The Incubator

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In this premiere episode of On with Von, The Incubator launches an exciting new collaboration with the Vermont Oxford Network (VON). Hosts Dr. Ben Courchia and Dr. Daphna Yasova Barbeau sit down with Dr. Roger Soll, President of VON, and Dr. Bob White, a pioneer in NICU design, to explore the critical "Evidence to Practice" gap in the NICU environment. Moving beyond simple neuroprotection, the conversation dives into neuropromotion, examining the impact of light, sound, and sensory inputs on the developing brain. From debunking misconceptions about retinopathy to optimizing design for family integration, this...

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How much oxygen is enough when resuscitating extremely preterm infants? This week on The Incubator Podcast, Ben and Daphna explore the TORPIDO 30/60 trial comparing 60% versus 30% FiO2 at birth. While primary outcomes were similar, babies in the 60% group needed fewer chest compressions and less epinephrine—a signal worth discussing.

They examine an Indian non-inferiority study on surfactant thresholds (40% vs 30% FiO2), where waiting until 40% meant significantly fewer intubations and shorter respiratory support for the youngest babies. Ben presents compelling Melbourne data showing growth-restricted preterm infants face six-fold higher NEC risk—even with identical feeding prot...

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In this episode of Neo News, the team examines the intersection of immigration policy and neonatal care. We review a recent op-ed discussing the "chilling effect" of immigration enforcement on families seeking care in "sensitive locations" like hospitals. The discussion highlights a harrowing report from The 19th about a family detained by ICE while en route to the NICU, sparking a conversation on how fear impacts parental presence and follow-up adherence. The hosts explore the Protecting Sensitive Locations Act and the critical role neonatologists play in advocating for safe access to healthcare for all...

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In this segment, Ben and Daphna review a retrospective study from the Hospital for Sick Children comparing outcomes of therapeutic hypothermia in late preterm (34-35 weeks) versus early term (36-37 weeks) infants. They discuss the significantly higher rates of mortality, hemodynamic instability, and hypoglycemia found in the younger cohort, known as "Group 1". The hosts explore the implications of using MRI scoring systems like the Weeke score for preterm brains and debate the ethical challenges of conducting future randomized trials as clinical practice shifts away from cooling younger babies based on emerging retrospective data.

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In this episode of Journal Club, Ben and Daphna review a prospective cohort study from the Journal of Perinatology that examines the care of neonates following in-utero growth restriction. The hosts unpack the critical distinction between Fetal Growth Restriction (FGR) and Small for Gestational Age (SGA), highlighting how the "decay of information" in the NICU can lead clinicians to overlook early risk factors as babies grow. They discuss the study’s alarming findings regarding the six-fold increased risk of Necrotizing Enterocolitis (NEC) in SGA infants and the importance of maintaining a comprehensive medical history th...

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In this episode of Journal Club, Ben and Daphna review a non-inferiority trial from the European Journal of Pediatrics exploring surfactant administration thresholds in preterm neonates. The study, conducted in India, compares a 30% versus 40% FiO2 threshold for babies 26-32 weeks gestational age. The hosts break down the counterintuitive findings regarding respiratory support duration in younger subgroups and discuss the broader implications of using rigid FiO2 heuristics versus individualized patient assessment. They also debate how resource availability influences clinical protocols and the potential benefits of "LISA" (Less Invasive Surfactant Administration) for avoiding intubation.

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In this episode of The Incubator, Ben and Daphna return from the Delphi Conference to dive back into Journal Club. They review the highly anticipated TORPIDO 30/60 trial published in JAMA, comparing initial oxygen concentrations of 30% versus 60% for preterm resuscitation. The hosts discuss the primary outcomes of survival and brain injury, while highlighting intriguing secondary findings regarding chest compressions and epinephrine use in the delivery room. They also share exciting updates on the Vermont Oxford Network collaboration and a new family study from the GFCNI.

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Targeted Oxygen for Initial...

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This recording captures the AI panel discussion from the 2026 Delphi Neonatal Innovation Conference, held live on Monday afternoon. Dr. Jim Barry (University of Colorado), Dr. Thao Ho (UCSF), Lindsey Knake (University of Iowa), Selva Selvaraj (Nicklaus Children's Health System), and Dr. Ryan McAdams (University of Wisconsin-Madison) discuss where AI stands in the NICU today.

