The Incubator

Send us Fan Mail

On July 1st, nine neonatologists at the only Level III NICU in Southern Oregon were terminated and replaced with a locums-only staffing model. Dr. Shelly Haug Monti, one of those physicians and a founding member of Babies First, joins Ben to describe what happened, what the group had been trying to raise with hospital leadership beforehand, and why they chose to organize rather than quietly move on. She discusses continuity of care in a 32-bed unit covering 20,000 square miles, what meaningful physician voice in staffing decisions should look like, how the group engaged nurses, families and state legislators, and how clinicians anywhere can recognize the early signs of a deteriorating healthcare system.

Learn more about Babies First here: https://www.babiesfirst.org/

Support the show

As always, feel free to send us questions, comments, or suggestions to our email: [email protected]. 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.

Enjoy!

Send us Fan Mail

Dr. Charles Roehr joins Daphna for the third episode of The Incubator’s special series on non-invasive ventilation, recorded ahead of Hot Topics in Neonatology. The conversation starts with a question most of us stopped asking long ago: is the pressure on the screen the pressure in the lung? From there they work through leak, interface cycling and skin injury, how to tell whether a baby needs more pressure, why a unit’s familiarity with its equipment may predict success better than the mode itself, and when the right wean is no wean at all. Charles closes with his wish list for the ideal neonatal interface.

This series is produced in partnership with Hot Topics in Neonatology and Fisher & Paykel Healthcare.

Join us at Hot Topics in Neonatology

National Harbor, MD, December 6 to 9, 2026. Register here: https://hottopicsinneonatology.nemours.org/registration.html 

Don’t miss the live session continuing this conversation: Pressure, Flow, and the Grey Areas In Between. Monday, December 7 at 11:45 AM

Full agenda: https://hottopicsinneonatology.nemours.org/agenda.html

Support the show

As always, feel free to send us questions, comments, or suggestions to our email: [email protected]. 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.

Enjoy!

Send us Fan Mail

This week we are replaying one of our most listened-to episodes, which sits right at the heart of our special series on non-invasive ventilation recorded ahead of Hot Topics in Neonatology. Dr. Cindy McEvoy, Professor of Pediatrics and Director of Neonatal Research at OHSU, joins Ben and Daphna to discuss her work on extended CPAP in preterm infants. CPAP has long been a cornerstone of neonatal care, but how long should stable infants remain on support? Dr. McEvoy shares findings from two randomized controlled trials that explored whether an additional two weeks of CPAP could promote lung growth and improve longer-term outcomes.

We review the physiologic rationale behind extended CPAP, including the role of mechanical stretch in stimulating alveolar and vascular development. Dr. McEvoy explains the stability criteria used to determine eligibility for extended CPAP and how her team measured pulmonary function in neonates. Results from her studies showed significant improvements in lung volume, diffusion capacity, and expiratory flows, with early signals of reduced wheezing at one year of age.

The conversation also touches on feeding tolerance, the practicalities of implementing extended CPAP in the NICU, and the need for larger multicenter studies to confirm these findings. This episode offers an evidence-based look at how a simple extension of an existing therapy might reshape respiratory outcomes for preterm infants.

This series is produced in partnership with Hot Topics in Neonatology and Fisher & Paykel Healthcare.

Join us at Hot Topics in Neonatology

National Harbor, MD, December 6 to 9, 2026. Register here: https://hottopicsinneonatology.nemours.org/registration.html

Don’t miss the live session continuing this conversation: Pressure, Flow, and the Grey Areas In Between. Monday, December 7 at 11:45 AM

Full agenda: https://hottopicsinneonatology.nemours.org/agenda.html

Support the show

As always, feel free to send us questions, comments, or suggestions to our email: [email protected]. 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.

Enjoy!

Send us Fan Mail

Dr. Brett Manley joins Ben for the opening episode of The Incubator’s special series on non-invasive ventilation, recorded ahead of Hot Topics in Neonatology. They work through the full arc of non-invasive support, from the delivery room to the convalescent phase and beyond. What actually counts as nasal high flow, and when should it come off? Why did HIPSTER and HUNTER move clinicians back toward CPAP as primary support? Is the benefit of NIPPV about synchronization or simply higher mean airway pressure? Brett shares his own weaning approach, the ÉCLAT findings, and the trials he believes the field needs next.

This series is produced in partnership with Hot Topics in Neonatology and Fisher & Paykel Healthcare.

Join us at Hot Topics in Neonatology: National Harbor, MD, December 6 to 9, 2026. Register here: https://hottopicsinneonatology.nemours.org/registration.html

Don’t miss the live session continuing this conversation: Pressure, Flow, and the Grey Areas In Between. Presented by Fisher & Paykel Healthcare. Monday, December 7 at 11:45 AM. Full agenda: https://hottopicsinneonatology.nemours.org/agenda.html

Support the show

As always, feel free to send us questions, comments, or suggestions to our email: [email protected]. 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.

