The Incubator

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Dr. Wanda Barfield, MD, MPH, neonatologist at Emory University, former director of the Division of Reproductive Health at the CDC, and former Assistant Surgeon General of the United States Public Health Service, joins Ben and Daphna for a conversation about the broader obligations of pediatricians in an era of growing maternal and infant health disparities. She reflects on what it means to truly know your community — not just your unit — and makes the case that engaging with local health departments, infant mortality review committees, and population health data can make you a better clin...

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Dr. Ravi Patel, neonatologist and leading voice in neonatal hematology and transfusion medicine, joins Ben and Daphna to discuss the launch of NeoHeat — the first dedicated neonatal hematology and transfusion medicine group at PAS. He explains why transfusion medicine in neonatology is still full of unanswered questions, from how we manage iron supplementation to whether we are truly following the latest transfusion threshold guidelines at the bedside. He also introduces one of the most exciting emerging concepts in the field: using cord blood from healthy term newborns to transfuse premature infants, replacing adult he...

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Dr. Seetha Shankaran one of the pioneers of therapeutic hypothermia for hypoxic-ischemic encephalopathy (HIE) and longtime member of the NICHD Neonatal Research Network, reflects on a career devoted to preventing and treating neonatal brain injury. She discusses what neonatal MRI can and cannot tell us about long-term neurodevelopmental outcomes in infants with HIE, why a normal MRI does not equal a normal future, and how the pattern of brain injury on imaging should shape the counseling conversation with families. She closes with a message that no imaging study can replace: consistent, long-term follow-up...

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Dr. Charles Roehr, neonatologist from Bristol, UK and faculty member of the Tiny Baby Collaborative, makes the case that caring for extremely preterm infants is as much about engaging families as it is about mastering the medicine. He discusses why parents of tiny babies are among the most vulnerable to enter a research conversation — often facing precipitous deliveries with little to no preparation — and what it takes for clinical teams to meet them where they are. He also addresses one of the hardest conversations in neonatology: how to counsel families around survival and neur...

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Jennifer Canvasser, founder of the NEC Society and mother of Micah, a 27-weeker who passed away from necrotizing enterocolitis (NEC) in 2014, shares what is new at the world's largest organization dedicated to NEC. She discusses the upcoming NEC Family Summit — the first of its kind globally — taking place in Davis, California this September, and explains why bringing families together as active research partners is not just about healing but about advancing the science. She also addresses how clinicians can better empower NICU families with information before a diagnosis is ever made, and highlights the...

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Dr. Atul Malhotra, neonatologist and researcher at Monash University in Melbourne, Australia, makes the case that cell therapy for neonatal brain injury is a slow burn that is finally gaining momentum. He shares why tempering expectations doesn't mean losing hope, how regulatory complexity sets stem cells apart from conventional therapies, and why cell therapy may look different for preterm infants with white matter injury versus term infants with HIE.

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Breaking news from the American Board of Pediatrics: a proposal to move all 15 pediatric subspecialties to a two-year, competency-based training model by July 2028 just dropped, and Ben and Daphna are breaking it down in real time. What does shifting from time-based to EPA-grounded training mean for neonatology fellows? Is two years actually enough? What happens to scholarship, research exposure, and the physician-scientist pipeline? And should neonatology take this reshuffling of the cards as an opportunity to chart its own course entirely? This is essential listening for fellows, program directors, and anyone who cares...

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The transfusion threshold consensus is here — but practice hasn't fully caught up. In the second episode of On with VON, Ben and Daphna sit down with Dr. Roger Soll and Dr. Ravi Patel to extend the conversation from the Vermont Oxford Network Grand Rounds on evidence to practice for transfusion thresholds.

The core finding across trials is consistent: lower thresholds for both packed red blood cells and platelets appear safe. The guidelines are freely available in JAMA Network Open and actionable — 11, 10, 9 grams per deciliter across the first three weeks for infants on r...

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The AAP has weighed in on therapeutic hypothermia for HIE, and Daphna walks through the clinical report in full. The core eligibility criteria haven't moved — but the edges have gotten more nuanced. Late initiation, the 35-week zone, mild HIE, sentinel events, MRI timing, and feeding during cooling are all addressed.

