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In this retrospective single-center study from Toronto, Adrianne and Nim explore the echo findings of preterm infants with septic shock and hypoxemic respiratory failure. Contrary to the common assumption that elevated pulmonary vascular resistance drives hypoxemia in sepsis, the data points to left ventricular dysfunction as a key contributor. Babies with hypoxemic respiratory failure showed lower LV systolic and diastolic performance, while pulmonary pressures were similar between groups. Mortality was significantly higher in the hypoxemic group. This challenges the reflex to reach for nitric oxide first and asks clinicians to look at the whole heart.

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Cardiopulmonary Physiology of Hypoxemic Respiratory Failure Among Preterm Infants with Septic Shock. Kharrat A, Nissimov S, Zhu F, Deshpande P, Jain A.J Pediatr. 2025 Mar;278:114384. doi: 10.1016/j.jpeds.2024.114384. Epub 2024 Nov 6.PMID: 39510164

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What would it really mean to shorten neonatology fellowship training to two years? In this episode, Ben and co-host Dr. Shetal Shah sit down with three division heads, Dr. Jill Maron (Brown), Dr. Patrick McNamara (University of Iowa), and Dr. Sarah Taylor (Yale), to examine the ABP's proposed changes from the perspective of those who run major academic NICUs. From the operational and financial strain of losing an entire class of third-year fellows, to the erosion of scholarly development, dwell time, and faculty wellbeing, the conversation makes clear that the costs of this proposal go far deeper than the curriculum. How do you staff an 80-bed NICU without junior fellows? Who funds the gap? And what happens to the next generation of academic neonatologists if we train them in isolation from the very experiences that shape their identity as clinicians and scholars?

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What does it mean to truly improve outcomes for very low birth weight infants, and are we actually doing it? In this episode, Daphna sits down with Dr. Joseph Kaempf, neonatologist and Medical Director of Value Research and Innovation at Providence Health System in Oregon, to examine some uncomfortable truths about neonatal quality improvement. Dr. Kaempf shares findings from a study spanning 16 NICUs over 14 years showing that composite morbidity outcomes have remained flat while length of stay has increased. He explores why traditional QI tools like driver diagrams and PDSA cycles may no longer be sufficient, and why augmented intelligence may be the next frontier. The conversation also touches on culture as a driver of NICU performance and the gap between institutional interests and true shared decision-making with families. A candid episode for anyone invested in the future of neonatology.

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Phototherapy duration, jaundice and UTIs, extended CPAP, and The Pitt. A full week on the Incubator Journal Club.

Ben opens with a nationwide Swedish cohort study from JAMA Network Open examining phototherapy duration in nearly 5,000 very preterm infants. Longer phototherapy was not significantly associated with late neonatal mortality, but six to seven days was associated with significantly higher rates of severe neonatal morbidity. With 95% of the cohort receiving phototherapy, Ben and Daphna question how much evidence actually supports the near-universal practice.

Daphna follows with a retrospective study from Istanbul showing that 31% of term and near-term neonates hospitalized for unexplained hyperbilirubinemia had culture-proven UTIs, with pathological renal ultrasound findings independently associated with a 4.6-fold increased odds of UTI.

Ben then reviews the extended CPAP secondary analysis by Mamidi and McEvoy, showing that two additional weeks of bubble CPAP reduced intermittent hypoxemia episodes from 151.7 to 57.6 compared to discontinued CPAP.

Daphna closes with the NEOASP five-day UTI treatment guideline from Nationwide Children's Hospital, where a structured stewardship approach yielded a 1% failure rate.

Ben and Eli close the week reflecting on The Pitt and what it reveals about the broken realities of American healthcare.

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In this episode of Neo News, Ben and Eli discuss the cultural phenomenon of HBO Max’s new hit medical drama, The Pitt. Sparked by an insightful critique in The New Yorker by Dr. Dhruv Khullar, they dive into why this Noah Wyle-led series is capturing the attention of millions of Americans, including healthcare workers and patients alike. They explore how the show’s unflinching portrayal of systemic failures, from ER overcrowding to uninsured patients leaving against medical advice, mirrors their daily reality in the hospital. Tune in as they discuss whether the shared humanity seen on screen can bridge the gap between doctors and patients or simply highlight the exhausting "pit" of modern medicine!

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The Pitt: https://www.newyorker.com/culture/the-lede/what-the-pitt-taught-me-about-being-a-doctor

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As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. 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 five days of antibiotics enough to treat a urinary tract infection in a NICU infant? In this Journal Club episode, Ben and Daphna review a single-center study from Nationwide Children's Hospital examining adherence and safety of a five-day antibiotic treatment guideline for culture and urinalysis-proven UTIs in the NICU. Among 77 infants with 93 bacterial UTIs, the five-day course was associated with a 1% failure rate, defined as reinitiation of antibiotics within seven days for the same organism. The episode also explores the potential role of enteral antibiotic therapy and what shorter treatment courses could mean for babies still weeks away from discharge.

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Urinary tract infection in the neonatal intensive care unit. Magers J, Burton A, Prusakov P, White NO, Miller RR, Moraille R, Theile AR, Sánchez PJ; Nationwide Children’s Hospital Neonatal Antimicrobial Stewardship Program (NEO-ASP).J Perinatol. 2026 May;46(5):754-760. doi: 10.1038/s41372-026-02690-1. Epub 2026 Apr 29.PMID: 42056240 Free PMC article.

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As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. 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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What happens to intermittent hypoxemia when you keep a stable preterm infant on CPAP for two extra weeks? In this Journal Club episode, Ben and Daphna review a secondary analysis from the Journal of Pediatrics by Mamidi and McEvoy. Among 95 infants randomized to either two additional weeks of bubble CPAP on room air or discontinued CPAP, those in the extended CPAP group experienced significantly fewer intermittent hypoxemia episodes (57.6 versus 151.7), higher baseline saturations, and greater functional residual capacity. The episode also touches on the practical implications for units navigating oral feeding protocols alongside extended CPAP.

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Extended Continuous Positive Airway Pressure in Infants Born Preterm Decreases Intermittent Hypoxemia: A Secondary Analysis of a Randomized Controlled Trial. Mamidi RR, Go MDA, Harris J, Olson M, Milner K, Tepper RS, Morris C, Park B, Schelonka R, MacDonald KD, McEvoy CT.J Pediatr. 2026 May 25:115165. doi: 10.1016/j.jpeds.2026.115165. Online ahead of print.PMID: 42190903

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As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. 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, Daphna reviews a retrospective cohort study from Istanbul examining clinical, laboratory, and ultrasound factors associated with UTI in neonates hospitalized for unexplained hyperbilirubinemia. Among 96 term and near-term infants, 31% had culture-proven UTIs, a striking prevalence. Pathological renal ultrasound findings were independently associated with UTI, with affected neonates 4.6 times more likely to have a concurrent infection. Notably, standard laboratory markers including CRP and white blood cell count failed to distinguish UTI-positive from UTI-negative infants. The findings prompt a practical question: should urine culture be part of the routine workup for neonatal hyperbilirubinemia?

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Renal ultrasonography findings are associated with urinary tract infection in neonates with asymptomatic hyperbilirubinemia. Sarı EE, Salihoğlu Ö.J Perinatol. 2026 Apr 13. doi: 10.1038/s41372-026-02686-x. Online ahead of print.PMID: 41975209

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As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. 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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