The Incubator

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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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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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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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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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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 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.<...

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In this Journal Club episode, Ben and Daphna review the 24-month follow-up of the BeNeDuctus trial, which compared expectant management with early ibuprofen for PDA in infants born before 28 weeks. Survival without neurodevelopmental impairment was identical in both groups, at 49%. Ben places the findings alongside Baby-OSCAR, the PDA trial, TRIOCAPI, and SMART-PDA, and explains why a neutral result does not mean no PDA should ever be treated. The conversation then turns to how targeted neonatal echocardiography and lung ultrasound are changing bedside PDA assessment, and previews an upcoming hemodynamics series with Dr. Gabriel...

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Feeding in the NICU is rarely one person's job, yet the language around it changes from nurse to therapist to physician to parent. In this Tech Tuesday episode, Ben and Daphna sit down with Lisa Kleinz and Erin Lesage of Dr. Brown's Medical to unpack feeding together, a philosophy built on team approach, family at the center, and feeding that begins on day one rather than at first bottle. They discuss what separates cue-based feeding from a truly standardized Infant-Driven Feeding® Program, the outcomes reported so far, and why nearly half of NICU g...

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Ben sits down with Dr. Shetal Shah and AAP federal advocacy director Stephanie Glier to unpack HR1, the sweeping reconciliation bill that could cut $1.15 trillion in federal Medicaid spending over the next decade. With 40% of US births and up to 65% of NICU graduates covered by Medicaid, the stakes for neonatology are enormous. Shetal and Stephanie break down state directed payments, provider taxes, shortened retroactive coverage windows, and new work requirements, explaining how administrative friction alone could push families out of coverage. They also offer a clear playbook: connect with your AAP state chapter...

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This week on The Incubator Podcast, Ben and Daphna dig into four studies reshaping bedside decisions. They open questioning whether routine DAT screening for ABO and RhD incompatibility still earns its place, finding transcutaneous bilirubin alone predicts phototherapy need just as well. Next, a Swedish national registry of over two million births links missed intramuscular vitamin K, and rising oral substitution, to a near-doubling of bleeding and intracranial hemorrhage risk. Ben then presents the PHILODENDRON pilot trial out of Milan, testing initial delivery-room CPAP of 5 versus 8 cmH2O in infants under 30 weeks, feasible...

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Ben and Eli dig into a Journal of Perinatology study that asks a deceptively simple question: can we trust birth certificate data to tell us how many babies actually need NICU care? The answer, it turns out, is no. Nearly 40% of NICU admissions are missing from birth certificates, with the biggest gaps among full-term and late-preterm infants, and troubling racial disparities in which admissions get missed. Ben and Eli unpack what this means for how states and hospitals allocate resources, why underreporting could be quietly starving NICUs of funding and attention, and why...

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Ben and Daphna  dig into a large, population-based study linking IVF conception to VACTERL association, a rare but serious pattern of congenital anomalies spanning the vertebral, anal, cardiac, tracheoesophageal, renal, and limb systems. Drawing on over 1.5 million births across four US states and linked SART registry data, the study finds IVF-conceived infants face significantly higher odds of VACTERL and related multiple anomaly syndromes compared to naturally conceived infants. Daphna and Ben unpack what this means for clinical suspicion at the bedside, why some VACTERL phenotypes may be easy to miss, and how better t...

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Ben and Daphna dig into a pilot RCT that asks a deceptively simple delivery-room question: should very preterm infants start on CPAP of 5 or CPAP of 8 cmH2O? The PHILODENDRON trial, out of Milan's Buzzi Children's Hospital, randomized 56 babies born between 26 and 29 weeks to find out — testing feasibility, safety, and early physiological adaptation before committing to a larger multicenter trial. No major safety signals emerged, but babies on lower CPAP reached surfactant thresholds faster, while higher CPAP trended toward fewer air leaks and shorter ventilation. Ben and Daphna weigh the physiology against the da...

