The Incubator

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Dr. Brett Manley joins Ben for the opening episode of The Incubator’s special series on non-invasive ventilation, recorded ahead of Hot Topics in Neonatology. They work through the full arc of non-invasive support, from the delivery room to the convalescent phase and beyond. What actually counts as nasal high flow, and when should it come off? Why did HIPSTER and HUNTER move clinicians back toward CPAP as primary support? Is the benefit of NIPPV about synchronization or simply higher mean airway pressure? Brett shares his own weaning approach, the ÉCLAT findings, and the trials he believes the field needs next.

This series is produced in partnership with Hot Topics in Neonatology and Fisher & Paykel Healthcare.

Join us at Hot Topics in Neonatology: National Harbor, MD, December 6 to 9, 2026. Register here: https://hottopicsinneonatology.nemours.org/registration.html

Don’t miss the live session continuing this conversation: Pressure, Flow, and the Grey Areas In Between. Presented by Fisher & Paykel Healthcare. Monday, December 7 at 11:45 AM. Full agenda: https://hottopicsinneonatology.nemours.org/agenda.html

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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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During a code, who is making sure the chest compressions are actually high quality? Recording live at the CHNC Symposium, Daphna sits down with Gina Klein, a simulation education consultant, and Sherry Casey, a NICU nurse and simulation coordinator, both from Cincinnati Children’s, to discuss their poster on implementing the CPR coach. Gina explains how video review in the emergency department revealed the microbehaviors that make feedback effective, like giving one piece of feedback at a time, and how that became a free curriculum at http://cincycpr.org. Sherry describes adapting it for the NICU, with a code blue arrival algorithm, clear criteria for switching to PALS, and an APP assigned as CPR coach on every floor each day.

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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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If a preterm infant’s PDA needs closing, does timing matter? Recording live at the CHNC Symposium, Daphna sits down with the CHNC’s mentored fellows, Dr. Miriam Avadis of Phoenix Children’s and Dr. Shannon Batone of Arkansas Children’s, to hear their projects ahead of their presentations. Dr. Batone shares a mixed methods study of about 1,300 neonates receiving renal replacement therapy since 2011, where mortality rose over time despite growing use, and interviews with 21 providers identifying culture, people, and process as keys to successful programs. Dr. Avadis presents a multicenter landmark analysis showing that infants under 28 weeks whose PDA was closed by transcatheter device before 28 days of life were liberated from respiratory support faster.

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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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When a baby with congenital heart disease decompensates in the delivery room, do we still follow NRP? Recording live at the CHNC Symposium, Daphna sits down with Dr. Noorjahan Ali of Children’s Health Dallas, Dr. Henry Lee of UC San Diego and Rady Children’s, and Dr. Anne Ades of the Children’s Hospital of Philadelphia. Dr. Ali explains a green, yellow, and red light approach to resuscitating heart babies, and why common things are still common. Dr. Lee reviews recent NRP updates, including a starting inflation pressure of 25 cm H2O and a ventilation rate of 30 to 60. Dr. Ades describes the Resuscitation in the NICU course, the value of a CPR coach, and why the NRP versus PALS debate may come down to the physiology of the patient in front of you.

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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 when most level IV NICUs are missing four to five advanced practice providers? Recording live at the CHNC Symposium, Daphna sits down with Sarah Shedler of Children’s Wisconsin and Chandler Williams, from Children's National, both members of the CHNC’s new APP Focus Group. They explain why APPs, caught between nursing and physician initiatives, needed a group of their own, and share results from their survey of member institutions: roles that vary widely from unit to unit, staffing shortages, burnout, and retention concerns. With only 250 to 300 NNPs graduating each year, they describe how fellowships for physician associates and pediatric nurse practitioners are helping fill the gap, and why sharing solutions across centers means no one has to reinvent the wheel.

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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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Why does first-attempt intubation success in the NICU still hover around 40 to 56%? Recording live at the CHNC Symposium, Daphna sits down with Dr. Somi Singh, a second-year neonatology fellow at the University of Wisconsin–Madison, to discuss her poster on standardizing neonatal intubation practices. Dr. Singh walks through her team’s QI project: a checklist with a time-out and video laryngoscopy, a standardized premedication order set, and a pocket-card workflow built around “PAP before push” and PPV before the blade. The changes improved first-attempt success and reduced adverse events, but severe desaturations remained stubbornly high, leading to a new focus on apneic oxygenation. They also discuss training fellows in both video and direct laryngoscopy.

