The Incubator

#454 - PEEP, Tidal Volume, and Physiology, How Far Has Resuscitation Science Traveled? (ft Dr. Charles Roehr) 20.07.2026 32λ

Send us Fan Mail How far has delivery room ventilation really come? In this special episode, recorded in collaboration with the Neonatal Resuscitation Symposium, Ben sits down with Dr. Charles Roehr, professor of neonatology and perinatal medicine at the University of Bristol, clinical trialist at the University of Oxford, and member of ILCOR. Together they trace the evolution of respiratory support at birth, from the era of fixed inflation breaths to today's focus on physiologic stability an...

#453 - 📑 Journal Club - The Complete Episode from July 18th 2026 18.07.2026 1ώ 43λ

Send us Fan Mail Which PDAs actually need treatment? Can maternal voice and scent shape language outcomes? Should we cool at 35 weeks? And did stepping away from probiotics come at a cost? This week’s Journal Club takes on five papers that push back on standard practice. Ben reviews the SMART-PDA trial and a comparative study of PDA pharmacotherapy, Daphna covers the MIND trial on multisensory maternal interventions and a Pediatrix database study on NEC after the FDA probiotic warning, and Be...

#453 - [Neo News] - 📌 Are You Still Assuming Every Newborn Got Vitamin K? 17.07.2026 17λ

Send us Fan Mail Vitamin K refusal has crossed 5%. That's one in twenty babies, and the curve is bending the wrong way. Ben and Eli work through a new Pediatrics case review that opens with a warning shot, that hemorrhagic presentation in an infant should no longer be a diagnostic mystery, alongside a JAMA letter tracking refusal from 2.9% in 2017 to 5.2% in 2024. Eighty-one times the risk. Intracranial hemorrhage in most late-onset cases. Twenty percent mortality. They talk about the halo ef...

#453 - [Journal Club] - 📌 What Happened to NEC When Centers Stopped Using Probiotics? 16.07.2026 17λ

Send us Fan Mail When the FDA warning landed in late 2023, probiotic use in high-use NICUs collapsed from 86% to under 7% almost overnight. What happened to NEC? This week Daphna brings Tolia and Patel's new Journal of Perinatology analysis of the Pediatrix Clinical Data Warehouse, a natural experiment across 347 NICUs and more than 10,000 extremely preterm infants. Centers that stopped saw NEC climb from 2.7% to 4.4%. Centers that never used probiotics saw nothing change. Ben and Daphna work...

#453 - [Journal Club] - 📌 Should We Cool 35 Week Infants with Encephalopathy? 15.07.2026 15λ

Send us Fan Mail Cooling works at 36 weeks. At 35 weeks, nobody is sure. Ben brings a new Journal of Perinatology analysis of the National Inpatient Sample, covering 1.4 million infants from 2016 to 2022, asking what happens when therapeutic hypothermia is offered just below the evidence line. Cooled 35-weekers died at higher rates than cooled 36-weekers, but within the 35-week group, cooling changed nothing either way. Coagulopathy rose with cooling. Mediation analysis says it wasn't the cau...

#453 - [Journal Club] - 📌 Can We Rewire a Preterm Baby's Brain for Language? 14.07.2026 21λ

Send us Fan Mail In this Journal Club, Daphna takes the reins with the MIND randomized controlled trial from Nathalie Maitre and colleagues in The Journal of Pediatrics. Can a multisensory bundle, combining infant-directed voice, a parent's scent, holding, and gentle containment, do more for a preterm baby's developing brain than recorded voice alone? Using event-related potentials to track how infants tell speech sounds apart, the team followed language outcomes all the way to age two. Daphn...

#453 - [Journal Club] - 📌 Should We Treat the PDA Based on Size Alone? (SMART PDA Trial) 13.07.2026 43λ

Send us Fan Mail In this Journal Club, Ben and Daphna dig into two new papers on PDA management in our smallest patients. First, the SMART-PDA pilot RCT from Souvik Mitra and colleagues, which uses comprehensive hemodynamic screening to selectively treat high-volume shunts in infants born before 26 weeks, and whose striking Bayesian signal for reduced pulmonary hemorrhage and NEC stopped the trial early. Then a companion JAMA Network Open comparative effectiveness study across four pharmacoth...

