The Incubator

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#386 - 🟢 HOT TOPICS 2025 COVERAGE - 20 minutes of prophylactic CPAP for late preterm infants - The PLANT study Dec 08, 2025

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Dr. Edgardo Szyld from Indiana University presents the PLANT study evaluating 20 minutes of prophylactic CPAP for late preterm infants (34-36+6 weeks) born via cesarean section. This population represents 70% of US preterm births and experiences five times higher respiratory distress rates with cesarean delivery. The pragmatic pilot enrolled 100 patients, demonstrating reduced NICU admissions without pneumothorax cases—addressing previous safety concerns from observational data. Szyld's team is planning PLANT 2, targeting 35-36 weekers across 11 international centers, which will compare outcomes with and without antenatal steroids. This pragmatic approach addresses a high-volume but understudied population significantly impacting NICU resources.

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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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#386 - 🟢 HOT TOPICS 2025 COVERAGE - The section on neonatal perinatal medicine: the hope for neonatology Dec 08, 2025

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Dr. Clara Song, Chair of the AAP Section on Neonatal-Perinatal Medicine, discusses urgent workforce challenges facing neonatology. With average neonatologist age around 50-55 and stable fellowship applications despite growing positions, the field faces potential shortages. The section launched initiatives addressing fair compensation, including a new website comparing negotiated commercial payer rates across states and engaging state chapters for payer advocacy. Song highlights concerning trends where neonatologist productivity increased while compensation decreased as the field became female-dominated. She discusses the section's comprehensive staffing toolkit and proposes restructured training pathways—potentially shortened residency with targeted 2-5 year fellowships—to attract trainees while ensuring adequate clinical preparation for increasingly complex neonatal care.

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#386 - 🟢 HOT TOPICS 2025 COVERAGE - Should Moderate Preterm Infants Start with Higher Oxygen at Birth? Dec 08, 2025

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Dr. Louise Owen from Royal Women's Hospital Melbourne presents the AEROPLANE trial comparing 21% versus 30% oxygen for 32-35 week infants at birth. This understudied cohort represents 80% of preterm births globally. Using cluster randomization with waived consent, the trial captured real-world practice across centers. Infants receiving 30% oxygen required less delivery room intervention including assisted ventilation, intubation, and chest compressions. Three-quarters of infants needing initial support continued requiring respiratory support beyond delivery. Both groups ultimately received average oxygen in the 50s, suggesting moderate preterm infants may behave more like very preterm rather than term babies regarding oxygen needs.

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#386 - 🟢 HOT TOPICS 2025 COVERAGE - How Does Maternal Air Pollution Exposure Affect the Infant Microbiome? Dec 08, 2025

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Dr. Divya keerthy (New York Presbyterian Queens/Weill Cornell Medicine) and Dr. Katherine Nyman (UCSD/Rady Children's, San Diego) discuss their Hot Topics conference experience. Keerthy presents research on prenatal polycyclic aromatic hydrocarbon exposure measured via backpack monitors and silicone wristbands during the third trimester. Her longitudinal study tracked infant microbiome at three time points over six months, identifying two air pollutants affecting microbiome development. Nyman highlights interest in the Tiny Baby collaborative, particularly PDA management challenges in extremely premature infants. Both emphasize the value of Hot Topics' evidence-based sessions including "green and rotten apples" that stress-test current practices. They note the conference's focus on moderate preemies (32-34 weekers) who comprise 80% of NICU populations yet receive less research attention.

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#386 - 🟢 HOT TOPICS 2025 COVERAGE - How Should We Navigate the Complexity of Genetic Information in the NICU? Dec 08, 2025

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Dr. Katherine P Callahan, neonatologist and bioethicist at Children's Hospital of Philadelphia, discusses the complexity of genetic testing in neonatal care. While the NICU serves as a launch point for genetic technologies due to high prevalence of genetic disease, genetic information is often ambiguous or uncertain rather than straightforwardly diagnostic. Variants of uncertain significance represent just one challenge—even clearly pathogenic findings may have unclear implications for individual patients, as demonstrated when parents carry the same mutation as their severely affected child. Callahan emphasizes that genetic information poses "informational hazards" requiring careful consideration of psychological and ethical impacts. She advocates for acknowledging complexity, rethinking outcomes beyond traditional measures, and embracing shared decision-making rather than standardized approaches to genomic counseling.

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#384 - Finding Your Voice After Prematurity: A Conversation with Mandy Daly Nov 30, 2025

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In this episode, Mandy Daly shares her profound journey as a NICU parent and her advocacy work through the Irish Neonatal Health Alliance (INHA). She discusses the emotional challenges faced by parents of preterm infants, the importance of family-centered care, and the need for systemic changes in neonatal healthcare. Mandy emphasizes the significance of building support networks, empowering families through education, and the impact of lived experiences in shaping healthcare policies. The conversation highlights the collaborative efforts required to improve outcomes for families navigating the complexities of neonatal care.