Also this week: a prospective pilot from Australia tests whether adding bedside ultrasound to plain radiography improves surgical risk stratification in NEC. The X-ray-only model couldn't separate the clusters. The combined model produced a more than six-fold difference in odds of su...

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In this episode of Neo News, Ben and Eli discuss a sobering Guttmacher Institute study recently featured in Bloomberg. Analyzing data from 2005 to 2023, the research reveals a troubling association between restrictive abortion laws and increased maternal mortality, specifically driven by cardiovascular complications and violent deaths. The hosts explore the clinical and social pathophysiology behind these findings, emphasizing how a lack of prenatal care and compounded social stressors disproportionately affect birthing people. Tune in for an important conversation on the "package" of restrictions driving these outcomes and practical ways neonatal professionals can advocate for...

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In this Journal Club episode, Ben reviews a secondary analysis of the CALI trial, published in JAMA Network Open, examining two-year neurodevelopmental and pulmonary outcomes in preterm infants who received early caffeine combined with LISA versus caffeine and CPAP alone. Building on the original CALI trial's finding that early caffeine prior to LISA reduced intubation rates and BPD, this follow-up asks the next logical question: does that early advantage translate into better long-term outcomes? Ben walks through the Bayley scores, gross motor function, ASQ-3, M-CHAT, and pulmonary outcomes — and delivers a reassuring if no...

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In this Journal Club episode, Daphna presents the F-NeoBright trial — a pilot feasibility and safety study out of Hungary exploring intranasal fresh breast milk administration in neonates with moderate to severe HIE undergoing therapeutic hypothermia. With so few adjunct therapies available beyond cooling, the idea of harnessing breast milk's rich bioactive components — including neurotrophic growth factors, cytokines, and multipotent stem cells — to support the developing brain is both compelling and refreshingly low-risk. Daphna walks us through the protocol, the feasibility outcomes, and why 100% of approached families consented, including those who had never planned to bre...

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In this Journal Club episode, Ben takes the lead and reviews a prospective cohort pilot study from the Archives of Disease in Childhood examining whether combining abdominal ultrasound with plain radiography can improve surgical risk stratification in neonates with suspected NEC. With mortality remaining as high as 20–40% and diagnosis still heavily reliant on clinical judgment, the stakes couldn't be higher. Ben walks through the study's unsupervised clustering approach, explaining how adding ultrasound data to X-ray findings produced a more than six-fold difference in the odds of surgery between risk groups — something X-ray alone simp...

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In this Journal Club episode, Ben and Daphna dive into the American Academy of Pediatrics' February Clinical Report on Therapeutic Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy. Daphna, who presented this paper at the Florida Neonatal Neurologic Network, walks us through the key action statements — from the established 33.5°C target temperature to the more nuanced discussions around late cooling (6–24 hours), gestational age eligibility at 35 weeks, and the controversial question of cooling mild HIE. They also cover optimal MRI timing post-rewarming, continuous EEG monitoring, early enteral feeds during cooling, and the growing evidence supporting the "cool cuddl...

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In this Tech Tuesday episode, Ben sits down with Dr. Itamar Nitzan and Alon Meritrikin-Gold, the co-founders of SkinCubator, a revolutionary wearable incubator designed to transform neonatal skin-to-skin care. They discuss how reframing kangaroo care from a rare procedure to a continuous necessity inspired this paradigm-shifting device. The hosts dive into the clinical logistics, from safely transferring intubated extremely preterm infants to alleviating parental anxiety and nursing resistance. Tune in to hear how this innovative "pocket incubator" maintains thermoregulation, secures critical lines, and promises to safely extend skin-to-skin duration for our most vulnerable...

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In this interview episode, Ben and Daphna sit down with Professor Brett Manley to discuss a paradigm shift in neonatal research: adaptive platform trials. Frustrated by the inefficiencies and underpowered results of traditional RCTs, Dr. Manley outlines the ambitious Platypus Adaptive Platform Trial launching in Australia and New Zealand. They dive into how shared primary outcomes, novel consent models, and massive cross-center collaboration can answer pressing clinical questions—like optimal PPROM antibiotics and caffeine dosing—simultaneously. Tune in for a fascinating conversation on moving beyond medical dogma, embracing humility, and keeping families at the...

