The Incubator's Journal Club

How long should you treat a UTI in an 8-day-old, and when do you really need a VCUG? On this Journal Club, Daphna breaks down the brand-new AAP clinical practice guideline for urinary tract infection in children from 8 days to 5 years, the first update since 2011 and the first to include infants under two months. She walks through the key action statements: a lower culture threshold of 10,000 CFU with evidence of inflammation, age-specific urinalysis criteria, shorter antibiotic courses for low-risk children, early transition to oral antibiotics even in the neonatal period, renal and bladder ultrasound before VCUG, and narrower use of continuous antibiotic prophylaxis. Ben highlights the printable flow sheets every NICU should post.

----

Clinical Practice Guideline for the Diagnosis and Treatment of Urinary Tract Infection in Children From 8 Days to 5 Years of Age. Alverson BK, Hains DS, Downs SM, El Feghaly RE, Forster CS, Jain S, Johnston A, Mattoo TK, Nelson CP, Olakanpo O, Otero HJ, Peters CA, Poppinga NM, Saha D, Schroeder AR, Senerth E, Pilcher L, Flinn SK, Morgan RL, Mustafa RA.Pediatrics. 2026 Oct 1;158(4):e2026078565. doi: 10.1542/peds.2026-078565.PMID: 42803578

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!

What FiO2 should you start at for a 34-week preterm infant who needs help breathing at birth? On this Journal Club, Ben reviews the AIROPLANE trial, a cluster randomized crossover study across 26 Australian maternity hospitals comparing initial FiO2 of 30% versus 21% in 1,818 infants born at 32 to 35 weeks. Ongoing respiratory support leaving the delivery room was nearly identical between groups, but infants started at 30% needed less escalation in the delivery room and less endotracheal ventilation afterward. Ben places the findings alongside ILCOR guidance and the TORPIDO 30/60 trial, and explains why this common population has gone understudied for so long. Daphna and Ben agree: for now, consistency is the best practice.

----

Oxygen vs Air at Birth for Moderate- to Late-Preterm Infants: The AIROPLANE Cluster Randomized Crossover Trial. Peart SR, Manley BJ, Cheong JLY, Oei JL, Grobler AC, Moore CL, Allen RL, Alda MG, Bell G, Bhola K, Carman K, de Waal K, Dombagahawaththage CAN, Fan WQ, Fang AYW, Goyadi PK, Houghton KA, Jain KF, John J, Joshi D, Kunjunju A, Marshall IR, Mills JF, Nichol J, Parkhurst K, Priyadarshi A, Roberts CT, Thomas N, Tickell DJ, Walsh T, Yates KM, Ziffer J, Davis PG, Owen LS; AIROPLANE Trial Investigators and the IMPACT Clinical Trials Network for Mothers’ and Babies’ Health.JAMA. 2026 Sep 9:e2614201. doi: 10.1001/jama.2026.14201. Online ahead of print.PMID: 42714881

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!

What do you do when a feeder-grower has tried every bottle, nipple, and pacing strategy and still can’t finish a feed? On this Journal Club, Daphna brings a palate cleanser after yesterday’s deep dive on probiotics: a retrospective study from Rainbow Babies & Children’s Hospital testing banana puree as a natural thickener for NICU infants with dysphagia. Among 43 mature preterm infants who had failed standard interventions, oral intake rose from about half of feeds to full volume within seven days, with no respiratory adverse events and no change in weight gain. Ben and Daphna discuss why low-tech, inexpensive interventions deserve a place in our toolkit, whether a randomized trial is even needed, and why parents might already be ahead of us.

----

We're going bananas! The effectiveness and safety of banana puree as an intervention for improving oral feeding in a level IV NICU. Carr CB, Ricciardi SE, Bery S, Levin R, Wilson-Costello D, Yalcinkaya G, Ryan RM.J Perinatol. 2026 Sep;46(9):1635-1640. doi: 10.1038/s41372-026-02765-z. Epub 2026 Jul 7.PMID: 42414579 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.

Enjoy!

Has the evidence on probiotics finally reached a tipping point? On this Journal Club, Ben, fresh off a night shift, opens with two announcements: a follow-up on the ABP’s fellowship length decision and a new partnership with Pediatrix that may finally bring CME to the platform. Daphna highlights the Neonatal Insights conference in Houston. Ben then reviews a Swedish national cohort of nearly 4,700 infants born at 28 to 31 weeks, where a three-strain probiotic was linked to a 72% lower risk of death or NEC and near elimination of surgical NEC. He places the findings alongside recent Dutch and US studies, discusses Ravi Patel’s editorial on immortal time bias, and asks where the probiotic evidence truly lands.

