The Incubator

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Ben and Daphna  dig into a large, population-based study linking IVF conception to VACTERL association, a rare but serious pattern of congenital anomalies spanning the vertebral, anal, cardiac, tracheoesophageal, renal, and limb systems. Drawing on over 1.5 million births across four US states and linked SART registry data, the study finds IVF-conceived infants face significantly higher odds of VACTERL and related multiple anomaly syndromes compared to naturally conceived infants. Daphna and Ben unpack what this means for clinical suspicion at the bedside, why some VACTERL phenotypes may be easy to miss, and how better tracking of conception history through delivery could change how NICU teams approach anomaly workups in IVF-conceived infants.

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In Vitro Fertilization and VACTERL Birth Defects. Tark JY, Richard MA, Schraw JM, Fisher SC, Betancourt D, Stone SL, Forestieri NE, Baker VL, Cameron K, Eisenberg ML, Belva F, Lu Y, Williams CL, Sutcliffe AG, Lupo PJ, Luke B.JAMA Netw Open. 2026 Aug 3;9(8):e2629355. doi: 10.1001/jamanetworkopen.2026.29355.PMID: 42616500 Free PMC article.

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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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Ben and Daphna dig into a pilot RCT that asks a deceptively simple delivery-room question: should very preterm infants start on CPAP of 5 or CPAP of 8 cmH2O? The PHILODENDRON trial, out of Milan's Buzzi Children's Hospital, randomized 56 babies born between 26 and 29 weeks to find out — testing feasibility, safety, and early physiological adaptation before committing to a larger multicenter trial. No major safety signals emerged, but babies on lower CPAP reached surfactant thresholds faster, while higher CPAP trended toward fewer air leaks and shorter ventilation. Ben and Daphna weigh the physiology against the data, and ask whether trials like this even test the right question in the first place.

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Initial CPAP of 5 versus 8 cmH2O during delivery room stabilisation of very preterm infants: the PHILODENDROOM pilot randomised trial. Cavigioli F, Bresesti I, Castoldi F, Gatto S, Lupo E, Rossi S, La Verde A, Bianchi S, Meneghin F, Viaroli F, Pivetti V, Manfredini V, Cannata G, Bastrenta P, Fontana P, Stucchi I, Daniele I, Chiera M, Lista G.Eur J Pediatr. 2026 Aug 17;185(9):673. doi: 10.1007/s00431-026-07322-6.PMID: 42608615 Free PMC article. Clinical Trial.

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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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Is the newborn vitamin K shot really being skipped more often these days, and does that actually matter clinically? This week on Journal Club, Ben and Daphna review a nationwide Swedish cohort study of over two million births, published in JAMA Pediatrics, examining trends in non-receipt of intramuscular vitamin K and its link to bleeding in infancy. Non-receipt nearly doubled between 2006 and 2021, and infants without intramuscular vitamin K had significantly higher odds of bleeding, including intracranial bleeding, than those who received it — oral vitamin K carried an even higher bleeding risk still. Ben and Daphna also discuss home birth data, families requesting oral alternatives, and how best to counsel parents navigating a vitamin K refusal in clinic today.

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Vitamin K Prophylaxis in Newborns and Bleeding in Infancy. Simatou E, Tsamantioti E, Hallström A, Stephansson O, Razaz N, Persson M, Bolk J.JAMA Pediatr. 2026 Sep 1;180(9):995-1004. doi: 10.1001/jamapediatrics.2026.2606.PMID: 42440325

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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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Do we really need a DAT on every baby born to a group O or Rh-negative mother? This week on Journal Club, Ben and Daphna dig into a new Pediatrics study questioning routine Direct Antiglobulin Testing (DAT) in low-risk neonates with ABO or RhD incompatibility. Using data from over 1,300 infants, the authors found that transcutaneous bilirubin alone predicted the need for phototherapy just as well as DAT in ABO-incompatible babies, and that passive anti-D from RhoGAM rarely caused significant hemolysis in RhD-incompatible infants. Ben and Daphna also discuss what this means for institutions running DAT on every newborn, how to tell passive anti-D apart from true alloimmunization, and why a more targeted approach to bilirubin screening may be overdue.

