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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...

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Dr. Arpitha Chiruvolu, neonatologist and infant nutrition researcher, joins Ben to share three posters from this year's PAS covering two of her core research interests. She presents pilot data on using Prolacta human milk cream as an alternative to dextrose gel for treating asymptomatic neonatal hypoglycemia — highlighting the well-known limitations of dextrose gel including inconsistent dosing, poor tolerance, and the way it interferes with breastfeeding immediately after administration. In 25 babies treated with cream, blood glucose rose from a median of 36 to 56 mg/dL, only one baby required NICU admission, and nurses and families lo...

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Dr. Kyle Willsey, pediatric critical care transport director at Cedars-Sinai, joins Daphna to discuss one of the least standardized corners of pediatric and neonatal medicine — critical care transport. With children's hospitals closing across the country and tertiary centers absorbing more of the patient load, the demand for safe, well-trained transport teams is growing at the same time that national standards remain nearly nonexistent. He shares the challenges of building a transport program from the ground up, presents early pilot data using the NASA Task Load Index to measure the subjective cognitive burden on tr...

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Dr. David Sas, pediatric nephrologist at Mayo Clinic, joins Ben to discuss primary hyperoxaluria type 1 — a rare but devastating genetic disease where the liver overproduces oxalate, flooding the kidneys with crystals and leading to end-stage kidney failure in roughly 60% of patients, historically requiring both a liver and kidney transplant. He presents 60-month long-term extension data on Lumasiran, an siRNA-based therapy that suppresses oxalate production at its source — showing that urinary oxalate drops rapidly within the first three months and stays down with quarterly injections, potentially changing the trajectory of this disease forever. He also...

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Dr. Lily Lou joins Daphna and Rupa to reflect on this year's Silverman Lecture at PAS — the annual honorary lecture of the AAP Section on Neonatal Perinatal Medicine — delivered by Dr. John Ioannidis of Boston, who turned the lens of research methodology back on the research community itself. Drawing on meta-analyses of meta-analyses, he offered ten provocations about how neonatology studies its own practice: are we studying the right populations, asking about race and ethnicity appropriately, and publishing the right amount? Dr. Lou also makes a heartfelt call for trainees to prioritize these foun...

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Dr. Emily Wassmer, researcher at Children's Hospital of Philadelphia, presents findings from one of the first studies to examine gaming addiction in young children ages 5 to 12 with ADHD diagnoses. Using a newly developed caregiver-report screening tool based on DSM-5 criteria for internet gaming disorder, she found that inattention — more than hyperactivity, anxiety, depression, or autism symptoms — was the factor most strongly associated with meeting criteria for gaming addiction, mirroring patterns seen in adolescent research. Perhaps most striking was the parenting finding: each additional negative parenting behavior, such as yelling or losing one's temper, trip...

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Dr. Satyan Lakshminrusimha, pediatric chair and neonatologist, joins Ben hot off the ONTPD meeting to share his perspective on the ABP fellowship reform debate — and it's more nuanced than a simple yes or no to a two-year fellowship. He argues that the real problem is a six-year training pipeline that is driving medical students away from pediatric subspecialties under crushing debt, and that the solution for procedure-heavy specialties like neonatology is not to shorten fellowship but to truncate the pediatric residency to two years — following the precedent already set by pediatric neurology. He also...

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Dr. Matthew Saxonhouse, neonatologist at Atrium Health, joins Ben to discuss two initiatives designed to fill the gaps that traditional conferences often leave behind. The first is Neonatal Insights, a biennial meeting returning January 29-31, 2027 in Houston — both in person and virtual — where controversial topics like the new hypoglycemia guidelines, cord blood transfusions, optimal caloric targets for growing infants, and wasteful NICU practices are presented from all sides with the explicit goal of reaching a working consensus. The second is Neonatal Insider, a monthly virtual series combining physiology and current evidence on hot topi...

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Dr. Nathan Sundgren, neonatologist and NRP educator at Texas Children's Hospital, joins Ben to discuss one of the most deceptively difficult skills in neonatal resuscitation — effective bag mask ventilation. He shares findings from a fellowship training study showing that respiratory function monitor feedback improves ventilation technique equally well across all three device types, and tackles the harder question of why that same technology has yet to show clinical benefit in the delivery room — pointing to human factors, cognitive overload, and the need for a dedicated respiratory coach role rather than a better device alon...

