The Incubator

Latest Episodes:

#223 - 🚀 How to write better notes (ft EMR guru Dr. Shama Patel) Jul 03, 2024

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In this Tech Tuesday episode of the Incubator podcast, Ben and Daphna engage in an enlightening conversation with Dr. Shama Patel, a neonatologist and clinical informaticist at Nationwide Children's Hospital. Dr. Patel sheds light on the pressing issues surrounding electronic medical record (EMR) systems and documentation practices in neonatology. She addresses the problem of "note bloat," where progress notes become excessively long and filled with redundant information, contributing to physician burnout and potential errors in patient care. Dr. Patel shares her innovative work in creating a more efficient and relevant patient review screen in Epic, tailored explicitly for neonatology, and discusses the development of a new progress note template aimed at reducing documentation burden while improving accuracy.

The conversation delves into the importance of having dedicated informaticists in each medical division to continuously improve EMR workflows. Dr. Patel envisions a future where all NICU progress notes follow a standardized format, enabling better communication and data analysis. She emphasizes that improving EMR systems is an ongoing process that requires cultural change within medical teams. The hosts and Dr. Patel explore the potential for standardized documentation practices across NICUs to enhance patient care and facilitate research, as well as the future possibilities for using AI in medical documentation. The episode concludes by highlighting the career opportunities in clinical informatics for young medical professionals and the potential for this work to significantly impact patient care, physician well-being, and medical research.

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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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#222 - 🫁 Mastering the Mechanics, A Deep Dive into Neonatal Ventilation Strategies (ft Bryan King) Jun 30, 2024

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In this episode of the Incubator podcast, Ben interviews Bryan King, an experienced respiratory therapist and educator in neonatal and pediatric care. Bryan shares his journey into respiratory therapy, which began unexpectedly after initially pursuing x-ray technology. He discusses his passion for working in the NICU and the challenges of treating increasingly smaller premature infants.

The conversation delves into the evolution of neonatal respiratory therapy, focusing on the impact of surfactant and antenatal steroids in improving infant lung compliance. Bryan emphasizes the importance of avoiding lung hyperexpansion in nano-premies and discusses various ventilation strategies, including volume-targeted ventilation, high-frequency ventilation, and pressure support.

Bryan shares insights on selecting appropriate ventilation modes and settings, stressing the need to adapt strategies based on individual patient responses. He advocates for having a diverse set of tools and modalities available in Level 4 NICUs to provide comprehensive care and education.

The interview also touches on the challenges of weaning patients from ventilators and the importance of considering long-term outcomes rather than focusing solely on immediate blood gas results. Bryan discusses his experience as a non-physician educator teaching physicians and emphasizes the value of lifelong learning in the medical field.

Throughout the conversation, Bryan shares valuable tips for respiratory care, including the importance of encouraging spontaneous breathing, understanding ventilator feedback, and being open to trying different approaches when standard methods aren't effective. He also mentions his current project of writing a book about his experiences as an educator in the field of neonatal ventilation.

The episode provides a wealth of knowledge for healthcare professionals working in neonatal and pediatric respiratory care, emphasizing the importance of adaptability, continuous learning, and patient-centered approaches in this rapidly evolving field.

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#220 - 📑 Journal Club - The complete episode (June 23rd 2024) Jun 23, 2024

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In our latest Journal Club episode, we review several important recent studies in neonatology. We begin by discussing a paper on the changing trends in Apgar scoring, noting a shift from scores of 10 to 9, likely due to increased recognition of normal transitional acrocyanosis.

Next, we examine a study on using ChatGPT and Google Translate for pediatric discharge instructions, finding mixed results across different languages. We then review new transfusion guidelines for very preterm neonates, featuring an interview with co-author Dr. Ravi Patel who provides insights on the guideline development process and implementation considerations.

We also discuss an observational study from Sweden on early skin-to-skin contact and its potential benefits for reducing intraventricular hemorrhage and sepsis in preterm infants, though we note limitations in the study design.

