controlled trial of an exclusive human milk diet (EHMD) in Japan. The results: significantly better weight and length gain, fewer antibiotic days, and improved feeding tolerance in very preterm infants. After an eight-year regulatory journey, Japan's Pharmaceuticals and Medical Devices Agency (PMDA) granted Prolacta's human milk-based...

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Japan has some of the best survival rates for extremely preterm infants in the world, yet feeding practices there look very different from what many of us are used to. In this episode of Journal Club, Ben reviews the JASMINE trial, a multicenter phase three randomized controlled trial evaluating an exclusive human milk diet compared to a standard cow milk-based diet in very low birth weight infants in Japan. Infants on an exclusive human milk diet gained weight significantly faster, reached full feeds six days sooner, and had fewer antibiotic days. Ben then...

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Could putting a few drops of breast milk in a preterm infant's nose actually improve cerebral oxygenation? In this episode of Journal Club, Daphna reviews a randomized controlled trial from the European Journal of Pediatrics investigating the physiologic effects of intranasal expressed breast milk (EBM) administration in preterm infants. The study found that infants receiving 0.2 mL of fresh breast milk intranasally three times daily showed significantly higher cerebral oxygenation levels, along with more favorable trends in heart rate and respiratory rate, compared to controls. While time to full oral feeding and length of...

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One infant is diagnosed with neonatal opioid withdrawal syndrome every 27 minutes, and rates are rising. In this episode of Journal Club, Ben and Daphna review the Optimized NOW randomized clinical trial, a landmark multicenter study published in JAMA. The trial compared symptom-based dosing,  a single opioid dose given when a withdrawal threshold is met against the traditional scheduled opioid taper in infants managed with Eat Sleep Console. The results are striking: symptom-based dosing reduced time to medical readiness for discharge by nearly two and a half days, and 65% of pharmacologically treated infants avoided s...

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The NICU is one of the loudest environments a newborn will ever experience, yet it is also where the most vulnerable infants spend their earliest, most developmentally critical days. In this Tech Tuesday episode, Ben and Daphna sit down with Gabby Daltoso and Sophie Ishiwari, co-founders of the Sonura Beanie. Their device tackles two pressing NICU challenges at once: harmful noise exposure and disrupted parental connection. By embedding a low-pass filtration system tuned to the acoustic environment of the womb into standard hospital beanies, Sonura attenuates high-frequency alarms while preserving the frequency of...

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Every neonatologist has built a protocol or written a guideline, and most have done it completely alone. In this episode, Ben sits down with Dr. Christina Muffy Sollinger (UC Davis) and Dr. Sarvin Ghavam (CHOP), the co-founders of NeoGuide, a national collaborative dedicated to connecting clinicians around the shared work of clinical guidelines and practice pathways. Born from a single email that broke a listserv and generated over 120 responses overnight, NeoGuide has grown into a structured community offering a seminar series on topics like transfusion medicine and HIE management, and a curriculum series...

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Cerebral oxygenation, staffing economics, delivery room scoring, neurodevelopmental prognostication, and public health — a full week on the Incubator Journal Club.

Ben walks through the NIRTURE trial, a single-device RCT testing cerebral oximetry-guided care in infants born under 29 weeks. The intervention dramatically reduced the burden of cerebral hypoxia and hyperoxia compared to standard care. Secondary clinical outcomes were neutral and neurodevelopmental follow-up is still pending. The question of whether stabilizing cerebral oxygenation actually moves the needle for these babies remains unanswered.

Daphna covers a brief communication fr...

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In this episode of Neo News, Ben and Eli tackle the recent, quiet—but massive—public health funding cuts implemented by the Department of Health and Human Services. With $600 million pulled back from four targeted states and additional CDC block grants eliminated, they discuss the severe domestic implications for local health departments, HIV/STI surveillance, and lead poisoning prevention. They also zoom out to examine the global health consequences of the US withdrawing from the WHO. Tune in as the hosts break down why these macro-level policy shifts directly impact the frontlines of neon...

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In this episode of Journal Club, we wrap up a marathon recording session with a deep dive into the world of neonatal neuroprognostication. Daphna reviews a systematic review and meta-analysis from Pediatric Neurology that evaluates whether combining EEG and MRI provides better answers for families of preterm infants. While MRI remains a powerful tool for structural assessment, the data suggests that adding the functional insights of EEG significantly boosts specificity, particularly when predicting severe neurodevelopmental outcomes. We discuss the importance of timing these studies and the clinical value of sleep-wake cycling as a...

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Ben kicks things off with a major career update before we dive into a critical study from JAMA Network Open. We explore the predictive value of the five minute Apgar score when combined with umbilical artery pH in very preterm infants. While the Apgar score was originally designed for term babies, this analysis of the EPICE cohort reveals its enduring utility even in the smallest patients. We discuss how these two measures interact, which one "wins" when they conflict, and why the clinician assessment remains a powerful predictor of mortality and severe morbidity...

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Is your NICU considering the shift to 24 hour in house attending coverage? In this episode of Journal Club, we explore a provocative brief communication from the Journal of Perinatology. Ben and Daphna discuss the impact of moving from home call to on site presence at UC Davis. While the change was intended to improve patient care, the data reveals a surprising 15 percent decrease in work RVUs. We examine how proactive weaning and bedside presence might actually lower billing levels under current CPT codes. Are we being penalized for doing the right thing for...