Enjoy!

Send us Fan Mail

During a code, who is making sure the chest compressions are actually high quality? Recording live at the CHNC Symposium, Daphna sits down with Gina Klein, a simulation education consultant, and Sherry Casey, a NICU nurse and simulation coordinator, both from Cincinnati Children’s, to discuss their poster on implementing the CPR coach. Gina explains how video review in the emergency department revealed the microbehaviors that make feedback effective, like giving one piece of feedback at a time, and how that became a free curriculum at cincycpr.org. Sherry describes adapting it for the NICU, with a code blue arrival algorithm, clear criteria for switching to PALS, and an APP assigned as CPR coach on every floor each day.

Support the show

As always, feel free to send us questions, comments, or suggestions to our email: [email protected]. 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.

Enjoy!

Send us Fan Mail

When a baby with congenital heart disease decompensates in the delivery room, do we still follow NRP? Recording live at the CHNC Symposium, Daphna sits down with Dr. Noorjahan Ali of Children’s Health Dallas, Dr. Henry Lee of UC San Diego and Rady Children’s, and Dr. Anne Ades of the Children’s Hospital of Philadelphia. Dr. Ali explains a green, yellow, and red light approach to resuscitating heart babies, and why common things are still common. Dr. Lee reviews recent NRP updates, including a starting inflation pressure of 25 cm H2O and a ventilation rate of 30 to 60. Dr. Ades describes the Resuscitation in the NICU course, the value of a CPR coach, and why the NRP versus PALS debate may come down to the physiology of the patient in front of you.

Support the show

As always, feel free to send us questions, comments, or suggestions to our email: [email protected]. 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.

Enjoy!

Send us Fan Mail

If a preterm infant’s PDA needs closing, does timing matter? Recording live at the CHNC Symposium, Daphna sits down with the CHNC’s mentored fellows, Dr. Meriam Avades of Phoenix Children’s and Dr. Shannon Vitone of Arkansas Children’s, to hear their projects ahead of their presentations. Dr. Vitone shares a mixed methods study of about 1,300 neonates receiving renal replacement therapy since 2011, where mortality rose over time despite growing use, and interviews with 21 providers identifying culture, people, and process as keys to successful programs. Dr. Avades presents a multicenter landmark analysis showing that infants under 28 weeks whose PDA was closed by transcatheter device before 28 days of life were liberated from respiratory support faster.

Support the show

As always, feel free to send us questions, comments, or suggestions to our email: [email protected]. 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.

Enjoy!

Send us Fan Mail

What happens when most level IV NICUs are missing four to five advanced practice providers? Recording live at the CHNC Symposium, Daphna sits down with Sarah Shedler of Children’s Wisconsin and Chandler Williams, from Children's National, both members of the CHNC’s new APP Focus Group. They explain why APPs, caught between nursing and physician initiatives, needed a group of their own, and share results from their survey of member institutions: roles that vary widely from unit to unit, staffing shortages, burnout, and retention concerns. With only 250 to 300 NNPs graduating each year, they describe how fellowships for physician associates and pediatric nurse practitioners are helping fill the gap, and why sharing solutions across centers means no one has to reinvent the wheel.

Support the show

As always, feel free to send us questions, comments, or suggestions to our email: [email protected]. 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.

Enjoy!

Send us Fan Mail

Why does first-attempt intubation success in the NICU still hover around 40 to 56%? Recording live at the CHNC Symposium, Daphna sits down with Dr. Somi Singh, a second-year neonatology fellow at the University of Wisconsin–Madison, to discuss her poster on standardizing neonatal intubation practices. Dr. Singh walks through her team’s QI project: a checklist with a time-out and video laryngoscopy, a standardized premedication order set, and a pocket-card workflow built around “PAP before push” and PPV before the blade. The changes improved first-attempt success and reduced adverse events, but severe desaturations remained stubbornly high, leading to a new focus on apneic oxygenation. They also discuss training fellows in both video and direct laryngoscopy.

Support the show

As always, feel free to send us questions, comments, or suggestions to our email: [email protected]. 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.

Enjoy!

Send us Fan Mail

When a nurse makes an error with 20 things happening at once, is it really a personal slip, or a system that pushed her past capacity? Recording from the CHNC Symposium, Daphna sits down with Dr. James Wan, director of the Human Factors and Systems Design team at the Children’s Hospital of Philadelphia, an engineer and pastor who keynoted on “Human Factors Empathy Science.” He explains the limited capacity model, why most clinicians live with almost no spare capacity, and why emotional workload matters alongside physical and cognitive workload. He shares how human factors can shape new hospital spaces, cut alarm and signage noise, and use simulation to redesign workflows, and why AI should support humans, not supplant them.

Support the show

As always, feel free to send us questions, comments, or suggestions to our email: [email protected]. 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.

Enjoy!