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Dr. Mitchell Goldstein, neonatologist at Loma Linda University and editor-in-chief of Neonatology Today, joins Ben to share the story behind one of neonatology's most accessible and wide-reaching publications — a peer-reviewed, open-access journal with 25,000 monthly readers worldwide, no publication fees, no page limits, and no color charges. He explains the philosophy behind the Academic True Open Model that guides the journal, why author development and rapid peer review turnaround of as little as 72 hours set it apart, and how the journal has used platforms like LinkedIn to find voices that traditional publishing would never ha...

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Christie Lawrence, clinical nurse specialist at Rush University Medical Center, joins Ben to discuss sudden unexpected infant death (SUID) — the updated term that encompasses all sleep-related infant deaths, including what was formerly called SIDS. In Cook County alone, an infant dies every week from SUID, with Black infants dying at 14 times the rate of white infants — a disparity far exceeding the already alarming national figure of three times. She explains why shifting the language from the mysterious "SIDS" to the more concrete word "suffocation" is not about being harsh but about giving families some...

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Dr. Jayasree Nair, neonatal resuscitation expert, joins Ben to reflect on one of the most humbling realities in neonatology — nearly everything we know about epinephrine use in extensive neonatal resuscitation comes from animal studies, adult data, or pediatric populations, not neonates. She explains why the pyramid of resuscitation research narrows dramatically as you move toward chest compressions and epinephrine, why randomized controlled trials in this space may never be fully achievable, and why collaborative registries like the DRIVE network offer one of the most promising paths forward. She also shares her experience piloting th...

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Kimberly Novod, community health advocate, founder of Sol's Light, and fierce voice for health equity, joins Ben for a conversation about what it actually means to build trust between hospitals and the communities they serve. Drawing on her experience in New Orleans — where the prematurity rate sits at 14% and environmental factors like air, water, and soil quality in areas like Cancer Alley drive devastating birth outcomes — she makes the case that health equity cannot be achieved within hospital walls alone. She calls on institutions to stop designing solutions without asking the people they're mean...

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Dr. Elisabeth Kuhn, researcher focused on hospital operations, presents findings from a mixed-methods study examining how US children's hospitals measure and respond to capacity strain — the point at which demand for care outpaces the ability to deliver it safely. In a survey of 45 tertiary children's hospitals, 43 reported experiencing capacity strain in the past year, underscoring just how widespread and persistent the problem has become since the triple-demic brought it into sharp focus. She argues that current metrics like occupancy rates and boarding times fail to capture the real clinical experience of strain — which is d...

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Dr. Brandon Hadfield and Dr. Debora Abimana join Ben for a conversation that brings the incubator's global neonatology work full circle — from the founding of Rwanda's first neonatology fellowship program to seeing its first trainee present scholarly work at PAS. Dr. Abimana shares findings from her research on healthcare provider attitudes toward donor human milk in Rwandan NICUs, where the concept is largely welcomed but faces cultural concerns around infants adopting the characteristics of their donor — a barrier the team hopes to address through targeted community education. She also paints a vivid picture of t...

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Dr. Zubair Aghai, neonatologist at Thomas Jefferson University in Philadelphia, presents results from one of the largest neonatal trials ever conducted — enrolling 3,448 late preterm and term infants across India to test whether umbilical cord milking in non-vigorous newborns reduces death or moderate-to-severe HIE. With over 100,000 deliveries screened and real-time data collected by research staff present at every delivery around the clock, the primary outcome showed no short-term harm from cord milking — and a secondary signal of reduced infection risk, possibly driven by the immunoglobulins transferred with the extra blood. He also explains why non...

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Dr. Melissa Zhou, researcher at the Developing Brain Institute at Children's National, joins Daphna to discuss functional MRI and what it reveals about how preterm brains are building connections during the NICU stay. Using functional connectivity — measuring how different brain regions communicate with each other over time — her team compares preterm infants to healthy in utero fetuses scanned as early as 20 weeks, finding that the ex utero preterm brain actually looks more mature in terms of connectivity, suggesting the NICU environment itself accelerates certain aspects of brain development. She shares why extremely and very...

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Dr. Ryan McAdams guest hosts alongside the NeoMind AI team — Dr. Ameena Husain, Dr. Kristyn Beam, Dr. Brynne Sullivan, and Dr. Zach Vesoulis — to recap their third annual pre-conference AI workshop at PAS, including a live predictive modeling bake-off using the Epic Cosmos database to predict late-onset sepsis in nearly 100,000 preterm infants. The group discusses where AI stands today in neonatology — from using large language models to reduce administrative burden and improve family communication, to Epic's growing investment in neonatal-specific tools — and makes an honest case for what clinicians should start doing now and what...

