The Incubator

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#467 - Navigating the Future of Pediatric Healthcare Funding Sep 21, 2026

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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, share bedside stories with policymakers, and don't be more intimidated by a congressional office than by a resuscitation.

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AAP Advocacy page: https://www.aap.org/en/advocacy/?srsltid=AfmBOoqcnlKDsPZkpNg6z6U7OlOuBqUiuCtWHrUPmRGzfqDiQEl-vf7s

Myers CN, Beck AF. H.R. 1’s Medicaid cuts threaten children’s health. Health Affairs Forefront. January 20, 2026. Accessed August 28, 2026. https://www.healthaffairs.org/content/forefront/h-r-1-s-medicaid-cuts-threaten-children-s-health

Little J, Kohler A. How H.R. 1 cuts and changes to Medicaid played out in 2026 state legislative sessions (Part 2). Georgetown University Center for Children and Families. July 2, 2026. Accessed August 28, 2026. https://ccf.georgetown.edu/2026/07/02/how-h-r-1-cuts-and-changes-to-medicaid-played-out-in-2026-state-legislative-sessions-part-2/

Academy of Managed Care Pharmacy. Implications of H.R. 1 – the One Big Beautiful Bill Act. Academy of Managed Care Pharmacy. 2026. Accessed August 28, 2026. https://www.amcp.org/H.R.1

Park E. New CMS guidance on H.R. 1's restrictions of state directed payments. Georgetown University Center for Children and Families. February 4, 2026. Accessed August 28, 2026. https://ccf.georgetown.edu/2026/02/04/new-cms-guidance-on-h-r-1s-restrictions-of-state-directed-payments/

Mudumala A, Mohamed M, Tolbert J, Burns A. The impact of H.R. 1 on two Medicaid eligibility rules. KFF. September 22, 2025. Accessed August 28, 2026. https://www.kff.org/medicaid/the-impact-of-h-r-1-on-two-medicaid-eligibility-rules/

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As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.

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#466 - 📑 Journal Club - The Complete Episode from September 19th 2026 Sep 19, 2026

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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 and safe, but not yet enough to settle the physiology question. Daphna closes Journal Club with a SART-linked study tying IVF conception to significantly higher odds of VACTERL association. The week wraps with Ben and Eli on Neo News, unpacking a study showing birth certificates miss nearly 40% of true NICU admissions, with troubling racial disparities.

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Utility of DAT in Low-Risk Neonates With ABO or RhD Incompatibility. Tsai TL, Ma T, Nester T.Pediatrics. 2026 Sep 1;158(3):e2026076989. doi: 10.1542/peds.2026-076989.PMID: 42642037

Vitamin K Prophylaxis in Newborns and Bleeding in Infancy. Simatou E, Tsamantioti E, Hallström A, Stephansson O, Razaz N, Persson M, Bolk J.JAMA Pediatr. 2026 Sep 1;180(9):995-1004. doi: 10.1001/jamapediatrics.2026.2606.PMID: 42440325

Initial CPAP of 5 versus 8 cmH2O during delivery room stabilisation of very preterm infants: the PHILODENDROOM pilot randomised trial. Cavigioli F, Bresesti I, Castoldi F, Gatto S, Lupo E, Rossi S, La Verde A, Bianchi S, Meneghin F, Viaroli F, Pivetti V, Manfredini V, Cannata G, Bastrenta P, Fontana P, Stucchi I, Daniele I, Chiera M, Lista G.Eur J Pediatr. 2026 Aug 17;185(9):673. doi: 10.1007/s00431-026-07322-6.PMID: 42608615 Free PMC article. Clinical Trial.

In Vitro Fertilization and VACTERL Birth Defects. Tark JY, Richard MA, Schraw JM, Fisher SC, Betancourt D, Stone SL, Forestieri NE, Baker VL, Cameron K, Eisenberg ML, Belva F, Lu Y, Williams CL, Sutcliffe AG, Lupo PJ, Luke B.JAMA Netw Open. 2026 Aug 3;9(8):e2629355. doi: 10.1001/jamanetworkopen.2026.29355.PMID: 42616500 Free PMC article.

Birth certificate data substantially misrepresent actual NICU admissions, including among most vulnerable. Hughes CS, Lorch SA, Schmitt S, Passarella M, Phibbs CS.J Perinatol. 2026 Jul;46(7):1307-1312. doi: 10.1038/s41372-026-02726-6. Epub 2026 May 27.PMID: 42204354

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#466 - [Neo News] - 📌 Why Are 4 in 10 NICU Stays Missing From Birth Records? Sep 18, 2026

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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 pairing solid epidemiologic data with individual bedside stories may be the most effective way to make the case for better-resourced newborn care.

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#466 - [Journal Club] - 📌 Does IVF Really Raise the Risk of VACTERL Birth Defects? Sep 17, 2026

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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 tracking of conception history through delivery could change how NICU teams approach anomaly workups in IVF-conceived infants.

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#466 - [Journal Club] - 📌 Should we start CPAP at 8 instead of 5 in the delivery room for very preterm infants? Sep 16, 2026

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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 data, and ask whether trials like this even test the right question in the first place.

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#466 - [Journal Club] - 📌 Oral isn't IM: Sweden's vitamin K data in two million infants Sep 15, 2026

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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 and Daphna also discuss home birth data, families requesting oral alternatives, and how best to counsel parents navigating a vitamin K refusal in clinic today.

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#466 - [Journal Club] - 📌 Do We Still Need a DAT on Every Newborn at Risk of Hemolytic Disease? Sep 14, 2026

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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 running DAT on every newborn, how to tell passive anti-D apart from true alloimmunization, and why a more targeted approach to bilirubin screening may be overdue.

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Utility of DAT in Low-Risk Neonates With ABO or RhD Incompatibility. Tsai TL, Ma T, Nester T.Pediatrics. 2026 Sep 1;158(3):e2026076989. doi: 10.1542/peds.2026-076989.PMID: 42642037

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#465 - [🫀 From The Heart] - Bringing NICU Feeding Practices to the CICU (ft Dr. Elgersma) Sep 13, 2026

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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 intake meant roughly nine fewer hospital days. They cover lactation support, donor milk gaps between NICUs and CICUs, and practical next steps.

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Elgersma et al. Human milk feeding, fortification initiation, and clinical outcomes in neonates with critical congenital heart disease: A multi-institutional study. medRxiv 2026. DOI 10.64898/2026.08.20.26360934 (preprint, no PMID)

Elgersma et al. Human milk feeding and direct breastfeeding improve outcomes for infants with single ventricle congenital heart disease: Propensity score-matched analysis of the NPC-QIC registry. J Am Heart Assoc 2023. PMID 37642030

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#464 - [🫀 From The Heart] - Right Drugs, Wrong Heart - A TTTS Recipient That Fooled Everyone Sep 10, 2026

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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 outflow obstruction, why vasopressin beats dobutamine, and when esmolol helps or harms. It's a masterclass in resisting anchoring bias and treating evolving physiology, not just numbers.

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#463 - 🗳️ Meet the Neonatologist Running for AAP President - A Conversation with Dr. Wanda Barfield Sep 07, 2026

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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 longtime director of the CDC's Division of Reproductive Health, to hear what she would bring to the role. She lays out her three priorities, supporting pediatricians, protecting access, and leading with science and equity, and addresses the questions our field is wrestling with right now: training, staffing, the erosion of trust in science, and whether neonatology should go it alone. Her answer is that we are stronger together, and that having a neonatologist at the helm of the AAP would give our specialty a voice it has never had. Voting is open to AAP members through September 16. Meet the candidate, then go vote.

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