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Utility of DAT in Low-Risk Neonates With ABO or RhD Incompatibility. Tsai TL, Ma T, Nester T.Pediatrics. 2026 Sep 1;158(3):e2026076989. doi: 10.1542/peds.2026-076989.PMID: 42642037

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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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In this episode of From the Heart, Drs. Nim Goldshtrom and Adrianne Bischoff talk with Dr. Kristin Elgersma, a nurse-researcher whose path into neonatal nutrition began at her son's bedside in a cardiac ICU. A former concert pianist turned nurse-researcher, Kristin asked a question no one had: does human milk change outcomes for babies with congenital heart disease? Her multicenter PC4 study of day-by-day data from over 800 infants across 25 centers found no link between human milk and NEC, though bovine-derived formula or fortifier tripled NEC risk within five days, while higher human milk intake meant roughly nine fewer hospital days. They cover lactation support, donor milk gaps between NICUs and CICUs, and practical next steps.

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Elgersma et al. Human milk feeding, fortification initiation, and clinical outcomes in neonates with critical congenital heart disease: A multi-institutional study. medRxiv 2026. DOI 10.64898/2026.08.20.26360934 (preprint, no PMID)

Elgersma et al. Human milk feeding and direct breastfeeding improve outcomes for infants with single ventricle congenital heart disease: Propensity score-matched analysis of the NPC-QIC registry. J Am Heart Assoc 2023. PMID 37642030

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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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In this episode of From the Heart, Dr. Nim Goldshtrom and Dr. Adrianne Bischoff dissect a hemodynamics consult that changes shape twice in 48 hours. A 30-week recipient twin from twin-to-twin transfusion syndrome presents with biventricular dysfunction and suprasystemic pulmonary hypertension, starts on epinephrine and milrinone, and stabilizes. Then overnight, everything falls apart: hypotension, rising lactate, falling urine output. Only on repeat echo does the real diagnosis emerge: hypertrophic obstructive cardiomyopathy (HOCM) with dynamic left ventricular outflow tract obstruction, where the "correct" initial therapy becomes dangerous. Nim and Adrianne unpack why milrinone can worsen outflow obstruction, why vasopressin beats dobutamine, and when esmolol helps or harms. It's a masterclass in resisting anchoring bias and treating evolving physiology, not just numbers.

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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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Disclosure: Dr. Wanda Barfield appeared on this episode in her personal capacity. The views she expresses are her own and do not represent the official positions of the Centers for Disease Control and Prevention, the Department of Health and Human Services, or the United States government.

The American Academy of Pediatrics has never had a neonatologist as president. This September, that could change. In this special episode, Ben sits down with Dr. Wanda Barfield, neonatologist, retired Rear Admiral and Assistant Surgeon General in the US Public Health Service, and longtime director of the CDC's Division of Reproductive Health, to hear what she would bring to the role. She lays out her three priorities, supporting pediatricians, protecting access, and leading with science and equity, and addresses the questions our field is wrestling with right now: training, staffing, the erosion of trust in science, and whether neonatology should go it alone. Her answer is that we are stronger together, and that having a neonatologist at the helm of the AAP would give our specialty a voice it has never had. Voting is open to AAP members through September 16. Meet the candidate, then go vote.

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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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This week's Journal Club. Monday, nasal CPAP versus NIPPV as the bridge to minimally invasive surfactant in infants born before 30 weeks, first author Dr. Hui Zhang. Tuesday, the PAEAN trial on high-dose erythropoietin for neonatal HIE, led by Dr. Helen Liley. Wednesday, extended infusion versus bolus feeding for weight gain in extremely-low-birth-weight infants, from Dr. Haribalakrishna Balasubramanian's team in India. Thursday, the DROP-ROP trial, testing dexamethasone eye drops against treatment-requiring ROP, led by Dr. Ann Hellström. Friday, Neo News: Eli and Ben on The Pitt's viral boundary-setting scene and what it says about burnout in medicine.

