The Incubator

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Dr. Benny Rossner, PGY-2 pediatrics resident and veteran physician recruiter with 15 years of experience building clinical teams across the country, joins Ben and Rupa for a candid look at the neonatology workforce from a side of the conversation trainees rarely hear. He breaks down why demand for neonatologists is rising — sicker and younger patients, a shrinking APP pipeline into high-acuity specialties, and hospitals stretching budgets on locums before finally raising permanent salaries — and why fellows coming out of training have more negotiating power than they typically realize. He also shares practical advice on contract negotiations, non-competes, and why knowing the right people still matters enormously when it comes to landing the most competitive academic or metropolitan positions.

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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. Gabriel Altit and Daniela Villegas from the NeoCardioLab at Montreal join Ben and Rupa to reflect on a packed PAS filled with hemodynamics science — from pulmonary hypertension phenotyping to heart-brain interactions in the golden hour. Dr. Altit makes the case that just as neonatology learned to embrace gentle ventilation, it is time to think about gentle hemodynamics — intervening thoughtfully, recognizing different clinical phenotypes, and knowing when to remove interventions before they carry a price. He also previews early 3D echo data suggesting that a single clip at day 7 to 10 of life may already carry a signature predicting which babies will develop adverse cardiopulmonary outcomes by 36 weeks. Daniela shares her approach to family consent and research recruitment — sitting down, leaving papers behind, connecting families to the history of research that made current NICU care possible, and always giving them space to process before returning for an answer.

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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. Kristen Leeman and Dr. Jonathan Levin join Ben to debrief a packed interactive session on tracheostomy timing and counseling for babies with severe bronchopulmonary dysplasia (BPD). Using iterative cases and live audience polling, they mapped the wide variability in practice across the country — finding rough consensus that tracheostomy conversations become likely around 44 to 48 weeks post-menstrual age for intubated infants and 48 to 52 weeks for those on non-invasive ventilation, with key comorbidities like pulmonary hypertension, poor growth, and neurological injury shifting the calculus significantly. Families who participated in the session delivered a powerful message: the conversation should start early, be repeated often, and be framed not as a failure but as a transition — and continuity of care, having a familiar face who knows the baby and the family, made all the difference.

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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. Rangasamy Ramanathan, division chief at Cedars-Sinai Guerin Children's Hospital and one of neonatology's most prolific investigators, joins Ben to share what's keeping him busy — 14 active clinical trials including studies on IGF-1 for lung injury prevention, oral insulin for weight gain, and the upcoming phase three trial of aerosolized surfactant. He reflects on what has sustained his passion through decades of work, from training a third of California's neonatologists to launching Southern California's first NeuroNICU with 24-7 neurology coverage and in-house whole genome sequencing. He also previews his next innovation — the ROM Smith ventilator, designed to be manufactured and distributed at cost to resource-limited settings around the world where babies are dying for lack of a $30,000 machine he believes he can build for under $2,000.

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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. Thais Queliz, neonatologist at Winnie Palmer Hospital in Orlando, presents ten years of data from one of the country's highest-volume programs caring exclusively for babies born at 22 to 24 weeks. She shares how survival rates for 22 and 23-weekers climbed from 40% before the Tiny Baby program launched to 67% overall — and 72% over the last two years — driven by institutional alignment, standardized protocols, and a dedicated multidisciplinary team. She also presents Golden Hour data showing a jump from 8% to 75% completion rate after implementing strict checklists and role-defined workflows that cut average admission time from nearly two hours to 54 minutes. And she previews work on prolonged empiric antibiotics in this population — extending courses based on placental pathology — which has been associated with decreased mortality in 22 and 23-weekers, echoing findings presented earlier in the conference by her fellow Dr. Gesca Borchardt.

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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. Indrani Bhattacharjee, neonatologist and POCUS program director at Tufts Medical Center in Boston, joins Ben to discuss a fascinating and largely unexplored frontier — intestinal ultrasound in healthy preterm infants. Rather than waiting for NEC to appear, her team has been systematically scanning babies born under 32 weeks every week from one week of age until eight weeks or discharge, building what may be the first normative dataset for bowel wall thickness in this population. Early findings are already challenging the standard radiological definitions, showing that extremely preterm babies have thinner bowel walls than current benchmarks would classify as normal — raising the question of whether definitions derived from term or older patients have ever been appropriate for our tiniest babies. The publication is forthcoming in the European Journal of Pediatrics.

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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. Surabhi Aggarwal, neonatologist at Stony Brook University, joins Ben and Rupa to share five years of experience building a LISA — Less Invasive Surfactant Administration — program from the ground up at her institution. She walks through the obstacles of getting IRB approval, gaining clinical buy-in from colleagues comfortable with intubation, and how the introduction of video laryngoscopy was the turning point that finally got the practice off the ground. She shares early results showing that 30% of eligible babies received surfactant via LISA rather than intubation, discusses the technical nuances of catheter placement and confirmation, and weighs in on the emerging SALSA technique using an LMA — with a candid admission that she may be a little biased. She also highlights her work with MidCan, the AAP mid-career neonatologist group supporting clinicians between seven and seventeen years post-training.

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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. Arpitha Chiruvolu, neonatologist and infant nutrition researcher, joins Ben to share three posters from this year's PAS covering two of her core research interests. She presents pilot data on using Prolacta human milk cream as an alternative to dextrose gel for treating asymptomatic neonatal hypoglycemia — highlighting the well-known limitations of dextrose gel including inconsistent dosing, poor tolerance, and the way it interferes with breastfeeding immediately after administration. In 25 babies treated with cream, blood glucose rose from a median of 36 to 56 mg/dL, only one baby required NICU admission, and nurses and families loved it. She also shares her center's experience with probiotics in extremely low birth weight infants — where NEC rates dropped significantly with no cases of probiotic sepsis — and raises the urgent question of what is happening to NEC rates now that probiotics have been pulled from use in the US.

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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Dr. David Sas, pediatric nephrologist at Mayo Clinic, joins Ben to discuss primary hyperoxaluria type 1 — a rare but devastating genetic disease where the liver overproduces oxalate, flooding the kidneys with crystals and leading to end-stage kidney failure in roughly 60% of patients, historically requiring both a liver and kidney transplant. He presents 60-month long-term extension data on Lumasiran, an siRNA-based therapy that suppresses oxalate production at its source — showing that urinary oxalate drops rapidly within the first three months and stays down with quarterly injections, potentially changing the trajectory of this disease forever. He also issues a direct call to urologists and nephrologists everywhere: if your patient has recurrent calcium oxalate stones, check a 24-hour urine — because primary hyperoxaluria is almost certainly being missed.

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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Dr. Kyle Willsey, pediatric critical care transport director at Cedars-Sinai, joins Daphna to discuss one of the least standardized corners of pediatric and neonatal medicine — critical care transport. With children's hospitals closing across the country and tertiary centers absorbing more of the patient load, the demand for safe, well-trained transport teams is growing at the same time that national standards remain nearly nonexistent. He shares the challenges of building a transport program from the ground up, presents early pilot data using the NASA Task Load Index to measure the subjective cognitive burden on transport nurses and respiratory therapists, and makes an open call for collaboration with anyone else navigating the same uncharted territory — because the transport leg of a critically ill child's journey should never be an afterthought.

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!