The Incubator’s Journal Club is a weekly podcast dedicated to reviewing the latest evidence published in peer-reviewed journals in neonatology and perinatal medicine. Each episode breaks down important studies in newborn and perinatal care, with a clear focus on methodology, key findings, and real-world clinical impact. Designed for clinicians, nurses, and trainees, this series highlights research that meaningfully informs bedside practice and clinical decision-making. It is an efficient and reliable way to stay current with the most relevant and practice-changing evidence in neonatal care.
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In this double-blind randomized controlled trial, Adrianne and Nim examine whether norepinephrine outperforms dopamine as a first-line vasoactive agent in neonates with fluid-refractory septic shock. The primary outcome, shock reversal at 30 minutes, was not significantly different between groups, at 32 percent for norepinephrine and 46 percent for dopamine. Secondary outcomes including mortality, IVH, NEC, and need for additional vasoactive support were also similar. The episode critically exam...
In this double-blind randomized controlled trial from northern India, Nim and Adrianne review whether early hydrocortisone reduces 14-day all-cause mortality in preterm infants with fluid-refractory shock. The primary outcome showed no statistically significant difference between groups, though an 11 percent absolute reduction in mortality in the hydrocortisone group raised clinical interest. A major limitation was the high rate of open-label steroid crossover, with over 70 percent of both group...
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. Mort...
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 orga...
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 f...
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 ma...
In this Journal Club episode, Ben and Daphna review a nationwide Swedish cohort study examining the association between phototherapy duration and neonatal outcomes in very preterm infants (22 to 31 weeks). The study’s primary outcome, late neonatal mortality on days 8 to 27, was not significantly associated with phototherapy duration. However, longer phototherapy exposure was associated with increased odds of severe neonatal morbidity, including IVH and BPD, in infants born at 26 to 31 weeks. Th...
How often are we missing dysphagia in our most vulnerable NICU patients? In this episode of Journal Club, Daphna reviews a retrospective cohort study from the Journal of Perinatology examining the incidence and risk factors of dysphagia confirmed by flexible endoscopic evaluation of swallowing (FEES) in very preterm and very low birth weight infants. Among infants showing persistent feeding difficulties at 38 weeks post-menstrual age, laryngeal penetration was detected in all infants who underwe...
Japan has some of the best survival rates for extremely preterm infants in the world, yet feeding practices there look very different from what many of us are used to. In this episode of Journal Club, Ben reviews the JASMINE trial, a multicenter phase three randomized controlled trial evaluating an exclusive human milk diet compared to a standard cow milk-based diet in very low birth weight infants in Japan. Infants on an exclusive human milk diet gained weight significantly faster, reached full...
Could putting a few drops of breast milk in a preterm infant's nose actually improve cerebral oxygenation? In this episode of Journal Club, Daphna reviews a randomized controlled trial from the European Journal of Pediatrics investigating the physiologic effects of intranasal expressed breast milk (EBM) administration in preterm infants. The study found that infants receiving 0.2 mL of fresh breast milk intranasally three times daily showed significantly higher cerebral oxygenation levels, along...
One infant is diagnosed with neonatal opioid withdrawal syndrome every 27 minutes, and rates are rising. In this episode of Journal Club, Ben and Daphna review the Optimized NOW randomized clinical trial, a landmark multicenter study published in JAMA. The trial compared symptom-based dosing, a single opioid dose given when a withdrawal threshold is met against the traditional scheduled opioid taper in infants managed with Eat Sleep Console. The results are striking: symptom-based dosing reduced...
In this episode of Journal Club, we wrap up a marathon recording session with a deep dive into the world of neonatal neuroprognostication. Daphna reviews a systematic review and meta-analysis from Pediatric Neurology that evaluates whether combining EEG and MRI provides better answers for families of preterm infants. While MRI remains a powerful tool for structural assessment, the data suggests that adding the functional insights of EEG significantly boosts specificity, particularly when predict...
Ben kicks things off with a major career update before we dive into a critical study from JAMA Network Open. We explore the predictive value of the five minute Apgar score when combined with umbilical artery pH in very preterm infants. While the Apgar score was originally designed for term babies, this analysis of the EPICE cohort reveals its enduring utility even in the smallest patients. We discuss how these two measures interact, which one "wins" when they conflict, and why the clinician asse...
Is your NICU considering the shift to 24 hour in house attending coverage? In this episode of Journal Club, we explore a provocative brief communication from the Journal of Perinatology. Ben and Daphna discuss the impact of moving from home call to on site presence at UC Davis. While the change was intended to improve patient care, the data reveals a surprising 15 percent decrease in work RVUs. We examine how proactive weaning and bedside presence might actually lower billing levels under curren...
In this episode of Journal Club, Ben and Daphna dive into the results of the NIRTURE trial, recently published in JAMA Network Open. Building on the lessons of SafeBoosC 3 , the NIRTURE investigators aimed to reduce the burden of cerebral hypoxia and hyperoxia in extremely preterm infants using a standardized NIRS guided treatment protocol. While the study showed a dramatic improvement in maintaining cerebral normoxia, driven largely by a reduction in hyperoxia , the clinical outcomes before dis...
In this Journal Club episode, Ben reviews a secondary analysis of the CALI trial, published in JAMA Network Open, examining two-year neurodevelopmental and pulmonary outcomes in preterm infants who received early caffeine combined with LISA versus caffeine and CPAP alone. Building on the original CALI trial's finding that early caffeine prior to LISA reduced intubation rates and BPD, this follow-up asks the next logical question: does that early advantage translate into better long-term outcomes...