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Nasal Continuous Positive Airway Pressure vs Nasal Intermittent Positive Pressure Ventilation in Preterm Infants With Respiratory Distress Syndrome: A Randomized Clinical Trial. Zhang H, Zhang Y, Zeng L, Tong X, Piao M, He H, Zhao C, Xie H, Zheng Z, Cui Q, Lai Y, Wang H, Wang L, Liu H, Tian X, Wu H, Kang L, Han T.JAMA Netw Open. 2026 Jun 1;9(6):e2619785. doi: 10.1001/jamanetworkopen.2026.19785.

Erythropoietin for Neonatal Hypoxic-Ischemic Encephalopathy: A Randomized Clinical Trial. Liley HG, Hunt RW, O'Connell RL, Battin MR, Novak I, Wu YW, Ballard R, Askie L, Badawi N, Ghadge A, Jacobs SE, Juul SE, Sebastian L, Wagh D, Simes RJ; PAEAN Study Investigators.JAMA Pediatr. 2026 Jul 27:e263082. doi: 10.1001/jamapediatrics.2026.3082. Online ahead of print.

Effect of Extended Infusion Versus Intermittent Bolus Feedings on Hospital Weight Gain in Extremely Low Birth Weight Infants Born at <29 Weeks of Gestation: A Randomized Noninferiority Clinical Trial. Balasubramanian H, Sahoo M, Chhadva D, Choubey R, Sakharkar S, Pillai A, Kabra NS.J Pediatr. 2026 Jul 13;298:115235. doi: 10.1016/j.jpeds.2026.115235. Online ahead of print.

Dexamethasone Eye Drops to Prevent Treatment-Requiring Retinopathy of Prematurity: The DROPROP Randomized Clinical Trial. Hellström A, Petrishka-Lozenska M, Sjöbom U, Wallander J, Nilsson AK, Löfqvist C, Ley D, Gränse L, Öhnell HM, Hård AL, Jakobsson G, Sävman K, Domellöf M, Löfgren S, Larsson E, Smith LEH, Pivodic A, Lundgren P; DROPROP Collaboration Group.JAMA Pediatr. 2026 Aug 3:e263247. doi: 10.1001/jamapediatrics.2026.3247. Online ahead of print.

Haridasani Gupta A. On "The Pitt," She Clocked Out on Time. In Real Life, It Started a Debate. The New York Times. May 11, 2026. https://www.nytimes.com/2026/05/11/style/the-pitt-joy-kwon-irene-choi-work-life-balance.html

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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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A medical student on The Pitt finishes her shift, is asked to stay, and tells her supervisor to learn some boundaries. The internet did not let it go. Ben and Eli use that moment to work through what boundary setting actually looks like in a NICU, why a tired clinician makes different decisions at three in the morning than at three in the afternoon, and where duty hours collide with the fact that patients do not arrive on a curriculum. Also, why handing a resident your pager at two PM may be the cheapest patient safety intervention available.

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Haridasani Gupta A. On "The Pitt," She Clocked Out on Time. In Real Life, It Started a Debate. The New York Times. May 11, 2026. https://www.nytimes.com/2026/05/11/style/the-pitt-joy-kwon-irene-choi-work-life-balance.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.

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Steroids again? This time in the eye. Daphna brings the DROP-ROP trial from JAMA Pediatrics, a double-masked randomized study across fourteen Swedish centers asking whether topical dexamethasone can stop pre-threshold ROP from progressing to type one disease. One hundred infants, born under 30 weeks, dosed for up to twelve weeks, some still getting drops at home. Twenty percent needed laser or anti-VEGF in the dexamethasone arm versus thirty-eight percent on placebo, a relative risk reduction that did not reach significance. Ben and Daphna talk through the safety signals, the intraocular pressure question, and how fast our field adopts promising ROP data.

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Dexamethasone Eye Drops to Prevent Treatment-Requiring Retinopathy of Prematurity: The DROPROP Randomized Clinical Trial. Hellström A, Petrishka-Lozenska M, Sjöbom U, Wallander J, Nilsson AK, Löfqvist C, Ley D, Gränse L, Öhnell HM, Hård AL, Jakobsson G, Sävman K, Domellöf M, Löfgren S, Larsson E, Smith LEH, Pivodic A, Lundgren P; DROPROP Collaboration Group.JAMA Pediatr. 2026 Aug 3:e263247. doi: 10.1001/jamapediatrics.2026.3247. Online ahead of print.

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!