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Dr. Jayasree Nair, neonatal resuscitation expert, joins Ben to reflect on one of the most humbling realities in neonatology — nearly everything we know about epinephrine use in extensive neonatal resuscitation comes from animal studies, adult data, or pediatric populations, not neonates. She explains why the pyramid of resuscitation research narrows dramatically as you move toward chest compressions and epinephrine, why randomized controlled trials in this space may never be fully achievable, and why collaborative registries like the DRIVE network offer one of the most promising paths forward. She also shares her experience piloting the new NRP NICU resuscitation module and reflects on how the two-year fellowship debate ultimately circles back to the same root problem: the financial sustainability of a career in academic pediatrics.

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Christie Lawrence, clinical nurse specialist at Rush University Medical Center, joins Ben to discuss sudden unexpected infant death (SUID) — the updated term that encompasses all sleep-related infant deaths, including what was formerly called SIDS. In Cook County alone, an infant dies every week from SUID, with Black infants dying at 14 times the rate of white infants — a disparity far exceeding the already alarming national figure of three times. She explains why shifting the language from the mysterious "SIDS" to the more concrete word "suffocation" is not about being harsh but about giving families something they can actually understand and act on — and why meeting families where they are, involving the whole family unit, and addressing real barriers to safe sleep is the only way to move the needle on a problem that has been hiding in plain sight.

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Dr. Elisabeth Kuhn, researcher focused on hospital operations, presents findings from a mixed-methods study examining how US children's hospitals measure and respond to capacity strain — the point at which demand for care outpaces the ability to deliver it safely. In a survey of 45 tertiary children's hospitals, 43 reported experiencing capacity strain in the past year, underscoring just how widespread and persistent the problem has become since the triple-demic brought it into sharp focus. She argues that current metrics like occupancy rates and boarding times fail to capture the real clinical experience of strain — which is driven by acuity and complexity, not just bed counts — and calls for better measurement tools tied directly to patient outcomes, alongside broader policy change to address what no amount of internal reshuffling can fully solve.

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Kimberly Novod, community health advocate, founder of Sol's Light, and fierce voice for health equity, joins Ben for a conversation about what it actually means to build trust between hospitals and the communities they serve. Drawing on her experience in New Orleans — where the prematurity rate sits at 14% and environmental factors like air, water, and soil quality in areas like Cancer Alley drive devastating birth outcomes — she makes the case that health equity cannot be achieved within hospital walls alone. She calls on institutions to stop designing solutions without asking the people they're meant to serve, to share research findings back with the communities that participated in them, and to invest meaningfully in family partners who reflect the full spectrum of lived experience — not just the ones with the rosiest stories to tell.

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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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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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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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