The Incubator

Dr. David Stevenson, an esteemed neonatologist and leader in maternal and child health at Stanford, joins Dr. Jeffrey Gould to discuss the pioneering California Perinatal Quality Care Collaborative. They share how they transformed California's fragmented perinatal system by uniting stakeholders and focusing on shared goals. Key strategies included organizational development and harnessing data for quality improvement. Their innovative teamwork led to California boasting the lowest maternal mortality rates in the nation, while providing invaluable advice for aspiring clinicians.

Dr. Elizabeth Foglia, an academic neonatologist and principal investigator for the AAP DRIVE Network, delves into the disparities of delivery room practices across nearly 3,000 U.S. hospitals. She discusses the significant evidence-to-practice gap regarding supraglottic airways for infant resuscitation, despite strong supporting research. The conversation highlights the SUGAR trial, which seeks innovative strategies to boost clinical adoption, and the future growth of the DRIVE Network—aiming to enhance neonatal care through collaborative quality improvement and benchmarking.

Dr. Daniele De Luca discusses the Lancet Commission's innovative blueprint for the future of neonatology. He highlights the stagnation in therapeutic advancements since the 1990s and explores the barriers to innovation. The necessity for a united approach to elevate neonatology's profile is emphasized, alongside the importance of family advocacy. De Luca also contrasts the slow approval of drugs with faster device innovations, urging for adaptive trials and innovative funding methods to enhance patient care.

Dr. Michael Narvey, a leading neonatologist and vice president of the Canadian Paediatric Society, challenges the necessity of pre-discharge car seat testing for newborns. He argues that the test fails to represent real-world scenarios and lacks substantial evidence of life-saving benefits. Drawing from decades of autopsy data, he highlights that rare car seat-related deaths stem from unsupervised asphyxiation, not from travel incidents. Narvey advocates for better car seat education and proper positioning instead of routine testing.

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Dr. Matthew Laughon discusses a groundbreaking study on PDA management, revealing that expectant management has significantly lower mortality rates compared to active treatment methods. The trial stopped early due to safety concerns, highlighting the importance of cautious approaches for symptomatic infants. Interestingly, secondary outcomes like BPD and NEC showed no differences, aligning new findings with updated guidelines suggesting minimal routine treatment in the initial weeks. Key challenges of randomization and clinician preferences also emerge as noteworthy points.

Dr. Elaine Boyle discusses the SURFON trial, which evaluates the use of early surfactant in late preterm infants with respiratory distress. Findings reveal no significant difference in hospital stays or severe respiratory disease progression. However, early surfactant slightly reduces NICU time and non-invasive support duration. Safety concerns arise with an increase in pneumothorax cases, prompting ongoing research for this vulnerable group. The conversation highlights the need for mindful approaches in managing late preterm infants.

Dr. Shalini Ojha dives into her groundbreaking Feed One trial, exploring the benefits of full enteral feeding for moderate preterm infants from day one. The study challenges the long-held fears surrounding necrotizing enterocolitis (NEC), showing no increase in risk while significantly reducing the need for parenteral nutrition and IV interventions. With a focus on streamlined care, this research highlights how early full feeding can simplify the treatment of these vulnerable infants, particularly in resource-limited settings.

Three first-year neonatology fellows from UVA share their experiences at a key conference. They explore cutting-edge research interests, including POCUS, ENT interventions, and neurodevelopmental outcomes. The fellows express excitement about learning from practice variations across institutions, especially in fluid management. Instead of feeling daunted by evidence gaps, they find motivation and plan to initiate research projects. They emphasize the accessibility of neonatology leaders at the conference, aiming to engage collaboratively and enhance their learning.

Dr. Pankaj Agarwal, Division Chief of Neonatology at the University of Miami and a pioneer in genomic research, dives into the rapid advancements in neonatal genomic sequencing. He highlights how diagnostic timelines have shrunk from six months to same-day results. Agarwal advocates for universal genomic testing in NICUs, emphasizing the need to overcome barriers like cost and consent processes. The value of negative results is discussed, offering families reassurance and aiding research, while ongoing gene discoveries reveal just a fraction of linked genes.