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This week on The Incubator Podcast, Ben and Daphna cover five topics spanning clinical practice, emerging technology, and neonatal policy. They open with a large Swedish national cohort study from JAMA Network Open examining early prophylactic hydrocortisone in extremely preterm infants, debating whether a blanket approach to BPD prevention holds up across gestational ages and in the presence of chorioamnionitis.They then take a critical look at predischarge car seat tolerance screening, questioning whether this decades-old AAP recommendation still earns its place in routine NICU discharge planning given its failure to reduce mortality...

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In this Neo News segment, Ben and Eli tackle a pressing Stateline report on the paradoxical struggle of freestanding birth centers. While hospital labor and delivery units are closing nationwide, alternative birth centers are facing aggressive regulatory hurdles and forced closures in states like Alabama. The hosts discuss the downstream effects on maternal health equity, the rise of unregulated crisis pregnancy centers, and the clinical realities of out-of-hospital births like hyperbilirubinemia and missed newborn screens. Plus, they dive into the EMTALA implications for hospital transfers and highlight key takeaways on neonatal advocacy and...

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In this Journal Club episode, Ben and Daphna explore an exciting new frontier in neonatology: oculomics. Reviewing a recent paper from JAMA Ophthalmology, they discuss how deep learning models applied to routine ROP screening images can predict the development of BPD and pulmonary hypertension in preterm infants. By combining visual features extracted via neural networks with standard demographic data, researchers achieved impressive predictive accuracy weeks before clinical diagnosis is typically made. Tune in to hear how the eyes might just be the window to the neonatal pulmonary vasculature!

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In this episode of Journal Club, Ben and Daphna review a pivotal paper from the Journal of Pediatrics led by the Pediatric Pulmonary Hypertension Network (PPHNet). The study explores invasive hemodynamic metrics and long-term outcomes in infants with BPD-associated pulmonary hypertension. Surprisingly, researchers found an almost equal distribution of pulmonary hypertension across mild, moderate, and severe BPD grades using the Jensen criteria. The hosts discuss the implications of these findings, questioning whether our traditional 36-week assessment timepoint is sufficient and if current grading criteria capture the true severity of pulmonary vascular disease in...

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In this Journal Club episode, Ben and Daphna review a systematic review and meta-analysis from JAMA Network Open questioning the clinical value of predischarge car seat tolerance screening (CSTS). Driven by data suggesting that testing does not reduce 30-day mortality or hospital readmissions, they discuss the high failure rates, varying definitions of bradycardia and desaturation, and the unintended consequence of prolonged NICU stays. They also highlight the practical reality of CSTS in ensuring parents actually have an appropriate car seat at discharge. Tune in for a critical look at whether this 1991 AAP recommendation...

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In this Daily Journal Club episode, Ben and Daphna review a massive Swedish national cohort study from JAMA Network Open examining early prophylactic hydrocortisone in extremely preterm infants. They discuss the targeted regimens used, differences in gestational age outcomes, and whether a blanket prophylactic approach is truly effective for preventing BPD. With impressive data covering 98% of all NICU admissions in Sweden, the hosts debate the nuances of targeting 24 to 25-weekers versus older preemies and the potential confounding impact of chorioamnionitis. Tune in for your daily snack of evidence-based medicine and insights into optimizing...

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Dr. Kelly Mahaney, Assistant Professor of Pediatric Neurosurgery at Stanford and researcher focused on the role of iron in post hemorrhagic hydrocephalus, joins the podcast to challenge the traditional watch and wait approach to IVH complications. She describes Stanford’s early radiographic intervention pathway, which has reduced shunt dependency from 90% to 45% in reservoir-placed infants, explains why waiting for clinical symptoms means waiting too long, and outlines her effort to build a statewide CPQCC nested network to standardize and study early intervention practices across California NICUs.

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Dr. Clara Song, neonatal intensivist with Southern California Permanente Medical Group, Chair of the AAP Section on Neonatal Perinatal Medicine Executive Committee, and founding leader of the Women in Neonatology group, shares the lessons from her Cool Topics talk on quiet power and soft skills in leadership. She explores how communication, emotional intelligence, and servant leadership drive team performance more than technical expertise, breaks down the four personality types every leader needs to understand, and offers a practical framework for structuring communication so every type of team member actually receives the message.