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In this episode of Journal Club, Ben and Daphna dive into the results of the NIRTURE trial, recently published in JAMA Network Open. Building on the lessons of SafeBoosC 3 , the NIRTURE investigators aimed to reduce the burden of cerebral hypoxia and hyperoxia in extremely preterm infants using a standardized NIRS guided treatment protocol. While the study showed a dramatic improvement in maintaining cerebral normoxia, driven largely by a reduction in hyperoxia , the clinical outcomes before discharge remained neutral. Join us as we discuss whether regional oximetry is a must have bedside tool or...

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The American Board of Pediatrics (ABP) recently announced a move toward competency-based subspecialty training that would shorten fellowships — including neonatology — from three years to two. The proposal has sent shockwaves through the training community. In this episode, Daphna sits down with three leaders from the Organization of Neonatal Perinatal Training Program Directors (ONTPD): Dr. Patrick Myers from Northwestern, Dr. Heather French from the Children's Hospital of Philadelphia, and Dr. Melissa Scala from Stanford. Together, they break down what competency-based medical education actually means in practice, why the math simply doesn't add up when appl...

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Dr. Benny Rossner, PGY-2 pediatrics resident and veteran physician recruiter with 15 years of experience building clinical teams across the country, joins Ben and Rupa for a candid look at the neonatology workforce from a side of the conversation trainees rarely hear. He breaks down why demand for neonatologists is rising — sicker and younger patients, a shrinking APP pipeline into high-acuity specialties, and hospitals stretching budgets on locums before finally raising permanent salaries — and why fellows coming out of training have more negotiating power than they typically realize. He also shares practical advice on cont...

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Dr. Daniel Rauch, PAS 2026 program chair, joins Ben for a behind-the-scenes look at what it takes to pull off a conference of this scale — and what he's learned from this year's record-breaking attendance in Boston. He reflects on the sessions that packed rooms beyond capacity, from the Tiny Baby Collaborative to AI in pediatrics, and shares what's on the horizon for PAS 2027 in Minneapolis and PAS 2028 in Vancouver. He also makes the case for why PAS remains uniquely valuable for trainees and early career clinicians — not just for the science, but for the cros...

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Dr. Kristen Leeman and Dr. Jonathan Levin join Ben to debrief a packed interactive session on tracheostomy timing and counseling for babies with severe bronchopulmonary dysplasia (BPD). Using iterative cases and live audience polling, they mapped the wide variability in practice across the country — finding rough consensus that tracheostomy conversations become likely around 44 to 48 weeks post-menstrual age for intubated infants and 48 to 52 weeks for those on non-invasive ventilation, with key comorbidities like pulmonary hypertension, poor growth, and neurological injury shifting the calculus significantly. Families who participated in the session delivered a powerful message: th...

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Dr. Gabriel Altit and Daniela Villegas from the NeoCardioLab at Montreal join Ben and Rupa to reflect on a packed PAS filled with hemodynamics science — from pulmonary hypertension phenotyping to heart-brain interactions in the golden hour. Dr. Altit makes the case that just as neonatology learned to embrace gentle ventilation, it is time to think about gentle hemodynamics — intervening thoughtfully, recognizing different clinical phenotypes, and knowing when to remove interventions before they carry a price. He also previews early 3D echo data suggesting that a single clip at day 7 to 10 of life may alre...

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Dr. Rangasamy Ramanathan, division chief at Cedars-Sinai Guerin Children's Hospital and one of neonatology's most prolific investigators, joins Ben to share what's keeping him busy — 14 active clinical trials including studies on IGF-1 for lung injury prevention, oral insulin for weight gain, and the upcoming phase three trial of aerosolized surfactant. He reflects on what has sustained his passion through decades of work, from training a third of California's neonatologists to launching Southern California's first NeuroNICU with 24-7 neurology coverage and in-house whole genome sequencing. He also previews his next innovation — the ROM Smith vent...

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Dr. Surabhi Aggarwal, neonatologist at Stony Brook University, joins Ben and Rupa to share five years of experience building a LISA — Less Invasive Surfactant Administration — program from the ground up at her institution. She walks through the obstacles of getting IRB approval, gaining clinical buy-in from colleagues comfortable with intubation, and how the introduction of video laryngoscopy was the turning point that finally got the practice off the ground. She shares early results showing that 30% of eligible babies received surfactant via LISA rather than intubation, discusses the technical nuances of catheter placement and conf...

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Dr. Indrani Bhattacharjee, neonatologist and POCUS program director at Tufts Medical Center in Boston, joins Ben to discuss a fascinating and largely unexplored frontier — intestinal ultrasound in healthy preterm infants. Rather than waiting for NEC to appear, her team has been systematically scanning babies born under 32 weeks every week from one week of age until eight weeks or discharge, building what may be the first normative dataset for bowel wall thickness in this population. Early findings are already challenging the standard radiological definitions, showing that extremely preterm babies have thinner bowel walls than cu...

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Dr. Thais Queliz, neonatologist at Winnie Palmer Hospital in Orlando, presents ten years of data from one of the country's highest-volume programs caring exclusively for babies born at 22 to 24 weeks. She shares how survival rates for 22 and 23-weekers climbed from 40% before the Tiny Baby program launched to 67% overall — and 72% over the last two years — driven by institutional alignment, standardized protocols, and a dedicated multidisciplinary team. She also presents Golden Hour data showing a jump from 8% to 75% completion rate after implementing strict checklists and role-defined workflows that cut average admission time from nearly two hour...