The Incubator

Latest Episodes:

#442 - [Journal Club] - 📌 Does NIRS guided treatment improve clinical outcomes for extremely preterm infants? May 11, 2026

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In this episode of Journal Club, Ben and Daphna dive into the results of the NIRTURE trial, recently published in JAMA Network Open. Building on the lessons of SafeBoosC 3 , the NIRTURE investigators aimed to reduce the burden of cerebral hypoxia and hyperoxia in extremely preterm infants using a standardized NIRS guided treatment protocol. While the study showed a dramatic improvement in maintaining cerebral normoxia, driven largely by a reduction in hyperoxia , the clinical outcomes before discharge remained neutral. Join us as we discuss whether regional oximetry is a must have bedside tool or just another data point in search of a clear clinical benefit.

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Cerebral Oximetry-Guided Treatment and Cerebral Oxygenation in Extremely Preterm Infants: A Randomized Clinical Trial. Jani PR, Goyen TA, Balegar KK, Maheshwari R, Saito-Benz M, Schindler T, Moore J, Merhi M, Cruz M, Song Y, McDonagh H, Luig M, Tracy M, D'Cruz D, Perdomo A, Morakeas S, Dasireddy V, Culcer M, Shingde V, Bennington K, Michalowski J, Fucek A, Querim J, Stevens S, Santanelli J, Elhindi J, Gloss B, Halliday R, Shah D, Popat H.JAMA Netw Open. 2026 Feb 2;9(2):e2557620.

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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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#441 - Is Two Years Enough? Fellowship Directors Respond to the ABP’s Proposed Training Overhaul May 10, 2026

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The American Board of Pediatrics (ABP) recently announced a move toward competency-based subspecialty training that would shorten fellowships — including neonatology — from three years to two. The proposal has sent shockwaves through the training community. In this episode, Daphna sits down with three leaders from the Organization of Neonatal Perinatal Training Program Directors (ONTPD): Dr. Patrick Myers from Northwestern, Dr. Heather French from the Children's Hospital of Philadelphia, and Dr. Melissa Scala from Stanford. Together, they break down what competency-based medical education actually means in practice, why the math simply doesn't add up when applied to neonatology, and what this could mean for procedural training, scholarly activity, fellow well-being, and ultimately patient care. They also address the workforce concerns driving the ABP's proposal, share survey data from program directors across the country, and offer concrete alternative pathways forward. The message from the field is clear: the community wants to innovate — but they want a seat at the table first.

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#440 - 🔵 [PAS 2026] - What Goes Into Planning the Biggest Pediatric Conference in the World? Apr 29, 2026

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Dr. Daniel Rauch, PAS 2026 program chair, joins Ben for a behind-the-scenes look at what it takes to pull off a conference of this scale — and what he's learned from this year's record-breaking attendance in Boston. He reflects on the sessions that packed rooms beyond capacity, from the Tiny Baby Collaborative to AI in pediatrics, and shares what's on the horizon for PAS 2027 in Minneapolis and PAS 2028 in Vancouver. He also makes the case for why PAS remains uniquely valuable for trainees and early career clinicians — not just for the science, but for the cross-disciplinary hallway conversations that become next year's publications — and highlights the steps the conference is taking to be more inclusive, from closed captioning and a first-ever Spanish language session to on-site daycare and mobility devices for attendees with ambulatory difficulties.

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#440 - 🔵 [PAS 2026] - Is the Neonatology Job Market About to Shift Dramatically in Fellows' Favor? Apr 29, 2026

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Dr. Benny Rossner, PGY-2 pediatrics resident and veteran physician recruiter with 15 years of experience building clinical teams across the country, joins Ben and Rupa for a candid look at the neonatology workforce from a side of the conversation trainees rarely hear. He breaks down why demand for neonatologists is rising — sicker and younger patients, a shrinking APP pipeline into high-acuity specialties, and hospitals stretching budgets on locums before finally raising permanent salaries — and why fellows coming out of training have more negotiating power than they typically realize. He also shares practical advice on contract negotiations, non-competes, and why knowing the right people still matters enormously when it comes to landing the most competitive academic or metropolitan positions.

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#440 - 🔵 [PAS 2026] - Are We Ready for Gentle Hemodynamics the Way We Embraced Gentle Ventilation? Apr 28, 2026

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Dr. Gabriel Altit and Daniela Villegas from the NeoCardioLab at Montreal join Ben and Rupa to reflect on a packed PAS filled with hemodynamics science — from pulmonary hypertension phenotyping to heart-brain interactions in the golden hour. Dr. Altit makes the case that just as neonatology learned to embrace gentle ventilation, it is time to think about gentle hemodynamics — intervening thoughtfully, recognizing different clinical phenotypes, and knowing when to remove interventions before they carry a price. He also previews early 3D echo data suggesting that a single clip at day 7 to 10 of life may already carry a signature predicting which babies will develop adverse cardiopulmonary outcomes by 36 weeks. Daniela shares her approach to family consent and research recruitment — sitting down, leaving papers behind, connecting families to the history of research that made current NICU care possible, and always giving them space to process before returning for an answer.