----

Probiotics and Risk of Death, Necrotizing Enterocolitis, and Sepsis in Very Preterm Infants. Mitha A, Söderquist Kruth S, Sinervo E, Domellöf M, Brindefalk B, Abrahamsson T, Johansson S, Rakow A.JAMA Netw Open. 2026 Sep 1;9(9):e2635560. doi: 10.1001/jamanetworkopen.2026.35560.PMID: 42776528 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.

Enjoy!

In this Journal Club episode, Daphna reviews the first national estimate of potential neonatal organ donors, a Pediatrics cohort study from 23 Australian NICUs, along with its companion commentary. Of 1,760 infants who died in the NICU between 2012 and 2022 at 35 weeks corrected age or later, about one in three met conservative eligibility criteria. Most would have donated after circulatory death, and a smaller group with severe HIE could potentially have donated after neurological determination of death. They discuss referral timing, outcomes of en bloc kidney transplants from neonatal donors, and how NICUs can offer families this option as part of end-of-life care.

----

Potential Neonatal Donors in Australia: A National Cohort Study. Barzegar R, Cavazzoni E, Popat H, Wong G.Pediatrics. 2026 Sep 3:e2025075110. doi: 10.1542/peds.2025-075110. Online ahead of print.PMID: 42686207

The Untapped Potential of Organ Donation from the NICU. Nguyen BV, Coloma M, Crouch EE.Pediatrics. 2026 Sep 3:e2026076954. doi: 10.1542/peds.2026-076954. Online ahead of print.PMID: 42686210 No abstract available.

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!

In this Journal Club episode, Ben reviews a JAMA Network Open study from two Dutch Level IV NICUs. It examined NEC before and after routine implementation of a three-strain probiotic in 1,413 infants born before 30 weeks or under 1,000 grams. NEC fell from 11.9% to 5.3%, and late-onset sepsis also declined. But non-NEC mortality rose after implementation. NEC also dropped in an unexposed reference cohort, and one infant died of B. infantis sepsis. Ben and Daphna discuss how baseline NEC rates, seasonal patterns, and number needed to harm should shape how units weigh probiotic use.

----

Probiotic Implementation and Necrotizing Enterocolitis Risk in Preterm Infants. Imren C, Jongejans V, Onland W, Keyzer-Dekker CMG, Been JV, Derikx JPM, van Kaam AH, Simons SHP, Twisk JWR, van den Akker CHP, Vermeulen MJ.JAMA Netw Open. 2026 Aug 3;9(8):e2631601. doi: 10.1001/jamanetworkopen.2026.31601.PMID: 42671836 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.

Enjoy!

In this Journal Club episode, Daphna presents a JAMA Pediatrics randomized trial led by Mandy Belfort and Terrie Inder. It tested whether point-of-care human milk analysis, used to individually target protein and fat fortification, improves outcomes in infants born at 24 to 30 weeks. Milk was analyzed every weekday with the Miris analyzer. Fortification in the intervention group was adjusted to meet protein and energy targets. Growth, body composition by air displacement plethysmography, and term-equivalent brain MRI were no different from standard fortification, and all infants met recommended intakes. Two-year outcomes will be reported separately.

----

Individually Targeted Human Milk Fortification: A Randomized Clinical Trial. Belfort MB, Ahtam B, Bell KA, Berger P, Cherkerzian S, Ellard D, Foster L, Fusch C, Gagoski B, Grant PE, Kuncham M, Pepin H, Solti M, Steele T, Woodward L, Inder T.JAMA Pediatr. 2026 Sep 14:e264220. doi: 10.1001/jamapediatrics.2026.4220. Online ahead of print.PMID: 42734908

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!

In this Journal Club episode, Ben and Daphna review the 24-month follow-up of the BeNeDuctus trial, which compared expectant management with early ibuprofen for PDA in infants born before 28 weeks. Survival without neurodevelopmental impairment was identical in both groups, at 49%. Ben places the findings alongside Baby-OSCAR, the PDA trial, TRIOCAPI, and SMART-PDA, and explains why a neutral result does not mean no PDA should ever be treated. The conversation then turns to how targeted neonatal echocardiography and lung ultrasound are changing bedside PDA assessment, and previews an upcoming hemodynamics series with Dr. Gabriel Altit.

----

Long-Term Outcomes of Expectant Management versus Early Ibuprofen for Patent Ductus Arteriosus: 24-Month Follow-Up of the BeNeDuctus Trial. Apers WMJ, Hundscheid T, Kooi EMW, Onland W, Vijlbrief D, Steiner K, Donders R, Mulder AL, de Boode WP; BeNeDuctus Trial Investigators.J Pediatr. 2026 Sep 17;299:115292. doi: 10.1016/j.jpeds.2026.115292. Online ahead of print.PMID: 42637114 

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!

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.

----

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.

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!

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.

----

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.

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!