The Incubator

Latest Episodes:

#439 - 🔵 [PAS 2026] - Can We Give Fewer Opioids to Babies With Withdrawal Syndrome? Apr 26, 2026

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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 compare buprenorphine versus morphine for babies who do require pharmacologic treatment, and reflects on how far the field has come since Eat Sleep Console first changed the way we think about caring for this population and their families.

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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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#439 - 🔵 [PAS 2026] - Are Language Barriers in the NICU Actually Costing Babies Their Lives? Apr 26, 2026

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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 helped NICU and hospital families claim thousands of dollars in refundable tax credits — with 90% of participants reporting that the service improved their trust in their medical team.

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#439 - 🔵 [PAS 2026] - Hep C and Long COVID: Two Infections We're Not Taking Seriously Enough Apr 26, 2026

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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 things that matter most to them — sports, dance, school — since even mild or repeat COVID infections can double the risk of debilitating long COVID symptoms.

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#439 - 🔵 [PAS 2026] - Can We Vaccinate Teenagers Against Fentanyl Overdose? Apr 26, 2026

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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 current surveillance questions fail to capture how teens actually talk about drug use, and why kids who need treatment most are paradoxically the ones most likely to answer screening questions honestly.

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#439 - 🔵 [PAS 2026] - Does It Matter How You Close a PDA for Neurodevelopment? Apr 26, 2026

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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 much ground this population has to cover. He also makes a case for centering the counseling conversation not on technique but on what each center does best, and what families actually care about most: their child's brain.

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#439 - 🔵 [PAS 2026] - Does What We Feed and How We Clear Meconium Change Survival in Tiny Babies? Apr 26, 2026

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Dr. Brandon Tucker and Dr. Jenelle Ferry share two studies tackling some of the most pressing challenges in the care of extremely low birth weight infants. Dr. Tucker presents a quality improvement initiative examining whether switching from PRN glycerin suppositories to scheduled glycerin enemas every 12 hours reduces feeding intolerance and spontaneous intestinal perforation in babies under 1,000 grams — with early results trending in the right direction. Dr. Ferry then shares findings from a meta-analysis of 14 studies and nearly 4,700 babies showing that an exclusive human milk diet is associated with a roughly 20% reduction in the odds of death — a finding that reached statistical significance when RCTs and observational cohorts were pooled together, and one that carries real weight for units still weighing the evidence on human milk-based nutrition.

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#439 - 🔵 [PAS 2026] - Are We Leaving Dads Out of the Most Important Moments in Their Baby's Care? Apr 26, 2026

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Dr. John James Parker, internist, pediatrician, and researcher at Northwestern University and Lurie Children's Hospital, joins Daphna and Rupa for a conversation about one of the most overlooked players in family-centered care — fathers. He shares why paternal stress in the NICU and postpartum period often peaks later than maternal stress, why discharge instructions routinely go home with only one parent, and how a few small changes — making eye contact with dad, asking him a question, giving him a specific task — can fundamentally shift how engaged fathers feel in their child's care. He also reflects on the inaugural Fathers in Pediatrics special interest group at PAS, and makes the case that thinking about the whole family unit, including the mental and physical health of every caregiver, is not a nice-to-have but a core part of caring for the child.

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#439 - 🔵 [PAS 2026] - Are We Visiting Language-Minority Families Less Often in the Hospital? Apr 26, 2026

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Dr. Christina Rojas, from Lurie Children's Hospital, presents findings from a multi-center study across eight hospitals examining how often hospitalized patients and families receive communication touchpoints from their care team — and whether that differs based on preferred language. Across more than 30 languages represented in the study, families who preferred a language other than English experienced significantly fewer room visits, less direct communication when staff did enter the room, and a 55% gap in language-concordant interactions. She discusses what this means for patient safety — since missed touchpoints are missed opportunities to catch medication errors and address family concerns — and makes the case that interpreter access needs to stop being an extra step and start being the cultural default built into every care process.

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#439 - 🔵 [PAS 2026] - Does Tylenol During Pregnancy Actually Cause Autism or ADHD? Apr 26, 2026

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Dr. Ayesha Khalid, resident at Marshall University, presents findings from a large meta-analysis pooling data from eight national registries across Europe — covering 2.5 million pregnancies — to examine whether prenatal acetaminophen exposure is truly linked to autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) in children. She shares why the association with ASD largely disappears when accounting for heterogeneity and confounders, why the previously reported link with ADHD appears significantly smaller than what has been published, and why publication bias may have inflated the estimates we have been working from. She also addresses the critical limitation that no patient-level dose or timing data was available, why the risk-benefit calculation around fever control in pregnancy complicates any simple recommendation, and what kind of studies — ideally sibling-controlled designs like those done in Sweden — would be needed to actually settle this question.

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#439 - 🔵 [PAS 2026] - Is Procalcitonin Plus CRP the Better Sepsis Screen for Febrile Infants? Apr 26, 2026

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Dr. Lyubina Yankova, hospitalist at Yale, presents findings from a large retrospective multi-center analysis across 106 sites examining whether the combination of procalcitonin and C-reactive protein (CRP) can match or outperform the inflammatory marker combinations currently recommended by the 2021 AAP guidelines for risk-stratifying febrile infants between 8 and 60 days of age. She shares why this combination showed similar sensitivity but higher specificity for detecting invasive bacterial infections — meaning fewer false positives, fewer unnecessary lumbar punctures, and fewer unnecessary antibiotics. She also addresses the limitations of retrospective data, why preterm infants were excluded from this analysis and what future research in that population might look like, and what it would take for guideline committees to feel confident enough to incorporate this combination into routine practice.

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