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#440 - 🔵 [PAS 2026] - When Is the Right Time to Talk to a Family About a Tracheostomy for BPD? Apr 28, 2026

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Dr. Kristen Leeman and Dr. Jonathan Levin join Ben to debrief a packed interactive session on tracheostomy timing and counseling for babies with severe bronchopulmonary dysplasia (BPD). Using iterative cases and live audience polling, they mapped the wide variability in practice across the country — finding rough consensus that tracheostomy conversations become likely around 44 to 48 weeks post-menstrual age for intubated infants and 48 to 52 weeks for those on non-invasive ventilation, with key comorbidities like pulmonary hypertension, poor growth, and neurological injury shifting the calculus significantly. Families who participated in the session delivered a powerful message: the conversation should start early, be repeated often, and be framed not as a failure but as a transition — and continuity of care, having a familiar face who knows the baby and the family, made all the difference.

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#440 - 🔵 [PAS 2026] - What Does It Take to Build a World-Class NICU From the Ground Up? Apr 28, 2026

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Dr. Rangasamy Ramanathan, division chief at Cedars-Sinai Guerin Children's Hospital and one of neonatology's most prolific investigators, joins Ben to share what's keeping him busy — 14 active clinical trials including studies on IGF-1 for lung injury prevention, oral insulin for weight gain, and the upcoming phase three trial of aerosolized surfactant. He reflects on what has sustained his passion through decades of work, from training a third of California's neonatologists to launching Southern California's first NeuroNICU with 24-7 neurology coverage and in-house whole genome sequencing. He also previews his next innovation — the ROM Smith ventilator, designed to be manufactured and distributed at cost to resource-limited settings around the world where babies are dying for lack of a $30,000 machine he believes he can build for under $2,000.

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#440 - 🔵 [PAS 2026] - How Did One NICU Take 22-Weeker Survival From 12% to 72%? Apr 28, 2026

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Dr. Thais Queliz, neonatologist at Winnie Palmer Hospital in Orlando, presents ten years of data from one of the country's highest-volume programs caring exclusively for babies born at 22 to 24 weeks. She shares how survival rates for 22 and 23-weekers climbed from 40% before the Tiny Baby program launched to 67% overall — and 72% over the last two years — driven by institutional alignment, standardized protocols, and a dedicated multidisciplinary team. She also presents Golden Hour data showing a jump from 8% to 75% completion rate after implementing strict checklists and role-defined workflows that cut average admission time from nearly two hours to 54 minutes. And she previews work on prolonged empiric antibiotics in this population — extending courses based on placental pathology — which has been associated with decreased mortality in 22 and 23-weekers, echoing findings presented earlier in the conference by her fellow Dr. Gesca Borchardt.

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#440 - 🔵 [PAS 2026] - Do We Even Know What a Healthy Preterm Gut Looks Like on Ultrasound? Apr 28, 2026

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Dr. Indrani Bhattacharjee, neonatologist and POCUS program director at Tufts Medical Center in Boston, joins Ben to discuss a fascinating and largely unexplored frontier — intestinal ultrasound in healthy preterm infants. Rather than waiting for NEC to appear, her team has been systematically scanning babies born under 32 weeks every week from one week of age until eight weeks or discharge, building what may be the first normative dataset for bowel wall thickness in this population. Early findings are already challenging the standard radiological definitions, showing that extremely preterm babies have thinner bowel walls than current benchmarks would classify as normal — raising the question of whether definitions derived from term or older patients have ever been appropriate for our tiniest babies. The publication is forthcoming in the European Journal of Pediatrics.

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#440 - 🔵 [PAS 2026] - Is LISA the Future of Surfactant Delivery for Premature Babies? Apr 28, 2026

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Dr. Surabhi Aggarwal, neonatologist at Stony Brook University, joins Ben and Rupa to share five years of experience building a LISA — Less Invasive Surfactant Administration — program from the ground up at her institution. She walks through the obstacles of getting IRB approval, gaining clinical buy-in from colleagues comfortable with intubation, and how the introduction of video laryngoscopy was the turning point that finally got the practice off the ground. She shares early results showing that 30% of eligible babies received surfactant via LISA rather than intubation, discusses the technical nuances of catheter placement and confirmation, and weighs in on the emerging SALSA technique using an LMA — with a candid admission that she may be a little biased. She also highlights her work with MidCan, the AAP mid-career neonatologist group supporting clinicians between seven and seventeen years post-training.

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