Additionally, we review a pilot randomized trial comparing whole-body hypothermia to targeted normothermia for neonates with mild hypoxic-ischemic encephalopathy. The study found no clear benefits to cooling in mild cases and highlighted the need for further research.

Finally, we highlight an op-ed emphasizing the importance of addressing mental health needs of new fathers, especially those with infants in the NICU. We note that while screening all NICU parents for postpartum depression is recommended, it is often overlooked, particularly for fathers.

Throughout the episode, we provide thoughtful analysis of the studies' methodologies, findings, and clinical implications, offering valuable insights for our community. We hope this Journal Club helps keep our listeners up-to-date on the latest research and encourages critical thinking about how to apply these findings in clinical practice.

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#220 - [Journal Club Shorts] - 📌 Can early skin-to-skin prevent IVH? Jun 23, 2024

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Early skin-to-skin contact and the risk of intraventricular haemorrhage and sepsis in preterm infants. Johansson MW, Lilliesköld S, Jonas W, Thernström Blomqvist Y, Skiöld B, Linnér A.Acta Paediatr. 2024 May 27. doi: 10.1111/apa.17302. Online ahead of print.PMID: 38803030

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#220 - [Journal Club Shorts] - 📌 Transfusion Guidelines from the Neonatal Transfusion Network Jun 23, 2024

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Clinical Practice Guideline for Red Blood Cell Transfusion Thresholds in Very Preterm Neonates. Deschmann E, Dame C, Sola-Visner MC, Fustolo-Gunnink SF, Guyatt GH, Patel RM, Stanworth SJ; Neonatal Transfusion Network.JAMA Netw Open. 2024 Jun 3;7(6):e2417431. doi: 10.1001/jamanetworkopen.2024.17431.PMID: 38874929 Free article.

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#220 - [Journal Club Shorts] - 📌 Apgar scores: Is 9 the new 10? Jun 23, 2024

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Nine is the New Ten of Apgar Scores: An Observational Retrospective Cohort Study. Everett SS, Bomback M, Roth P, Goldshtrom N, Polin RA, Lyford A, Hays T.J Pediatr. 2024 Jun 14:114150. doi: 10.1016/j.jpeds.2024.114150. Online ahead of print.PMID: 38880381

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#218 - Father's Day Special with Alex Zavala aka The NICU Dad Jun 16, 2024

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In this special Father's Day episode, host Daphna Barbeau interviews Alex Zavala, known as the "NICU Dad". Alex shares his emotional journey of becoming a father to his daughter Emerson, born at just 27 weeks.

Alex vividly recounts the day his wife's water broke, the frantic rush to the hospital, and the overwhelming fear and uncertainty as Emerson was delivered via emergency C-section weighing only 2 pounds 5 ounces. He describes feeling like he was thrust into a nightmare, trying to support his wife, make logistical plans, and grapple with the possibility of losing his daughter.

During Emerson's 67-day NICU stay, Alex did the "NICU dad shuffle" - spending early mornings with his daughter, tag-teaming with his wife in the afternoons so she could be there while he went to work, and returning in the evenings. He highlights the unique struggles dads face, including feeling like an afterthought, battling stress, anxiety and PTSD symptoms, weight gain, and having their trauma go unrecognized.

After Emerson came home, Alex continued to face challenges. His stress increased without the monitors and NICU staff, he became a stay-at-home dad, and suffered health issues from the emotional toll. Seeing a need, he started The NICU Dad website and podcast as resources for dads.

Alex's advice for NICU dads: take care of yourself to be the best version of yourself at home, seek counseling, join peer support groups, and utilize resources from organizations like March of Dimes and Hand to Hold. For healthcare professionals, he advocates involving dads from the start, understanding their unique trauma response, and encouraging them to actively participate in their baby's care.

