The Incubator

Latest Episodes:

#439 - 🔵 [PAS 2026] - Why Can't We Give the Same Vaccine to Every Baby and Call It a Day? Apr 26, 2026

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Dr. Ofer Levy, director of the Precision Vaccines Program at Boston Children's Hospital and member of the FDA's Vaccines and Related Biologic Products Advisory Committee, makes the case that vaccines must be tailored to the immune system of the person receiving them — and that immune system changes dramatically from the moment of birth through old age. He explains why preterm infants, who represent 11% of births worldwide, carry an increased risk of infection-related hospitalization all the way through age 18, and why almost no investment has been made in understanding how to optimally immunize them. He also discusses the FDA Modernization Act 2.0, which is shifting vaccine development away from animal models toward human in vitro modeling and systems biology, and reflects on what precision vaccinology could mean for rebuilding public trust in a deeply polarized conversation — not by dismissing concerns, but by taking vaccine safety science more seriously than ever before.

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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] - What Is the Right Cord Management Plan for Every Baby in the Delivery Room? Apr 26, 2026

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Dr. Anup Katheria, one of the world's leading researchers in umbilical cord management, joins Daphna to share the latest data on deferred cord clamping and cord milking across gestational ages. He presents new two-year follow-up findings showing that while cord milking remains a reasonable alternative to immediate cord clamping, delayed cord clamping still carries a measurable advantage in Bayley scores for motor and language — even in babies between 28 and 32 weeks where short-term outcomes looked identical. He also breaks down the practical decision tree for vigorous versus non-vigorous babies at different gestational ages, shares his vision for involving obstetricians more actively in that critical first minute of life, and previews an upcoming large-scale Neonatal Research Network trial testing 100% oxygen delivery during the cord clamping window. He closes with a call to move away from traditional composite outcomes in neonatal trials toward ranked ordinal outcomes that better reflect what actually matters to families.

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#439 - 🔵 [PAS 2026] - Good Morning From PAS 2026 Day Two! Apr 26, 2026

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Daphna is back for day two of PAS 2026 in Boston, joined in the booth by Christa and Rupa. More episodes coming all day — and if you're at the conference, stop by and say hi.

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#438 - 🔵 [PAS 2026] - Can Freeze-Dried Mother's Own Breast Milk Replace Commercial Fortifiers in the NICU? Apr 25, 2026

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Dr. Bridget Young, researcher at the University of Rochester, shares early but promising work on using freeze-dried mother's own breast milk — including a skim milk fraction — as a fortifier for human milk feeds in the NICU. She explains why milk variability makes accuracy the central challenge in this approach, how her team validated a method using macronutrient analysis to consistently hit a target caloric density of 28 kcal per ounce, and why the skim milk fraction in particular can deliver a protein content that rivals commercial bovine fortifiers. She also introduces the concept of mother's own breast milk cream — a centrifuge-derived calorie booster that families in her unit have found deeply empowering — and lays out honestly what it would take to bring lactoengineering from a research setting into routine clinical practice.

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#438 - 🔵 [PAS 2026] - What Happens to First Attempt LP Success When You Add Ultrasound? Apr 25, 2026

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From lumbar punctures to mitochondrial recycling, this booth interview from PAS 2026 covers a lot of ground. Ben and Daphna sit down with Dr. Ioanna Kotsopoulou from Mass General to discuss two distinct but equally compelling topics. First, a quality improvement project that took ultrasound-guided LP use from 12 to 73 percent and first attempt success from 32 to 68 percent. Then a pivot to basic science: impaired mitophagy in pulmonary hypertension, and whether dysfunctional mitochondrial recycling in cardiomyocytes may be contributing to the cardiac phenotype we see in these patients. A wide-ranging conversation with something for every neonatologist.