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Dr. Gesca Borchardt, third-year neonatology fellow at Winnie Palmer Hospital, presents findings from a retrospective study of 296 infants born under 25 weeks examining whether extending empiric antibiotic use beyond 72 hours reduces mortality in this vulnerable population. She shares why her unit moved to a seven-day antibiotic course for babies with placental pathology positive for chorioamnionitis — and what they found when they looked at the data. At 22 and 23 weeks, longer antibiotic courses were associated with a statistically significant decrease in mortality. At 24 weeks, no difference was seen. One puzzling finding clouds the picture however: an in...

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Dr. Kevin Cook, researcher at the Developing Brain Institute at Children's National, joins Daphna to discuss functional MRI and what it reveals about how preterm brains are building connections during the NICU stay. Using functional connectivity — measuring how different brain regions communicate with each other over time — his team compares preterm infants to healthy in utero fetuses scanned as early as 20 weeks, finding that the ex utero preterm brain actually looks more mature in terms of connectivity, suggesting the NICU environment itself accelerates certain aspects of brain development. He shares why extremely and very...

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Dr. Katie Ottolini, researcher at the Developing Brain Institute at Children's National in Washington DC, presents findings from a longitudinal MRI study comparing brain growth trajectories in preterm infants to healthy fetuses — scanning as early as 25 weeks and through term corrected age. Even in preterm babies with no significant brain injury and appropriate growth at birth, brain volumes were already smaller by the first MRI at around two weeks of life. She shares which regions are most vulnerable, why the amygdala-hippocampus shows a distinct window of impaired growth beginning after 32 weeks that may re...

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Dr. Lori Devlin, neonatologist and principal investigator of the Optimize Now trial, shares results from the first multicenter randomized trial comparing symptom-based opioid dosing to scheduled opioid tapers in babies with neonatal opioid withdrawal syndrome (NOWS). Published in JAMA on the day of this recording, the trial found that symptom-based dosing reduced medical readiness for discharge by an additional 2.1 days — and that 65% of babies who would traditionally have been placed on a scheduled opioid taper never needed one at all. She also previews the next trial in this series, TREAT Now, which will co...

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Dr. John Feister, neonatologist and health equity researcher at Cincinnati Children's Hospital, presents two studies that challenge us to look beyond the bedside. The first reveals that NICU babies whose families prefer a language other than English have nearly double the in-hospital mortality rate of English-speaking families — a difference that persisted even after adjusting for medical and sociodemographic risk factors, and one he suspects is driven in part by barriers to family advocacy and end-of-life communication. The second introduces the concept of medical-financial partnerships, and specifically a hospital-based free tax preparation clinic that he...

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Dr. Ravi Jhaveri, infectious disease physician at Lurie Children's Hospital in Chicago, joins Daphna for a conversation spanning two underappreciated threats in pediatrics. On hepatitis C, he shares that up to 90% of perinatally exposed infants never get tested despite clear guidance — and makes the case for point-of-care, heel-stick based testing that meets families where they are rather than relying on follow-up that often never happens. On long COVID, he reframes the vaccine conversation away from acute illness and toward something families actually care about: protecting their child's ability to show up for the th...

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Dr. Sharon Levy, director of the Division of Addiction Medicine at Boston Children's Hospital, joins Daphna for a wide-ranging conversation on adolescent substance use. She shares data showing a sudden spike in nicotine exposure among teens in treatment for substance use disorders — likely driven by larger vape devices and cooling agents that eliminate the burn sensation — and introduces one of the most novel concepts in addiction medicine: a vaccine that would create antibodies against fentanyl, blocking its effect at the meningeal level before it reaches the brain. She also presents findings on why curr...

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Dr. Jonathan Flyer, pediatric and fetal cardiologist at the University of Vermont, presents findings from a Vermont Oxford Network analysis of over 11,000 extremely low birth weight infants examining whether the method of patent ductus arteriosus (PDA) closure — transcatheter device versus surgical ligation — makes a difference for neurodevelopmental outcomes at 18 to 24 months. The answer: no difference between the two techniques on Bayley-4 cognitive, language, and motor scores. The more sobering finding is that both groups scored well below the normative mean of 100, sitting in the high 70s to low 80s — a reminder of just how mu...