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Ben and Daphna review the ICAF randomized clinical trial evaluating extended caffeine therapy in preterm infants and its impact on intermittent hypoxia through 41 weeks postmenstrual age. They discuss the study design, oximetry outcomes across multiple saturation thresholds, inflammatory biomarkers including TNF-α, and clinically relevant safety signals such as oxygen restart rates, length of stay, and weight gain. The conversation focuses on what intermittent hypoxia may mean for ongoing risk, and whether a targeted subgroup of infants might benefit from extending caffeine beyond traditional stopping points.

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Intermittent hypoxia and caffeine in infants born preterm: the ICAF Randomized Clinical Trial. Eichenwald E, Corwin M, McEntire B, Knoblach S, Limperopoulos C, Kapse K, Kerr S, Heeren TC, Ikponmwonba C, Hunt CE; ICAF Study Group.Arch Dis Child Fetal Neonatal Ed. 2025 Nov 24:fetalneonatal-2025-329230. doi: 10.1136/archdischild-2025-329230. Online ahead of print.PMID: 41285561

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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 Journal Club episode, Ben and Daphna review a salient study from JAMA Network Open examining outcomes of infants born at 21 weeks’ gestation at the University of Iowa. They walk through resuscitation practices, early physiologic challenges, survival trends, and short-term developmental outcomes, while placing the data in the broader context of shifting limits of viability. The discussion highlights both cautious optimism and the many unanswered questions that remain as neonatology continues to push the boundaries of what is possible.

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Outcomes of Infants Born at 21 Weeks' Gestational Age. Hyland RM, Mat HD, Boly TJ, Thomas BJ, Stanford AH, Harmon HM, Bermick JR, Davila RC, Colaizy TT, Dagle JM, Klein JM, Greiner AL, Bell EF, McNamara PJ; University of Iowa Neonatology Program.JAMA Netw Open. 2025 Dec 1;8(12):e2548211. doi:10.1001/jamanetworkopen.2025.48211.PMID: 41385227 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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In this Journal Club episode, Ben and Daphna review a major randomized clinical trial published in JAMA comparing expectant management with active pharmacologic treatment of patent ductus arteriosus in preterm infants. They walk through the trial design, inclusion criteria, and outcomes, highlighting the unexpected survival difference favoring expectant management despite similar rates of bronchopulmonary dysplasia. The discussion explores the implications for bedside decision-making, the limitations of PDA-focused strategies, and the need for a more physiologic, patient-centered approach to ductal management in extremely preterm infants.

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Expectant Management vs Medication for Patent Ductus Arteriosus in Preterm Infants: The PDA Randomized Clinical Trial. Laughon MM, Thomas SM, Watterberg KL, Kennedy KA, Keszler M, Ambalavanan N, Davis AS, Slaughter JL, Guillet R, Colaizy TT, Cotten CM, Dhawan MA, Bose CL, Talbert J, Smucny S, Benitz WE, Rysavy MA, Ohls RK, Baserga MC, DeMauro SB, Jaleel M, Jackson WM, Carlo WA, Puopolo KM, Hibbs AM, Katheria A, Sánchez PJ, D'Angio CT, Patel RM, Johnson BA, Chock VY, Bhatt AJ, Merhar SL, Moore R, Laptook AR, Ghavam S, Fuller J, Vyas-Read S, Kicklighter SD, Steinbrekera B, Anderson K, Reynolds AM, Wyckoff MH, Montoya C, Das A, Do B, Chang S, Higgins RD, Walsh MC; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.JAMA. 2025 Dec 9:e2523330. doi: 10.1001/jama.2025.23330. Online ahead of print.PMID: 41364689

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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 Beyond the Beeps, Leah MG Jayanetti discusses the unique challenges faced by families in the NICU during the holiday season. Joined by Alena Costume, a two-time NICU mother, they explore the emotional rollercoaster of having a baby in the NICU, the importance of community support, and strategies for coping with stress. Alena shares her personal experiences, highlighting the significance of parental presence and the impact of healthcare staff on the NICU journey. The conversation emphasizes resilience, hope, and the need for better support systems for NICU families. In this conversation, Leah MG Jayanetti and Alena discuss the profound experiences of families in the NICU, emphasizing the importance of nourishment, community support, and the unexpected connections that can arise during challenging times. They share personal stories about creating the Touching Tiny Hands organization, the emotional toll of having a child in the NICU, and the significance of hope and belonging in the journey of parenthood, especially during the COVID-19 pandemic.