The panelists cover predictive models for sepsis and NEC, AI documentation tools, and the gap between research prototypes and clinical implementation. They address challenges with generalizability across different units, ethical considerations, parent-facing AI applications, and what might...

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What if the smallest patients finally had a diaper designed just for them? For years, NICUs have struggled to find appropriately sized diapers for extremely premature infants, often resorting to makeshift solutions that compromised skin integrity and care quality. That changes now. In this breaking news episode, Ben sits down with Harry McCusker, Director of Research and Development for North America Pampers Diapers, to discuss the groundbreaking launch of the Pxxs diaper—the world's smallest commercially available diaper, specifically engineered for micropreemies born as early as 21-23 weeks gestation. Weighing less than a ni...

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Could a simple blood test help identify chronic pulmonary hypertension when echo access is limited? This week on The Incubator Podcast, Ben and Daphna explore this question and others relevant to daily NICU practice. A Toronto study examines NT-proBNP as a practical diagnostic tool in extremely preterm infants.

They also examine a puzzling finding from Italy and Belgium: despite near-universal antibiotic use in neonates with HIE undergoing cooling, actual culture-positive sepsis rates are surprisingly low. What does this mean for our approach to empiric antibiotics?

Ben presents...

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This week on Neo News, we tackle the recent and controversial divergence between CDC and AAP guidelines regarding the birth dose of the Hepatitis B vaccine. With the CDC now recommending a deferred schedule for infants of Hepatitis B-negative mothers, we explore the clinical implications, the risks of vertical transmission, and the challenge of navigating discordant public health advice. We discuss how to handle shared decision-making in an era of waning vaccine confidence and why the "birth dose" remains a critical safety net in a community setting. Join us as we break down...

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In this episode of Journal Club, Ben and Daphna review a retrospective cohort study from the Journal of Perinatology examining the association between NICU capacity strain and neonatal outcomes. We discuss how high census and acuity on admission day correlate with increased mortality and morbidity when adjusted for hospital and patient factors. Join us as we explore why being "slammed with admissions" is more than just a badge of honor—it’s a critical safety metric for our patients.

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The association of NICU capacity strain with neonatal mortality and...

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In this episode of The Incubator Podcast, Ben and Daphna review a pivotal population-based study from Norway examining a new approach to Early-Onset Sepsis (EOS). The hosts discuss whether serial physical examinations can safely replace routine antibiotic prophylaxis in at-risk term and late-preterm infants. With antibiotic exposure often far exceeding sepsis incidence, this study offers compelling data for a "less is more" strategy. Tune in as Ben and Daphna explore the safety, efficacy, and bedside implications of substituting automatic treatment with structured clinical monitoring—and what this means for reducing unnecessary interventions in th...

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In this episode of Journal Club, Ben and Daphna dive into a multicenter retrospective study from the European Journal of Pediatrics questioning the necessity of universal empiric antibiotics in neonates undergoing therapeutic hypothermia for HIE. Comparing Italian and Belgian cohorts, the team discusses the reality of a 111 Number Needed to Treat (NNT) for a single case of culture-proven sepsis. From the diagnostic challenges of overlapping clinical markers to the fascinating "asymptote" of postnatal leukocyte trends, we explore whether it's time to shift from routine to selective antibiotic use in our most complex patients.<...

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In this Journal Club episode of the Incubator Podcast, Ben Courchia and Daphna Yasova-Barbeau review a study from the Journal of Perinatology evaluating NT-proBNP as a diagnostic tool for chronic pulmonary hypertension in extremely preterm infants. The discussion walks through the clinical burden of pulmonary hypertension in babies with bronchopulmonary dysplasia, the limitations of echocardiography, and the appeal of accessible biomarkers. Using data from a SickKids Toronto cohort, the hosts unpack sensitivity, specificity, cutoff values, and real-world applicability, while exploring how NT-proBNP could support screening, risk stratification, and bedside decision-making in everyday NICU...

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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.

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: @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.

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: @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...