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Is the newborn vitamin K shot really being skipped more often these days, and does that actually matter clinically? This week on Journal Club, Ben and Daphna review a nationwide Swedish cohort study of over two million births, published in JAMA Pediatrics, examining trends in non-receipt of intramuscular vitamin K and its link to bleeding in infancy. Non-receipt nearly doubled between 2006 and 2021, and infants without intramuscular vitamin K had significantly higher odds of bleeding, including intracranial bleeding, than those who received it — oral vitamin K carried an even higher bleeding risk still. Ben an...

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Do we really need a DAT on every baby born to a group O or Rh-negative mother? This week on Journal Club, Ben and Daphna dig into a new Pediatrics study questioning routine Direct Antiglobulin Testing (DAT) in low-risk neonates with ABO or RhD incompatibility. Using data from over 1,300 infants, the authors found that transcutaneous bilirubin alone predicted the need for phototherapy just as well as DAT in ABO-incompatible babies, and that passive anti-D from RhoGAM rarely caused significant hemolysis in RhD-incompatible infants. Ben and Daphna also discuss what this means for institutions...

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In this episode of From the Heart, Drs. Nim Goldshtrom and Adrianne Bischoff talk with Dr. Kristin Elgersma, a nurse-researcher whose path into neonatal nutrition began at her son's bedside in a cardiac ICU. A former concert pianist turned nurse-researcher, Kristin asked a question no one had: does human milk change outcomes for babies with congenital heart disease? Her multicenter PC4 study of day-by-day data from over 800 infants across 25 centers found no link between human milk and NEC, though bovine-derived formula or fortifier tripled NEC risk within five days, while higher human milk...

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In this episode of From the Heart, Dr. Nim Goldshtrom and Dr. Adrianne Bischoff dissect a hemodynamics consult that changes shape twice in 48 hours. A 30-week recipient twin from twin-to-twin transfusion syndrome presents with biventricular dysfunction and suprasystemic pulmonary hypertension, starts on epinephrine and milrinone, and stabilizes. Then overnight, everything falls apart: hypotension, rising lactate, falling urine output. Only on repeat echo does the real diagnosis emerge: hypertrophic obstructive cardiomyopathy (HOCM) with dynamic left ventricular outflow tract obstruction, where the "correct" initial therapy becomes dangerous. Nim and Adrianne unpack why milrinone can worsen...

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Disclosure: Dr. Wanda Barfield appeared on this episode in her personal capacity. The views she expresses are her own and do not represent the official positions of the Centers for Disease Control and Prevention, the Department of Health and Human Services, or the United States government.

The American Academy of Pediatrics has never had a neonatologist as president. This September, that could change. In this special episode, Ben sits down with Dr. Wanda Barfield, neonatologist, retired Rear Admiral and Assistant Surgeon General in the US Public Health Service, and...

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This week's Journal Club. Monday, nasal CPAP versus NIPPV as the bridge to minimally invasive surfactant in infants born before 30 weeks, first author Dr. Hui Zhang. Tuesday, the PAEAN trial on high-dose erythropoietin for neonatal HIE, led by Dr. Helen Liley. Wednesday, extended infusion versus bolus feeding for weight gain in extremely-low-birth-weight infants, from Dr. Haribalakrishna Balasubramanian's team in India. Thursday, the DROP-ROP trial, testing dexamethasone eye drops against treatment-requiring ROP, led by Dr. Ann Hellström. Friday, Neo News: Eli and Ben on The Pitt's viral boundary-setting scene and what it says a...

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A medical student on The Pitt finishes her shift, is asked to stay, and tells her supervisor to learn some boundaries. The internet did not let it go. Ben and Eli use that moment to work through what boundary setting actually looks like in a NICU, why a tired clinician makes different decisions at three in the morning than at three in the afternoon, and where duty hours collide with the fact that patients do not arrive on a curriculum. Also, why handing a resident your pager at two PM may be the...