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#382 – 🗞️ NeoNews - What Should Neonatal Teams Prioritize This Winter? RSV Coverage Gaps, Congenital Syphilis, and New Research Shaping Care Nov 23, 2025

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In this episode of NeoNews, the team returns from a brief hiatus with a refreshed format and a packed review of neonatal stories dominating recent headlines. Eli, Ben, and Daphna open with updates on RSV prevention, highlighting new MMWR data showing significant gaps in nirsevimab and maternal vaccine uptake—despite strong evidence and renewed availability. They discuss how supply chain issues, insurance delays, and vaccine confusion continue to limit access, and they emphasize the unique role neonatologists can play in counseling families early and often. The hosts also review concerning national trends in congenital syphilis, noting that many affected infants had parents who received prenatal care but were never tested—an avoidable systems failure with major downstream costs. Additional segments cover the severity of last year’s influenza season, the emergence of new RSV monoclonal antibodies, and the rising use of polygenic risk scoring in IVF. The team reflects on the ethical tension between innovation and eugenics concerns, and how neonatal providers can prepare for these conversations. Finally, the deep dive explores Sherri Fink’s powerful reporting on trisomy 18, variability in care across institutions, and the growing emphasis on transparent, value-driven shared decision-making with families.

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#379 - 💡Rethinking Phototherapy – Engineering Innovation with Steve Falk of GE Healthcare Nov 19, 2025

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In the final episode of our Rethinking Phototherapy series, Ben speaks with Steve Falk, Chief Engineer of the Maternal Infant Care Strategic Business Unit at GE Healthcare. With more than three decades of engineering leadership, Steve has been instrumental in the development of landmark neonatal technologies, including the Giraffe Omnibed and Panda platforms.

This conversation highlights the critical role of engineering in making phototherapy precise, reliable, and safe. Steve explains how advances in LED technology have transformed phototherapy devices, ensuring consistent irradiance and long product life. He describes how engineers translate clinical needs—wavelength, intensity, surface coverage, and distance—into product requirements, and how rigorous usability testing with clinicians shapes intuitive bedside tools. The discussion also explores innovation on the horizon, from refining intermittent phototherapy strategies to integrating technologies that simplify care and support earlier discharge.

Listeners will gain a behind-the-scenes perspective on how engineering teams think about phototherapy as a true pharmacotherapy, and how collaboration between clinicians and industry can directly improve outcomes for newborns and families. This episode closes the series by reminding us that innovation in neonatal care happens not only in clinical practice, but also in the design labs where these essential tools are created.

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#378 - 💡 Rethinking Phototherapy – Considerations for Preterm Infants with Dr. Deepak Manhas Nov 18, 2025

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What happens when we challenge our long-standing assumptions about phototherapy in the NICU? In this special installment of our Rethinking Phototherapy series, Ben and Daphna are joined by Dr. Deepak Manhas to examine one of the most complex questions: how should we manage hyperbilirubinemia in preterm infants?

Unlike term babies, preemies face unique risks—shorter red blood cell lifespan, immature bilirubin conjugation, lower albumin binding, and increased blood-brain barrier permeability—all of which make them more vulnerable to bilirubin-induced neurologic dysfunction. This conversation explores why traditional guidelines cannot simply be applied to preterm infants and why clinicians often initiate phototherapy earlier.

Dr. Manhas discusses the creation of gestation-specific treatment charts, the challenges and dangers of exchange transfusion in this fragile population, and the uncertain role of therapies such as IVIG, albumin, and phenobarbital. The team also unpacks practical issues: what “double phototherapy” should really mean, how to order irradiance and body surface area coverage with precision, and the role of bili blankets in promoting family bonding.

By situating this discussion in the broader Rethinking Phototherapy series, the episode highlights both the progress and the unanswered questions in caring for preterm infants.

📖 Reference: Pathogenesis and Management of Indirect Hyperbilirubinemia in Preterm Neonates Less Than 35 Weeks: Moving Toward a Standardized Approach (NeoReviews)

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#377 - 💡 Rethinking Phototherapy – Phototherapy as Pharmacotherapy with Dr. Daniel Rauch Nov 17, 2025

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In the second installment of our Rethinking Phototherapy series, Ben and Daphna welcome Dr. Daniel Rauch, Professor of Pediatrics at the Hackensack Meridian School of Medicine and Division Chief of Pediatric Hospital Medicine and General Academic Pediatrics at Joseph Sanzari Children’s Hospital. Dr. Rauch co-authored the AAP technical report on phototherapy and brings a unique perspective on how light therapy should be understood and applied in clinical practice.

This conversation reframes phototherapy as a true pharmacotherapy—an intervention that must be delivered in precise doses with attention to wavelength, irradiance, body surface exposure, and treatment duration. Dr. Rauch explains why more light is not always better, how technology has evolved from “easy-bake oven” style lamps to modern LED systems, and why maximizing body surface exposure often matters more than piling on extra light banks. The discussion also touches on cycling strategies, the value and limitations of transcutaneous monitoring, and the potential of home phototherapy to reduce unnecessary hospitalizations while supporting family bonding.

Listeners will gain practical insights into the art and science of phototherapy: how to optimize treatment, minimize harm, and communicate clearly with families navigating jaundice management.

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