The Incubator

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Dr. Brandon Hadfield and Dr. Debora Abimana join Ben for a conversation that brings the incubator's global neonatology work full circle — from the founding of Rwanda's first neonatology fellowship program to seeing its first trainee present scholarly work at PAS. Dr. Abimana shares findings from her research on healthcare provider attitudes toward donor human milk in Rwandan NICUs, where the concept is largely welcomed but faces cultural concerns around infants adopting the characteristics of their donor — a barrier the team hopes to address through targeted community education. She also paints a vivid picture of the need: NICUs without TPN, near-universal breastfeeding rates driven by necessity rather than choice, and critically ill mothers who simply cannot produce enough milk for their premature babies in those first crucial hours.

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Dr. Zubair Aghai, neonatologist at Thomas Jefferson University in Philadelphia, presents results from one of the largest neonatal trials ever conducted — enrolling 3,448 late preterm and term infants across India to test whether umbilical cord milking in non-vigorous newborns reduces death or moderate-to-severe HIE. With over 100,000 deliveries screened and real-time data collected by research staff present at every delivery around the clock, the primary outcome showed no short-term harm from cord milking — and a secondary signal of reduced infection risk, possibly driven by the immunoglobulins transferred with the extra blood. He also explains why non-vigorous babies stand to gain the most from this simple ten-second intervention, and previews two-year neurodevelopmental follow-up data still to come.

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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.

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Dr. Ryan McAdams guest hosts alongside the NeoMind AI team — Dr. Ameena Husain, Dr. Kristyn Beam, Dr. Brynne Sullivan, and Dr. Zach Vesoulis — to recap their third annual pre-conference AI workshop at PAS, including a live predictive modeling bake-off using the Epic Cosmos database to predict late-onset sepsis in nearly 100,000 preterm infants. The group discusses where AI stands today in neonatology — from using large language models to reduce administrative burden and improve family communication, to Epic's growing investment in neonatal-specific tools — and makes an honest case for what clinicians should start doing now and what still requires caution. They close with an open invitation to join NeoMind AI, a growing community of neonatologists, data scientists, and researchers working to ensure the NICU is not left behind as this technology reshapes medicine.

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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.

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Dr. Melissa Zhou, researcher at the Developing Brain Institute at Children's National, joins Daphna to discuss functional MRI and what it reveals about how preterm brains are building connections during the NICU stay. Using functional connectivity — measuring how different brain regions communicate with each other over time — her team compares preterm infants to healthy in utero fetuses scanned as early as 20 weeks, finding that the ex utero preterm brain actually looks more mature in terms of connectivity, suggesting the NICU environment itself accelerates certain aspects of brain development. She shares why extremely and very preterm infants show a distinctly different pattern of connectivity compared to moderately preterm babies who seem to bounce back more quickly, and why the team's next goal is to use these early functional findings to predict which babies will struggle with neurodevelopmental outcomes at 36 months — and which ones will be just fine.

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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.

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Dr. Kevin Cook, researcher at the Developing Brain Institute at Children's National, joins Daphna to discuss functional MRI and what it reveals about how preterm brains are building connections during the NICU stay. Using functional connectivity — measuring how different brain regions communicate with each other over time — his team compares preterm infants to healthy in utero fetuses scanned as early as 20 weeks, finding that the ex utero preterm brain actually looks more mature in terms of connectivity, suggesting the NICU environment itself accelerates certain aspects of brain development. He shares why extremely and very preterm infants show a distinctly different pattern of connectivity compared to moderately preterm babies who seem to bounce back more quickly, and why the team's next goal is to use these early functional findings to predict which babies will struggle with neurodevelopmental outcomes at 36 months — and which ones will be just fine.

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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.

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Dr. Gesca Borchardt, third-year neonatology fellow at Winnie Palmer Hospital, presents findings from a retrospective study of 296 infants born under 25 weeks examining whether extending empiric antibiotic use beyond 72 hours reduces mortality in this vulnerable population. She shares why her unit moved to a seven-day antibiotic course for babies with placental pathology positive for chorioamnionitis — and what they found when they looked at the data. At 22 and 23 weeks, longer antibiotic courses were associated with a statistically significant decrease in mortality. At 24 weeks, no difference was seen. One puzzling finding clouds the picture however: an increased incidence of spontaneous intestinal perforation in the prolonged antibiotic group — a signal the team is still trying to understand and that the wider community will want to watch closely.

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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.

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Dr. Katie Ottolini, researcher at the Developing Brain Institute at Children's National in Washington DC, presents findings from a longitudinal MRI study comparing brain growth trajectories in preterm infants to healthy fetuses — scanning as early as 25 weeks and through term corrected age. Even in preterm babies with no significant brain injury and appropriate growth at birth, brain volumes were already smaller by the first MRI at around two weeks of life. She shares which regions are most vulnerable, why the amygdala-hippocampus shows a distinct window of impaired growth beginning after 32 weeks that may represent an opportunity for intervention, and why the goal for neonatology must now shift from neuroprotection alone to what she calls neuropromotion — actively supporting optimal brain development through nutrition, sleep, and other targeted interventions.

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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.

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Dr. Lori Devlin, neonatologist and principal investigator of the Optimize Now trial, shares results from the first multicenter randomized trial comparing symptom-based opioid dosing to scheduled opioid tapers in babies with neonatal opioid withdrawal syndrome (NOWS). Published in JAMA on the day of this recording, the trial found that symptom-based dosing reduced medical readiness for discharge by an additional 2.1 days — and that 65% of babies who would traditionally have been placed on a scheduled opioid taper never needed one at all. She also previews the next trial in this series, TREAT Now, which will compare buprenorphine versus morphine for babies who do require pharmacologic treatment, and reflects on how far the field has come since Eat Sleep Console first changed the way we think about caring for this population and their families.

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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.

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Dr. John Feister, neonatologist and health equity researcher at Cincinnati Children's Hospital, presents two studies that challenge us to look beyond the bedside. The first reveals that NICU babies whose families prefer a language other than English have nearly double the in-hospital mortality rate of English-speaking families — a difference that persisted even after adjusting for medical and sociodemographic risk factors, and one he suspects is driven in part by barriers to family advocacy and end-of-life communication. The second introduces the concept of medical-financial partnerships, and specifically a hospital-based free tax preparation clinic that helped NICU and hospital families claim thousands of dollars in refundable tax credits — with 90% of participants reporting that the service improved their trust in their medical team.

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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.

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Dr. Ravi Jhaveri, infectious disease physician at Lurie Children's Hospital in Chicago, joins Daphna for a conversation spanning two underappreciated threats in pediatrics. On hepatitis C, he shares that up to 90% of perinatally exposed infants never get tested despite clear guidance — and makes the case for point-of-care, heel-stick based testing that meets families where they are rather than relying on follow-up that often never happens. On long COVID, he reframes the vaccine conversation away from acute illness and toward something families actually care about: protecting their child's ability to show up for the things that matter most to them — sports, dance, school — since even mild or repeat COVID infections can double the risk of debilitating long COVID symptoms.

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.

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