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Dr. Sanjay Sinha, interventional pediatric cardiologist, Assistant Professor of Pediatrics at CHOC and UCI, and Co-Director of the UCLA Congenital Lymphatic Imaging and Intervention Program, opens a new chapter for neonatologists on neonatal chylothorax and lymphatic disease. He explains how to recognize lymphatic mimickers at the bedside, why woody edema should raise the index of suspicion, how MR lymphangiography is reshaping diagnosis and surgical planning, and how early targeted intervention is dramatically reducing NPO time and hospital length of stay in a population that was previously managed with a prolonged watch and wait...

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Dr. Robin Steinhorn, Professor and Vice Dean for Children’s Clinical Services at UC San Diego and President of Children’s Specialists of San Diego, tackles one of neonatology’s most uncomfortable conversations: compensation. She breaks down how to identify reliable benchmark data, explains why neonatologists are generating more RVUs than ever while pay has not kept pace with workload complexity, addresses gender discrepancy trends in the literature, and offers practical strategies for individuals and division chiefs to use rigorous national data when advocating for fair compensation at the institutional level.

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Dr. Susan Hintz, Medical Director of the Fetal and Pregnancy Health Program and Robert L. Hess Family Endowed Professor at Stanford Medicine, delivers this year’s Cool Topics keynote on collaboration, shared purpose, and the lessons learned building high risk infant follow-up infrastructure through the CPQCC. She challenges the neonatal community to move beyond the handoff to a pediatrician and think deliberately about true medical home design, including coordinated care teams, clearly defined roles across subspecialty and follow-up clinics, and better use of community based resources to support families long after NICU discharge. 

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Dr. Caitlin Carter, Clinical Director of Nephrology at Rady Children’s Hospital and associate clinical professor at UC San Diego, joins the podcast to challenge how neonatologists recognize and follow up on acute kidney injury. She explains why creatinine alone is insufficient, how biomarkers like NGAL can detect tubular injury before function declines, and why AKI too often disappears from the discharge summary. She also outlines published consensus guidelines on post NICU nephrology follow-up, with clear thresholds based on gestational age and AKI severity.

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Dr. Tarah Colaizy, Professor of Neonatology at the University of Iowa Stead Family Children’s Hospital and Medical Director of the Mother’s Milk Bank of Iowa, challenges the one size fits all approach to nutrition in periviable infants. She shares the Iowa philosophy of individualized, principle driven feeding management, explains why rigid protocol adherence can backfire in the most immature babies, and walks through her unit’s glycerin protocol for meconium obstruction of prematurity. She also discusses the practical realities of frequent low volume lab monitoring and the importance of patience over speed...

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Dr. Satyan Lakshminrusimha, Chair of Pediatrics and Pediatrician in Chief at UC Davis Children’s Hospital, makes a compelling case for rebranding and restructuring neonatology as a field. He argues for adopting the title of neonatal critical care physician, addresses the stark disparity between NICU revenue generation and neonatologist compensation, and outlines a step by step resuscitation framework for the field, from restoring professional identity to establishing a dedicated neonatal residency pathway and ultimately recognizing neonatology as its own independent department.

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Dr. Elizabeth Crouch, neonatologist, neuroscientist, and physician scientist at UCSF and co-host of At the Bench on The Incubator Podcast, joins Ben and Daphna live at Cool Topics to discuss palliative and comfort care in the NICU. Drawing from her research on organ donation, autopsy, and research donation after neonatal loss, Dr. Crouch shares how meaning making supports families through grief, offers practical tips for approaching these conversations with compassion and good timing, and reflects on the role of chaplains, ethics consultants, and care pathways in supporting a death with dignity.

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Dr. Shmuel Zangen, Director of Neonatology at Barzilay Medical Center in Ashkelon, Israel, and former chair of the Israeli Neonatal Association, joins the podcast during his California sabbatical embedded with CPQCC. Having already led national QI collaborations targeting nosocomial infections and intraventricular hemorrhage across all 26 Israeli NICUs, he shares what he is learning about the culture, infrastructure, and methodology behind effective statewide quality improvement, and what he hopes to bring home as Israel transitions its neonatal database to the Ministry of Health.