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#216 - 🫁 A Better Understanding of CDH - ft. Dr. Neil Patel and Dr. Gopal Jun 09, 2024

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In this episode of the Incubator podcast, host Dr. Ben Courchia is joined by two distinguished guests: Dr. Neil Patel, a neonatologist from the Royal Hospital for Children in Glasgow, UK, and Dr. Srirupa Hari Gopal, a third year neonatology fellow at Baylor College of Medicine.

The discussion delves into the complexities of congenital diaphragmatic hernia (CDH). Drs. Patel and Gopal share their passion for caring for these patients and the multidisciplinary approach required to optimize outcomes.

The conversation highlights the evolving understanding of CDH pathophysiology, with a focus on the increasingly recognized role of cardiac dysfunction alongside pulmonary hypoplasia and pulmonary hypertension. The guests also discuss recent advances in prenatal care for CDH, including the use of fetal endotracheal occlusion (FETO) to promote lung growth, and the challenges of counseling families facing a CDH diagnosis.

Looking to the future, Drs. Patel and Gopal express excitement about tailoring CDH management to different disease phenotypes, establishing consensus definitions for CDH-associated pulmonary hypertension, and investigating novel approaches such as physiologic cord clamping.

Throughout the episode, the guests' dedication to improving care for newborns with CDH shines through, leaving listeners with a deeper understanding of the challenges and opportunities in this field. This informative and engaging discussion is a must-listen for anyone interested in the latest developments in neonatal medicine and the tireless efforts of clinicians and researchers to give every baby the best possible start in life.

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#215 - 🚀 [Locus Health] - Connecting Hospital and Home via Remote Patient Monitoring Jun 05, 2024

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In our latest Tech Tuesday episode, Daphna and I spoke with Nancy Addison from Locus Health about their remote patient monitoring (RPM) platform. We learned how Locus Health bridges the gap between hospital and home for medically complex pediatric patients, including NICU babies, substance-exposed newborns, and infants on oxygen.

We discussed the potential benefits of RPM, such as empowering families, reducing length of stay, and preventing readmissions. Nancy emphasized the importance of maintaining close family-provider relationships during the transition to home.

We also explored the technical aspects of the platform, like data entry, EHR integration, and alert systems. While limitations exist in wireless home monitoring for infants, the potential for real-time data streaming is intriguing.

Finally, we touched on the research implications of capturing post-discharge data through RPM. Tools like Locus Health could accelerate research and quality improvement efforts to help medically complex infants thrive at home. This thought-provoking discussion left us excited about the future of RPM in pediatrics

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#214 - 📑 Journal Club - The Complete Episode (June 1st 2024) Jun 02, 2024

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In this jam-packed episode of Journal Club, Ben & Daphna discuss several impactful new studies in neonatology.

First up is an important clinical report from the AAP on infant feeding for people living with HIV. The hosts dive into the nuanced recommendations, which state that while avoiding breastfeeding is still the only way to completely eliminate HIV transmission risk, breastfeeding can be supported in certain cases where the parent has a strong desire after comprehensive counseling and meeting strict criteria like sustained viral suppression.

Next, they examine a study linking congenital CMV infection with an increased risk of autism spectrum disorder diagnoses, highlighting the importance of screening for this common congenital infection.

A randomized trial comparing video laryngoscopy to direct laryngoscopy for urgent neonatal intubation is also discussed. While video laryngoscopy resulted in higher first-attempt success rates, the hosts note some adverse events to consider as this technology becomes more widespread for these critical procedures.

The effectiveness of NICU music therapy on neurodevelopmental outcomes is also covered, with a study finding no significant language benefits at 24 months. The hosts question the impact and necessity of these programs.

Practical coding tips for NICU consultations from a recent paper are shared, with an emphasis on the financial impact of proper billing.

Lastly, the increasing frequency of heat waves and their association with preterm and early-term births is explored, underscoring the environmental factors that influence neonatal health.

With insightful analysis and engaging discussion, Ben & Daphna provide a fantastic overview of some of the most noteworthy recent publications in neonatology. Be sure to tune in for this informative and thought-provoking installment of Journal Club!

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