#452 - 🚀 [Tech Tuesday] - Why Midline Positioning Matters More Than We Think 10.07.2026 35λ

Send us Fan Mail In this episode, Ben and Daphna sit down with Dr. Scott, pediatrician, neonatologist, and inventor of the Tortle. She shares how a simple observation in her Idaho practice, babies developing flat heads despite diligent parents, sparked a second career in medical device innovation. The conversation covers the evolution from the original corrective beanie to the Midliner and Transportal, the physiologic rationale for midline positioning in IVH prevention, and real-world data fr...

#451 - On with VON (EPS 3) - Re-examining the Evidence for Erythropoiesis-Stimulating Agents in Preterm Infants 06.07.2026 36λ

Send us Fan Mail Does the latest Cochrane evidence finally tip the balance in favor of erythropoiesis stimulating agents in preterm infants? In this VON Grand Rounds follow-up episode, Ben sits down with Dr. Roger Soll and Dr. Souvik Mitra to review the 2026 Cochrane systematic review on early ESA use in preterm newborns. Across 37 trials and over 6,000 infants, early ESAs consistently reduce the need for red blood cell transfusion. The review also confirms with high certainty that ESAs do no...

#450 - 📑 [Journal Club] - 🫀From The Heart - The Complete Episode from July 4th 2026 04.07.2026 1ώ 9λ

Send us Fan Mail Neonatal sepsis physiology, steroids, vasopressors, and moms.gov. A full week on The Incubator Journal Club. Adrianne and Nim open with a retrospective study from Toronto challenging the assumption that hypoxemic respiratory failure in septic preterm infants is driven by elevated pulmonary vascular resistance. The data points instead to left ventricular dysfunction as a key contributor, raising questions about the reflex to reach for nitric oxide first. Nim then reviews a dou...

#450 - [Neo News] - 📌 What Does the Launch of moms.gov Mean for Your Patients? 02.07.2026 20λ

Send us Fan Mail In this episode of Neo News, Ben and Eli discuss the federal government's Mother's Day press conference and the launch of moms.gov, a new website aimed at supporting new and expecting mothers. They examine what the administration got right, including the real barriers families face in accessing maternal care and the economic challenges of having children in America today. They also dig into what the website links to, including Option Line, run by Heartbeat International, an o...

#450 - [Journal Club] - 🫀 From The Heart - Is Dopamine Still Defensible as First-Line for Neonatal Septic Shock? 01.07.2026 16λ

Send us Fan Mail In this double-blind randomized controlled trial, Adrianne and Nim examine whether norepinephrine outperforms dopamine as a first-line vasoactive agent in neonates with fluid-refractory septic shock. The primary outcome, shock reversal at 30 minutes, was not significantly different between groups, at 32 percent for norepinephrine and 46 percent for dopamine. Secondary outcomes including mortality, IVH, NEC, and need for additional vasoactive support were also similar. The epi...

#450 - [Journal Club] - 🫀 From The Heart - Does Early Hydrocortisone Actually Move the Needle in Fluid-Refractory Shock? 30.06.2026 17λ

Send us Fan Mail In this double-blind randomized controlled trial from northern India, Nim and Adrianne review whether early hydrocortisone reduces 14-day all-cause mortality in preterm infants with fluid-refractory shock. The primary outcome showed no statistically significant difference between groups, though an 11 percent absolute reduction in mortality in the hydrocortisone group raised clinical interest. A major limitation was the high rate of open-label steroid crossover, with over 70 p...