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#438 - 🔵 [PAS 2026] - Do Febrile Infants in Their First Month of Life Still Need a Lumbar Puncture? Apr 25, 2026

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Dr. Nathan Kupperman and Dr. Brett Bernstein, lead investigators on a landmark international pooled analysis published in JAMA, present the most comprehensive evidence to date on whether a lumbar puncture can be safely avoided in febrile infants under one month of age. Using a simple three-criteria rule — negative urinalysis, procalcitonin of 0.5 or below, and absolute neutrophil count of 4,000 or below — across more than 2,500 prospectively collected cases from multiple international cohorts, the rule did not miss a single case of bacterial meningitis. They explain what this means for shared decision-making with families, why the number needed to perform a lumbar puncture to identify one case of bacterial meningitis is now vanishingly close to infinity for low-risk infants, and why implementing this approach requires a multidisciplinary coalition across emergency medicine, infectious disease, and inpatient teams before any individual physician changes their practice.

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#438 - 🔵 [PAS 2026] - What Would Periviable Counseling Look Like If We Let Parents Lead? Apr 25, 2026

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What does it actually feel like to be told your 22-week baby has no chance — before anyone asks what you want? In this booth interview recorded live at PAS 2026, Ben and Daphna sit down with two NICU parents, Christelle and Reem, both of whom delivered at the limits of viability. They share candid, at times difficult accounts of prenatal counseling experiences where they felt dismissed, pressured, and unheard — and what it would have taken to make those conversations feel human. This episode is a reminder that listening is not a soft skill. It is the clinical skill.

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#438 - 🔵 [PAS 2026] - How Do You Risk Stratify Sepsis In A Low Resource Setting? Apr 25, 2026

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Point-of-care biomarkers for predicting sepsis mortality, not from a resource-rich academic center, but from a tertiary referral hospital in Tanzania. In this booth interview from PAS 2026, Ben and Daphna sit down with Dr. Abigail Sorensen, a pediatrician now based in East Africa, to discuss how a lasso model combining malnutrition, altered mental status, respiratory distress, and procalcitonin can risk-stratify children with sepsis at the bedside. The lessons here are not just for low-resource settings. They are for anyone trying to identify the sickest kids before it is too late, with the tools already in front of them.

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#438 - 🔵 [PAS 2026] - Neonatology in Burundi: QI at the Edge of the World (ft. Dr. Jennifer Harling) Apr 25, 2026

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Dr. Jennifer Harling, pediatrician and neonatologist who spent six years practicing in Burundi, one of the poorest countries in the world, shares what it took to introduce breast milk fortification, bubble CPAP, and revised sepsis protocols in a setting with nurse-to-patient ratios as high as one to forty and near-zero access to medical supplies. She reflects on the extraordinary obstacles of implementing quality improvement in resource-limited environments — from procurement failures to language barriers to training nurses with limited formal education — and explains why sustainability ultimately came down to the same thing it does everywhere: culture. She also turns the lens around and offers what may be the most universally applicable lesson she brought back from Burundi: slow down, and ask the parent what their number one concern is today.

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#438 - 🔵 [PAS 2026] - Eat, Sleep, Console at Two Years: Long-Term Outcomes for Opioid-Exposed Infants (ft. Dr. Ward Rice) Apr 25, 2026

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Dr. Ward Rice, neonatologist and researcher within the Neonatal Research Network, presents two-year follow-up data from the landmark ACT NOW Eat Sleep Console trial — one of the largest multi-center randomized trials ever conducted on neonatal opioid withdrawal syndrome. He shares findings on neurodevelopmental and behavioral outcomes at two years of age in babies exposed to buprenorphine versus methadone in utero, explaining why the short-term advantages of buprenorphine did not translate into measurable differences at this time point — but why both groups still scored below population norms on Bayley testing, underscoring the ongoing developmental risk in this population. He also discusses why longer follow-up is planned, what a smaller four-year study suggests may still emerge, and why this research ultimately informs prenatal decision-making by obstetric colleagues just as much as neonatal care at the bedside.

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