The Incubator #392 - 📑 Journal Club - The Complete Episode from January 10th 2026
7 snips
Jan 10, 2026 Eli, a regular contributor with a focus on neonatal policy and legal aspects, joins the conversation on recent neonatal care studies. They discuss a JAMA trial showing expectant management could improve survival in preterm infants with PDA. The outcomes of 21-week gestation infants are reviewed, revealing survival strategies that challenge earlier practices. Eli also highlights the implications of a $32 million NEC settlement, sparking a discussion on informed consent for nutritional care, fostering better communication in NICUs.
AI Snips
Chapters
Transcript
Episode notes
Expectant PDA Management Increased Survival Signal
- Expectant PDA management did not change death or BPD at 36 weeks but showed higher survival to discharge versus active treatment.
- The trial was pragmatic, stopped early for futility and safety, and excluded infants with cardiopulmonary compromise.
Sepsis May Mediate Harm From Active PDA Treatment
- Increased mortality in the active PDA group was largely driven by higher infection-related deaths, raising concern about treatment risks.
- Medication choice (ibuprofen, indomethacin, acetaminophen) did not explain the mortality difference in subgroup analyses.
Tailor PDA Treatment To Physiology
- Focus on individual patient physiology rather than defaulting to treatment modality for PDA closure.
- Use detailed hemodynamic assessment to decide which infants actually benefit from intervention.