Support the show

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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When a nurse makes an error with 20 things happening at once, is it really a personal slip, or a system that pushed her past capacity? Recording from the CHNC Symposium, Daphna sits down with Dr. James Wan, director of the Human Factors and Systems Design team at the Children’s Hospital of Philadelphia, an engineer and pastor who keynoted on “Human Factors Empathy Science.” He explains the limited capacity model, why most clinicians live with almost no spare capacity, and why emotional workload matters alongside physical and cognitive workload. He shares how human factors can shape new hospital spaces, cut alarm and signage noise, and use simulation to redesign workflows, and why AI should support humans, not supplant them.

Support the show

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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Why does one difficult case sometimes feel heavier than it should? Recording at the CHNC Symposium, Daphna sits down with Dr. Jennifer Kett, division head for bioethics and palliative care at Seattle Children’s, ahead of her keynote on secondary trauma in the NICU. Dr. Kett unpacks the overlapping concepts of primary and secondary trauma, vicarious trauma, compassion fatigue, moral distress, the moral residue crescendo, and institutional betrayal, using the metaphor of a pitcher of water. She shares the personal warning signs she watches for, why clinicians try to go it alone, and how teams can shift difficult cases among themselves. Above all, she argues that burnout is a systems problem that requires system-level resources, not more yoga at work.

Support the show

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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How often have you searched for a parent handout on a fetal diagnosis and found nothing, or something too cold and branded to share? Recording live at the CHNC Symposium, Daphna sits down with Dr. Namrita Odackal of The Ohio State University and Nationwide Children’s Hospital, a neonatologist, fellowship program director, and medical illustrator, to celebrate the launch of the Atlas of Fetal Pathologies at http://fetalatlas.org. She explains how fellows and faculty mentors write each entry, how the CHNC Fetal Therapy Focus Group peer reviews it, and how physician artists create original, humanistic illustrations. Entries on agenesis of the corpus callosum, amniotic band syndrome, and tracheoesophageal fistula are live NOW, free to use, with many more on the way.

Support the show

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 if the baby with complex gastroschisis never needed months in the NICU? Recording live at the CHNC Symposium, Daphna sits down with Dr. Sundeep Keswani, associate surgeon-in-chief at Texas Children’s Hospital, after his keynote on fetoscopic in utero repair of gastroschisis. He explains how fetoscopy has made the risk-benefit balance possible, how intra-abdominal bowel dilation identifies babies at risk, and why a fetal Botox injection to relax the abdominal wall changed the procedure. He shares outcomes from the first five patients in the phase 1 FDA trial, including babies discharged within days, and his hypothesis that bowel dilation may drive the disease itself. He also explains why the 20% who don’t do well deserve our attention.

Support the show

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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Day two of the CHNC Symposium is here! Daphna sets the stage for a full lineup of keynote speakers sharing the latest in care for the most complex babies in level IV NICUs. Stay tuned for all of today’s conversations.

Support the show

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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When a baby crashes in the NICU, how long will it take before someone in the room can pick up a probe and look at the heart? Recording from day two of the CHNC Symposium, Daphna sits down with Dr. Rune Toms of Nicklaus Children’s Health System and Dr. Jae Kim of Cincinnati Children’s to discuss the urgent need to spread basic cardiac POCUS skills. They describe a minimum skill set for acute events, including function, volume, tamponade, and line position, and explain why depending on one champion per unit isn’t enough. They also tackle the barriers, from getting a machine to credentialing to turf with cardiology, and share practical advice: start with one application, partner with colleagues, and build from there.

Support the show

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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When a baby with a congenital kidney anomaly develops pulmonary hypoplasia and pulmonary hypertension, should ECMO be on the table? Recording live at the CHNC Symposium, Daphna sits down with Dr. Abhishek Makkar and Dr. Saeed Ahmed of Children’s Health in Dallas to discuss CAKUT, congenital anomalies of the kidney and urinary tract. They share findings from their multicenter survey of CHNC and pediatric ECMO centers, which found that only about 10% of centers have guidelines, and that willingness to offer ECMO varies widely by diagnosis. They explain the importance of multidisciplinary prenatal planning, why rapid whole genome sequencing can change the conversation, and their plan to develop consensus guidelines using a Delphi approach.