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Dr. Jochen Profit, Chair and Principal Investigator at CPQCC and Wendy J. Tomlin-Hess Endowed Professor of Pediatrics at Stanford Medicine, joins the podcast to discuss what truly separates high performing NICUs from the rest. He makes the case for process metrics over mortality as quality markers, highlighting normothermia on admission, breast milk feeding at discharge, and infection rates as deceptively simple yet deeply revealing indicators of unit culture. The conversation also explores how toxic work environments and provider burnout silently undermine quality improvement efforts.

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Dr. Alexis Davis, Clinical Professor of Pediatrics at Stanford and Medical Director of the NephroNICU at Lucile Packard Children’s Hospital, makes the case that neonatology is entering a nephro era. She discusses how AKI prevention through initiatives like the BABY NINJA collaborative, fluid management strategies, and the emerging concept of the NephroNICU are reshaping how we think about kidney health in premature infants. She also addresses the complex ethical and practical considerations around dialysis and renal replacement therapy in newborns with congenital kidney failure.

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Ra’Niesha Bratton, MPH, CHES, CPQCC Family Advisory Council board member and public health advocate, and Joanne Tillman, CPQCC Family Engagement Coordinator, join the podcast to discuss what genuine family centered care looks like in practice. Drawing from lived NICU experience, Ra’Niesha shares how implicit bias and cultural incompetence harm families at their most vulnerable and how structured family advisory councils can drive systemic change. The conversation also tackles peer to peer support gaps, bereavement resources, and how to access the CPQCC NICU Family Advisory Council Toolkit.

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Silvia Bor, NICU mom to a 24 weeker and Family Advisory Council member for the CPQCC, makes the case for why family centered care must go beyond a philosophy and become a structured practice. She shares how involving parents in quality improvement initiatives, including the NEOBrain early skin to skin project, drives meaningful change at the bedside. She also outlines the CPQCC toolkit for building hospital level Family Advisory Councils and discusses how to identify the right parent advocates, including those whose NICU journeys ended in loss.

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Recorded live at the Cool Topics in Neonatology conference, this episode features Dr. Denise Suttner, Clinical Director of the Rady Children's Hospital NICU, professor of pediatrics at UC San Diego, and director of the San Diego Regional ECMO Program. Dr. Suttner discusses the California Perinatal Quality Care Collaborative (CPQCC) as a model for statewide neonatal quality improvement, the importance of family centered communication in the NICU, and the value of state level professional organizations in advancing advocacy for neonatal healthcare funding and pediatric subspecialty reimbursement.

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In this episode, we sit down with Dr. Jessica Shui, attending neonatologist at Mass General for Children, to explore the game-changing potential of Electrical Impedance Tomography (EIT) in the NICU. We dive into her recent paper in the Journal of Perinatology on using non-invasive EIT to identify optimal PEEP in infants with severe bronchopulmonary dysplasia. Dr. Shui explains how this real-time, radiation-free technology allows clinicians to visualize lung mechanics, dynamically titrate ventilator settings, and confidently reduce PEEP without risking atelectasis. Join us as we discuss moving beyond blind adjustments and stepping into the...

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The PDA debate has a new data point. TREOCAPA, a phase 3 multicenter European RCT, tested prophylactic acetaminophen in infants born at 23 to 28 weeks. The ductus closed more reliably. Whether that translated into better survival without severe morbidity at 36 weeks is where the conversation gets interesting.

Also this week: a large multicenter cohort study puts real numbers on diazoxide use across US NICUs and the pulmonary hypertension risk that has driven so much practice variation. The NeoDry trial tests whether drying very preterm infants before plastic wrapping improves normothermia at admission, with...

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In this Neo News episode, Ben and Eli dive into the recent controversial announcement from the state of Florida regarding heavy metals and pesticides found in infant formulas. They discuss the implications of releasing testing data without transparent methodology or clinical context, especially for unregulated or recalled brands like ByHeart and Similac Soy Isomil. How should NICU clinicians counsel parents who want to bring their own formulas from home? Tune in as they unpack the regulatory loopholes, the evolving public health initiatives, and the ongoing challenge of navigating unverified reports in neonatal care!<...