The Incubator

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Dr. Sharon Levy, director of the Division of Addiction Medicine at Boston Children's Hospital, joins Daphna for a wide-ranging conversation on adolescent substance use. She shares data showing a sudden spike in nicotine exposure among teens in treatment for substance use disorders — likely driven by larger vape devices and cooling agents that eliminate the burn sensation — and introduces one of the most novel concepts in addiction medicine: a vaccine that would create antibodies against fentanyl, blocking its effect at the meningeal level before it reaches the brain. She also presents findings on why current surveillance questions fail to capture how teens actually talk about drug use, and why kids who need treatment most are paradoxically the ones most likely to answer screening questions honestly.

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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. Jonathan Flyer, pediatric and fetal cardiologist at the University of Vermont, presents findings from a Vermont Oxford Network analysis of over 11,000 extremely low birth weight infants examining whether the method of patent ductus arteriosus (PDA) closure — transcatheter device versus surgical ligation — makes a difference for neurodevelopmental outcomes at 18 to 24 months. The answer: no difference between the two techniques on Bayley-4 cognitive, language, and motor scores. The more sobering finding is that both groups scored well below the normative mean of 100, sitting in the high 70s to low 80s — a reminder of just how much ground this population has to cover. He also makes a case for centering the counseling conversation not on technique but on what each center does best, and what families actually care about most: their child's brain.

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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. Brandon Tucker and Dr. Jenelle Ferry share two studies tackling some of the most pressing challenges in the care of extremely low birth weight infants. Dr. Tucker presents a quality improvement initiative examining whether switching from PRN glycerin suppositories to scheduled glycerin enemas every 12 hours reduces feeding intolerance and spontaneous intestinal perforation in babies under 1,000 grams — with early results trending in the right direction. Dr. Ferry then shares findings from a meta-analysis of 14 studies and nearly 4,700 babies showing that an exclusive human milk diet is associated with a roughly 20% reduction in the odds of death — a finding that reached statistical significance when RCTs and observational cohorts were pooled together, and one that carries real weight for units still weighing the evidence on human milk-based nutrition.

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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 James Parker, internist, pediatrician, and researcher at Northwestern University and Lurie Children's Hospital, joins Daphna and Rupa for a conversation about one of the most overlooked players in family-centered care — fathers. He shares why paternal stress in the NICU and postpartum period often peaks later than maternal stress, why discharge instructions routinely go home with only one parent, and how a few small changes — making eye contact with dad, asking him a question, giving him a specific task — can fundamentally shift how engaged fathers feel in their child's care. He also reflects on the inaugural Fathers in Pediatrics special interest group at PAS, and makes the case that thinking about the whole family unit, including the mental and physical health of every caregiver, is not a nice-to-have but a core part of caring for the child.

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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. Christina Rojas, from Lurie Children's Hospital, presents findings from a multi-center study across eight hospitals examining how often hospitalized patients and families receive communication touchpoints from their care team — and whether that differs based on preferred language. Across more than 30 languages represented in the study, families who preferred a language other than English experienced significantly fewer room visits, less direct communication when staff did enter the room, and a 55% gap in language-concordant interactions. She discusses what this means for patient safety — since missed touchpoints are missed opportunities to catch medication errors and address family concerns — and makes the case that interpreter access needs to stop being an extra step and start being the cultural default built into every care process.

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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. Ayesha Khalid, resident at Marshall University, presents findings from a large meta-analysis pooling data from eight national registries across Europe — covering 2.5 million pregnancies — to examine whether prenatal acetaminophen exposure is truly linked to autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) in children. She shares why the association with ASD largely disappears when accounting for heterogeneity and confounders, why the previously reported link with ADHD appears significantly smaller than what has been published, and why publication bias may have inflated the estimates we have been working from. She also addresses the critical limitation that no patient-level dose or timing data was available, why the risk-benefit calculation around fever control in pregnancy complicates any simple recommendation, and what kind of studies — ideally sibling-controlled designs like those done in Sweden — would be needed to actually settle this question.

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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. Lyubina Yankova, hospitalist at Yale, presents findings from a large retrospective multi-center analysis across 106 sites examining whether the combination of procalcitonin and C-reactive protein (CRP) can match or outperform the inflammatory marker combinations currently recommended by the 2021 AAP guidelines for risk-stratifying febrile infants between 8 and 60 days of age. She shares why this combination showed similar sensitivity but higher specificity for detecting invasive bacterial infections — meaning fewer false positives, fewer unnecessary lumbar punctures, and fewer unnecessary antibiotics. She also addresses the limitations of retrospective data, why preterm infants were excluded from this analysis and what future research in that population might look like, and what it would take for guideline committees to feel confident enough to incorporate this combination into routine practice.

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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. Ofer Levy, director of the Precision Vaccines Program at Boston Children's Hospital and member of the FDA's Vaccines and Related Biologic Products Advisory Committee, makes the case that vaccines must be tailored to the immune system of the person receiving them — and that immune system changes dramatically from the moment of birth through old age. He explains why preterm infants, who represent 11% of births worldwide, carry an increased risk of infection-related hospitalization all the way through age 18, and why almost no investment has been made in understanding how to optimally immunize them. He also discusses the FDA Modernization Act 2.0, which is shifting vaccine development away from animal models toward human in vitro modeling and systems biology, and reflects on what precision vaccinology could mean for rebuilding public trust in a deeply polarized conversation — not by dismissing concerns, but by taking vaccine safety science more seriously than ever before.

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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. Anup Katheria, one of the world's leading researchers in umbilical cord management, joins Daphna to share the latest data on deferred cord clamping and cord milking across gestational ages. He presents new two-year follow-up findings showing that while cord milking remains a reasonable alternative to immediate cord clamping, delayed cord clamping still carries a measurable advantage in Bayley scores for motor and language — even in babies between 28 and 32 weeks where short-term outcomes looked identical. He also breaks down the practical decision tree for vigorous versus non-vigorous babies at different gestational ages, shares his vision for involving obstetricians more actively in that critical first minute of life, and previews an upcoming large-scale Neonatal Research Network trial testing 100% oxygen delivery during the cord clamping window. He closes with a call to move away from traditional composite outcomes in neonatal trials toward ranked ordinal outcomes that better reflect what actually matters to 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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Daphna is back for day two of PAS 2026 in Boston, joined in the booth by Christa and Rupa. More episodes coming all day — and if you're at the conference, stop by and say hi.

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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