The Incubator

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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 unit to unit, staffing shortages, burnout, and retention concerns. With only 250 to 300 NNPs graduating each year, they...

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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 around “PAP before push” and PPV before the blade. The changes improved first-attempt success and reduced adverse events, but severe desaturations remained stubborn...

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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 emotional workload matters alongside physical and cognitive workload. He shares how human factor...

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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 pitcher of water. She shares the personal warning signs she watches for, why clinicians try to go it alone, and ho...

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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 each entry, how the CHNC Fetal Therapy Focus Group peer reviews it, and how physician artists create or...

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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 the procedure. He shares outcomes from the first five patients in the phase 1 FDA trial, including babies discharged within days, an...

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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.

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As always, feel free to send us questions, comments, or suggestions to our email: [email protected]. 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 discussed in to...

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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 depending on one champion per unit isn’t enou...

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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, and that willingness to offer ECMO varies widely by diagnosis. They explain the importance of multidisciplinary prenatal pl...

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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, and respiratory therapists brings continuity for families, why they’ve stopped making knee-jerk changes base...

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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, vascular access, nutrition, and when to start. Dr. Slagle shares the lesson of a baby who got too cold on dia...

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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 to palliative care. Parents, meanwhile, often perceive information sharing as a response to emotion. She offers practical advice for an...

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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 prefer to listen or watch.

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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, where a single unplanned extubation at 3 a.m. can undo weeks of pro...

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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 screened because their attending judged them at risk. Among 5,700 screened infants, 7.2% had ROP, and risk factors included gestat...

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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, battery power that keeps warming through transport, and the ability to sit over a...

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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 demand library for those who couldn’t attend, and year round education through Facebook Live and YouTube. He a...

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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 the ground up, determines whether any guideline works.

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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 and neonatologists are partners, not competitors, and call on the neonatal community to invest...

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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, and why matters, and why she disagrees that less is more in charting...

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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 conversation then turns to simulation, where Nicole shares why debriefing is the single most critical step, how video playback an...

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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, cerebral palsy, and behavioral challenges. She describes her ideal developmental program, from prenatal consults to sibling playgroups, and makes the case for givi...

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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 enrollment, the ripple effects of the 2025 ACGME residency changes, an upcoming study on 24-hour shift fatigue, and why physicians and nurse practitioners mu...

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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 at the table. Catch all of these episodes on both our podcast channel and our YouTube channel, w...

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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, and why neonatal pain scoring remains so subjective. He also explains how his team learned that adding dexmedetomidine increased opioid...

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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 changed her life. Debbie shares how that experience shaped her commitment to health literacy, compassion, an...

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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. They also discuss why we should ask parents directly about their own care, how NNP educ...

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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 criteria should replace outdated cutoffs.

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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 reviews the AIROPLANE trial, comparing 21% and 30% initial oxygen in infants born at 32 to 35...

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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 Resuscitation Program. She explains why phones fall short at the bedside, how the ninth edition's...

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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 antibiotic courses for low-risk children, early transition to oral antibiotics even in the neonatal period, renal and bladder...

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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 endotracheal ventilation afterward. Ben places the findings alongside ILCOR guidance and the TORPIDO 30/60 trial, and explains why this common population has gone...

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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 full volume within seven days, with no respiratory adverse events and no change in weight gain. Ben an...

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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 72% lower risk of death or NEC and near elimination of surgical NEC. He places the findings al...

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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 describe how program directors, division chiefs, and the AAP Section on Neonatal-Perinatal Medicine presented a unified position, why the ABP listened...

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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 probiotics to halved NEC rates, but rising non-NEC mortality and a fatal probiotic sepsis case leave Ben ambivalent. Daphna closes Journal Club with an Australian...

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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 bedside: how do we explain study methodology to families without dismissing their concerns? Eli shares his approach...

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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 neurological determination of death. They discuss referral timing, outcomes of en bloc kidney transplants from neonatal donors, and how NICUs can offer families...

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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 baseline NEC rates, seasonal patterns, and number needed to harm should shape how units weigh probiotic use.

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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 plethysmography, and term-equivalent brain MRI were no different from standard fortification, and all infants met recommended intakes. Two-year outcomes will be reported separately.<...