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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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As 2025 comes to a close, Ben and Daphna reflect on a year of growth, community, and evolution for The Incubator Podcast. In this end-of-year wrap-up, they preview major changes coming in 2026, including new standalone podcast feeds, expanded journal club content, CME opportunities, and exciting partnerships with organizations like the Vermont Oxford Network and PAS. They also share what’s ahead for the Delphi Conference and offer a candid look at their personal and professional goals for the year ahead. Thank you for being part of this extraordinary neonatal community.

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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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Transitioning from fellowship to your first attending job? You're probably not prepared for the business side of medicine—and that's exactly the problem Dr. Tung Giep addresses in this episode. Dr. Giep, a neonatologist with over 30 years of experience, shares hard-earned lessons from building and selling a private practice in Houston, navigating toxic work environments, and eventually finding his place in telemedicine. His new book, The Business of Medicine: The Definitive Guide to Help New Physicians Start Their Career on the Right Path and Avoid Costly Mistakes, tackles what medical training ignores: contract negotiation, non-competes, choosing the right CPA and attorney, and understanding your self-worth.

Ben and Dr. Giep discuss why new physicians get blindsided by job offers, how to vet a practice properly, and the reality of community neonatology versus academic medicine. They also explore the growing role of AI in healthcare and what it means for the next generation of physicians. Whether you're finishing fellowship or reconsidering your current position, this conversation offers practical guidance on taking control of your career—and avoiding costly mistakes along the way.

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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 Journal Club episode, Ben and Daphna review five recent studies with practical implications for neonatal care. The FEED1 trial examines whether starting full milk feeds from day one is safe in 30-32 week preterm infants, finding no difference in length of stay compared to gradual feeding but fewer central line days. A brief communication from UAB explores high-volume feeding strategies (≥170 ml/kg/day) and their impact on body composition in very preterm infants.

The hosts discuss a mannequin study from Italy measuring forces applied during intubation with different laryngoscope types and bed heights, revealing that video laryngoscopy at navel height applies the lowest forces—contrary to most clinicians' perceptions.

A large Japanese cohort study highlights the association between maternal psychological distress and neurodevelopmental delays, with postpartum distress showing stronger effects than prenatal stress. Finally, analysis of Neonatal Research Network data identifies predictors of early cord clamping in extremely preterm infants, with lack of magnesium sulfate, cesarean delivery, and antepartum hemorrhage being key factors.

The episode wraps with reminders about upcoming conferences, including the Delphi Conference in Fort Lauderdale in January 2026.

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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Antenatal Prediction of Early Cord Clamping among Infants Born Extremely Preterm.

Katheria A, Dorner RA, Grobman W, Rysavy MA, Koo J, Wyckoff MH, Sandoval G, DeMauro SB, Das A, Lee HC, Cotten M, Calvo L, Saha S; Eunice Kennedy Schriver National Institute of Child Health and Human Development Neonatal Research Network.J Pediatr. 2025 Oct 31:114878. doi: 10.1016/j.jpeds.2025.114878. Online ahead of print.PMID: 41177398

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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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Maternal Psychological Distress Before and After Childbirth and Neurodevelopmental Delay in Toddlers.

Matsumura K, Tanaka T, Kuroda M, Tsuchida A, Hatakeyama T, Kasamatsu H, Inadera H; Japan Environment and Children’s Study Group.JAMA Netw Open. 2025 Oct 1;8(10):e2540907. doi: 10.1001/jamanetworkopen.2025.40907.PMID: 41171271 Free PMC article.

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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Treatment of Hypotension of Prematurity: a randomised trial.

Alderliesten T, Arasteh E, van Alphen A, Groenendaal F, Dudink J, Benders MJ, van Bel F, Lemmers P. Arch Dis Child Fetal Neonatal Ed. 2025 Dec 15;111(1):F60-F66. doi: 10.1136/archdischild-2024-328253.PMID: 40413017 Clinical Trial.

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!