#450 - [Journal Club] - 🫀From The Heart - When Nitric Oxide Fails: Is the Left Ventricle the Culprit in Septic Preterm Infants? 29.06.2026 23λ

Send us Fan Mail In this retrospective single-center study from Toronto, Adrianne and Nim explore the echo findings of preterm infants with septic shock and hypoxemic respiratory failure. Contrary to the common assumption that elevated pulmonary vascular resistance drives hypoxemia in sepsis, the data points to left ventricular dysfunction as a key contributor. Babies with hypoxemic respiratory failure showed lower LV systolic and diastolic performance, while pulmonary pressures were similar ...

#449 - What Do Division Heads Think About the Shortened Fellowship Proposal? 22.06.2026 44λ

Send us Fan Mail What would it really mean to shorten neonatology fellowship training to two years? In this episode, Ben and co-host Dr. Shetal Shah sit down with three division heads, Dr. Jill Maron (Brown), Dr. Patrick McNamara (University of Iowa), and Dr. Sarah Taylor (Yale), to examine the ABP's proposed changes from the perspective of those who run major academic NICUs. From the operational and financial strain of losing an entire class of third-year fellows, to the erosion of scholarly...

#448 - Are NICU Outcomes Actually Getting Better Over Time? (ft Dr. Joseph Kaempf) 16.06.2026 49λ

Send us Fan Mail What does it mean to truly improve outcomes for very low birth weight infants, and are we actually doing it? In this episode, Daphna sits down with Dr. Joseph Kaempf, neonatologist and Medical Director of Value Research and Innovation at Providence Health System in Oregon, to examine some uncomfortable truths about neonatal quality improvement. Dr. Kaempf shares findings from a study spanning 16 NICUs over 14 years showing that composite morbidity outcomes have remained flat ...

#447 - 📑 Journal Club - The Complete Episode from June 13th 2026 13.06.2026 1ώ 29λ

Send us Fan Mail Phototherapy duration, jaundice and UTIs, extended CPAP, and The Pitt. A full week on the Incubator Journal Club. Ben opens with a nationwide Swedish cohort study from JAMA Network Open examining phototherapy duration in nearly 5,000 very preterm infants. Longer phototherapy was not significantly associated with late neonatal mortality, but six to seven days was associated with significantly higher rates of severe neonatal morbidity. With 95% of the cohort receiving photother...

#447 - [Neo News] - 📌 - Why Are Doctors Flocking to HBO Max's The Pitt? 12.06.2026 19λ

Send us Fan Mail In this episode of Neo News, Ben and Eli discuss the cultural phenomenon of HBO Max’s new hit medical drama, The Pitt. Sparked by an insightful critique in The New Yorker by Dr. Dhruv Khullar, they dive into why this Noah Wyle-led series is capturing the attention of millions of Americans, including healthcare workers and patients alike. They explore how the show’s unflinching portrayal of systemic failures, from ER overcrowding to uninsured patients leaving against medical a...

#447 - [Journal Club] - 📌 Is a Five-Day Antibiotic Course Enough to Treat UTIs in the NICU? 11.06.2026 22λ

Send us Fan Mail Is five days of antibiotics enough to treat a urinary tract infection in a NICU infant? In this Journal Club episode, Ben and Daphna review a single-center study from Nationwide Children's Hospital examining adherence and safety of a five-day antibiotic treatment guideline for culture and urinalysis-proven UTIs in the NICU. Among 77 infants with 93 bacterial UTIs, the five-day course was associated with a 1% failure rate, defined as reinitiation of antibiotics within seven da...

#447 - [Journal Club] - 📌 Does Extended CPAP Reduce Intermittent Hypoxemia in Stable Preterm Infants? 10.06.2026 19λ

Send us Fan Mail What happens to intermittent hypoxemia when you keep a stable preterm infant on CPAP for two extra weeks? In this Journal Club episode, Ben and Daphna review a secondary analysis from the Journal of Pediatrics by Mamidi and McEvoy. Among 95 infants randomized to either two additional weeks of bubble CPAP on room air or discontinued CPAP, those in the extended CPAP group experienced significantly fewer intermittent hypoxemia episodes (57.6 versus 151.7), higher baseline satura...