Support the show

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 a baby with severe BPD when the attending changes every two weeks and every plan starts over? Recording live at the CHNC Symposium, Daphna sits down with Dr. Sushmita Yallapragada, Dr. Riddhi Desai, and Dr. Jonathan Ibrahim of UT Southwestern and Children’s Health in Dallas to talk about BOOST, their Bronchopulmonary Dysplasia Outcomes and Support Team, and the new 12-bed BPD unit within their NICU. They explain how a small core of physicians, APPs, nurses, and respiratory therapists brings continuity for families, why they’ve stopped making knee-jerk changes based on blood gases, and how they tailor ventilation to BPD phenotype. They also describe how developmental therapists and BSRI scores now help guide weaning decisions.

Support the show

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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If your NICU doesn’t offer dialysis, do families still know it’s an option? Recording live at the CHNC Symposium, Daphna sits down with pediatric nephrologist Dr. David Askenazi and nephrology nurse practitioner Kara Short of Children’s of Alabama, and neonatologist Dr. Cara Slagle, ahead of their workshop on practical approaches to neonatal renal replacement therapy. They explain why the most important topics are often the least discussed: medication dosing on dialysis, vascular access, nutrition, and when to start. Dr. Slagle shares the lesson of a baby who got too cold on dialysis, Kara makes the case for keeping these babies in the NICU, and all agree that patient selection, guided by what matters to families, will be the most debated question.

Support the show

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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When five specialists sit across from one frightened family, who responds when a parent starts to cry? Recording live at the CHNC Symposium, Daphna sits down with Dr. Zeynep Salih of Riley Children’s Hospital to talk about interdisciplinary prenatal counseling. Dr. Salih shares findings from interviews with 24 physicians: most prefer counseling together, so everyone is on the same page; nearly all said being a parent helps them empathize; and many deferred emotional moments to palliative care. Parents, meanwhile, often perceive information sharing as a response to emotion. She offers practical advice for an optimal consult: hold a pre-meeting, warn families about the size of the group, break the ice, and always ask permission before showing fetal images.

Support the show

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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The Incubator Podcast is coming to you from the Children’s Hospitals Neonatal Consortium (CHNC) Symposium in Denver, Colorado! Daphna sits down with the physicians, nurse practitioners, nurses, and researchers whose focus groups collaborate all year round, across the United States and into Canada, to move research to the bedside sooner for the most complex babies in level IV NICUs. Catch all of these episodes on both our podcast channel and our YouTube channel, wherever you prefer to listen or watch.

Support the show

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 does it take to back up a claim that your NICU delivers the highest quality of care? Recording live at the CHNC Symposium in Denver, Daphna reunites with Dr. Rune Toms, system chief of neonatology at Nicklaus Children’s Hospital and The Incubator’s very first guest. He explains why Nicklaus is joining the Children’s Hospitals Neonatal Consortium, and how its data on complex level IV patients goes beyond what other networks capture. He describes neonatal care as a chain, where a single unplanned extubation at 3 a.m. can undo weeks of progress, and why frontline clinicians need infrastructure that breaks down silos. He also reflects on the vulnerability it takes to share your data, and why rare conditions demand collaboration.

Support the show

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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Recording live at the CHNC Symposium, Daphna sits down with two Explore presenters. Dr. Rachel Han of Golisano Children’s Hospital shares a clinical prediction model for UTI in level IV NICUs, built from the CHND, which flags vesicoureteral reflux, urinary tract obstruction, male sex, and aneuploidy as risk factors, and explains why the new AAP guideline’s lower threshold may reveal more infections. Dr. Jeffrey Shenberger of Connecticut Children’s then examines ROP in infants screened because their attending judged them at risk. Among 5,700 screened infants, 7.2% had ROP, and risk factors included gestational age, Apgar score, postnatal steroids, and inhaled nitric oxide.

Support the show

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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Daphna and Christa sit down with Dr. Alfonso Vargas to preview his journal club. They review the NICHD Neonatal Research Network PDA trial, stopped early for higher mortality with treatment, the UK FEED1 trial on full milk feeds from day one in babies at 30 to 32 weeks, and the PLaNT trial of prophylactic CPAP after cesarean birth in late preterm infants. Dr. Vargas also shares his top takeaways from the 2026 AAP therapeutic hypothermia report and why unit culture, built from the ground up, determines whether any guideline works.

Support the show

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.

Enjoy!