In this Journal Club episode, Daphna presents the F-NeoBright trial — a pilot feasibility and safety study out of Hungary exploring intranasal fresh breast milk administration in neonates with moderate to severe HIE undergoing therapeutic hypothermia. With so few adjunct therapies available beyond cooling, the idea of harnessing breast milk's rich bioactive components — including neurotrophic growth factors, cytokines, and multipotent stem cells — to support the developing brain is both compelli...
In this Journal Club episode, Ben takes the lead and reviews a prospective cohort pilot study from the Archives of Disease in Childhood examining whether combining abdominal ultrasound with plain radiography can improve surgical risk stratification in neonates with suspected NEC. With mortality remaining as high as 20–40% and diagnosis still heavily reliant on clinical judgment, the stakes couldn't be higher. Ben walks through the study's unsupervised clustering approach, explaining how adding u...
In this Journal Club episode, Ben and Daphna dive into the American Academy of Pediatrics' February Clinical Report on Therapeutic Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy. Daphna, who presented this paper at the Florida Neonatal Neurologic Network, walks us through the key action statements — from the established 33.5°C target temperature to the more nuanced discussions around late cooling (6–24 hours), gestational age eligibility at 35 weeks, and the controversial question of c...
In this Journal Club episode, Ben and Daphna explore an exciting new frontier in neonatology: oculomics. Reviewing a recent paper from JAMA Ophthalmology, they discuss how deep learning models applied to routine ROP screening images can predict the development of BPD and pulmonary hypertension in preterm infants. By combining visual features extracted via neural networks with standard demographic data, researchers achieved impressive predictive accuracy weeks before clinical diagnosis is typical...
In this episode of Journal Club, Ben and Daphna review a pivotal paper from the Journal of Pediatrics led by the Pediatric Pulmonary Hypertension Network (PPHNet). The study explores invasive hemodynamic metrics and long-term outcomes in infants with BPD-associated pulmonary hypertension. Surprisingly, researchers found an almost equal distribution of pulmonary hypertension across mild, moderate, and severe BPD grades using the Jensen criteria. The hosts discuss the implications of these finding...
In this Journal Club episode, Ben and Daphna review a systematic review and meta-analysis from JAMA Network Open questioning the clinical value of predischarge car seat tolerance screening (CSTS). Driven by data suggesting that testing does not reduce 30-day mortality or hospital readmissions, they discuss the high failure rates, varying definitions of bradycardia and desaturation, and the unintended consequence of prolonged NICU stays. They also highlight the practical reality of CSTS in ensuri...
In this Daily Journal Club episode, Ben and Daphna review a massive Swedish national cohort study from JAMA Network Open examining early prophylactic hydrocortisone in extremely preterm infants. They discuss the targeted regimens used, differences in gestational age outcomes, and whether a blanket prophylactic approach is truly effective for preventing BPD. With impressive data covering 98% of all NICU admissions in Sweden, the hosts debate the nuances of targeting 24 to 25-weekers versus older ...
Ben and Daphna review a retrospective study investigating higher caffeine maintenance dosing in infants born at or before 28 weeks gestation. They analyze the findings, which suggest a significant reduction in severe bronchopulmonary dysplasia (BPD) and improved Bayley cognitive scores at six months with higher doses. The hosts debate the safety, clinical implications, and current NICU practices surrounding caffeine management, noting the transient nature of neurodevelopmental benefits but emphasizing the importance of BPD reduction.
Ben and Daphna dissect the NeoDry Trial, a randomized clinical trial investigating if drying very preterm infants before plastic wrapping in the delivery room improves normothermia upon NICU admission. While the intervention showed no benefit for temperature, it alarmingly revealed a significant increase in mortality, particularly for extremely premature babies. The hosts explore potential reasons for this unexpected safety signal, concluding that current thermal management strategies remain a critical, unresolved challenge for vulnerable preemies.
Ben and Daphna discuss a study from the Journal of Perinatology on diazoxide use in the NICU, highlighting its prevalence and safety. They explore its mechanism, FDA-approved indications versus widespread off-label use for transient hyperinsulinism, and the black box warning for pulmonary hypertension. The hosts analyze real-world data on concurrent diuretic therapy, respiratory support, and patient demographics, concluding with clinical implications and personal experiences.
The hosts review the highly anticipated TREOCAPA trial results, investigating prophylactic acetaminophen for PDA closure in extremely preterm infants. While the study achieved higher rates of early ductal closure using tailored dosing, this did not translate into improved survival free from severe morbidity. The discussion also highlights safety outcomes, including a notable increase in cholestasis, and emphasizes an individualized approach to PDA management in the NICU.
Ben and Daphna conclude Journal Club with a quality improvement study from Pediatrics titled "Improving Health-Related Social Needs Screening and Support Across a Pediatric Health Care System". The hosts discuss the successful implementation of universal social determinants of health (SDOH) screening across nine pediatric divisions at Levine Children's. They highlight the impressive results—screening compliance reaching 92%—and the practical impact of connecting families to resources like FindHe...
Ben and Daphna review a randomized controlled trial published in The Journal of Pediatrics by Dr. Ariel Salas and colleagues at UAB. The study investigates whether early high-dose vitamin D supplementation (800 IU/day starting day 1) in extremely preterm infants reduces the incidence of Bronchopulmonary Dysplasia (BPD) compared to standard care (starting day 14). The hosts discuss the physiologic rationale linking vitamin D to lung development, the use of impulse oscillometry to measure lung mec...
In this episode of Journal Club, Ben and Daphna review a retrospective cohort study from Pediatrics examining antibiotic duration for uncomplicated Gram-negative bloodstream infections in the NICU. The study, a collaboration between Nationwide Children’s Hospital and UT Health San Antonio, compares outcomes between short course (≤8 days) and long course (≥9 days) therapy. The hosts discuss the startling finding that while recurrence rates were similar, the long-duration group had a 14% rate of d...