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Steroids again? This time in the eye. Daphna brings the DROP-ROP trial from JAMA Pediatrics, a double-masked randomized study across fourteen Swedish centers asking whether topical dexamethasone can stop pre-threshold ROP from progressing to type one disease. One hundred infants, born under 30 weeks, dosed for up to twelve weeks, some still getting drops at home. Twenty percent needed laser or anti-VEGF in the dexamethasone arm versus thirty-eight percent on placebo, a relative risk reduction that did not reach significance. Ben and Daphna talk through the safety signals, the intraocular pressure question, and how...

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Every unit has a bolus camp and a continuous camp, and both are usually dug in. Ben brings a single center non-inferiority trial from India, published in the Journal of Pediatrics, randomizing 132 infants born before 29 weeks and under a thousand grams to extended infusion feeding or two hourly bolus feeds. Weight gain at discharge was essentially identical at 15.3 versus 15.7 grams per kilo per day, but the infusion group lost two fewer days to interrupted feeds. Ben and Daphna talk through the five on one off infusion cycle, two hourly bolus feeding, and why...

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We already had HEAL, so why run this trial at all? Daphna brings PAEAN from JAMA Pediatrics, a phase three trial across 24 units in Australia, New Zealand, and Singapore that gave high dose erythropoietin to 313 late preterm and term infants already receiving therapeutic hypothermia for HIE. Same drug, same dosing, nearly the same eligibility criteria as HEAL, by design. Death or moderate to severe developmental deficit at two years was 34 percent with EPO versus 29 percent with placebo. Ben and Daphna talk through the thrombosis signal, why replication feels so foreign in neonatology, and...

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Most trials comparing CPAP and NIMV leave a lingering doubt about whether surfactant explained the difference. This one does not. Ben brings a multicenter noninferiority trial from JAMA Network Open in infants born between 24 and 29 weeks, randomized to nasal CPAP or NIMV with every baby receiving less invasive surfactant administration. The trial stopped early for futility after 312 infants. Noninvasive ventilation failure within 72 hours was 26 percent on CPAP versus 13 percent on NIMV. Ben and Daphna talk through what happens when surfactant is off the table, the unexpected NEC signal, and where the guidelines may...

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A term newborn looks fine on mom's chest, then crashes within minutes. By the time transport arrives, there's a pH of 6.9, a lactate over 10, and a baby already intubated and on surfactant. Is this pulmonary hypertension, congenital heart disease, or something else entirely? In this episode of From the Heart, It's Complicated, Dr. Adrianne Bischoff and Dr. Nim Goldshtrom work through a real, complex neonatal cardiac case in real time — the kind of case that keeps neonatologists up at night. They break down how to clinically differentiate PPHN from congenital heart disease with li...

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Why does reading in the NICU still feel optional when the evidence says otherwise? Daphna sits down with Paige Pedroli, author of the Nic Zoo book and two-time NICU mom, and Dr. Raquel Garcia, a craniofacial and feeding specialist, to unpack why reading to preterm and critically ill infants belongs alongside kangaroo care as neuropromotive, not just neuroprotective. They cover the evidence behind auditory stimulation and language outcomes, why reading gives overwhelmed parents a real role in their baby's care, and how units can build low-cost reading programs with book libraries and student...

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Is your EMR actually built for neonatology, or just retrofitted to survive it? Ben sits down with Dr. Lindsey Knake, clinical assistant professor and associate chief health information officer at the University of Iowa, to talk AI in the NICU. They cover the real difference between Epic's homegrown tools and third-party options like Evidently and NABLA, why a six-month hospital stay breaks most chart summarization tools, and how ambient AI is starting to change documentation and family counseling. Lindsey also shares practical paths into clinical informatics for clinicians without a coding background. A...

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The full week of Journal Club in one place. Monday, the PLaNT trial of prophylactic CPAP for late preterm infants born by cesarean, with senior author Dr. Edgardo Szyld. Tuesday, whether parental holding during therapeutic hypothermia changes feeding and length of stay. Wednesday, the Connection Study, the first live biotherapeutic product tested under an IND, and what it means for probiotics returning to the NICU. Thursday, a handheld light probe that reads bowel through the skin to catch NEC before the X-ray does. Friday, Dr. Dinushan Kaluarachchi on the respiratory severity score and...