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 examines the methodological limitations of the study, including unclear sepsis definitions, absence of echo phenotyping, and unusually high starting doses, and asks whether the field needs better tools before these questions can be properly answered.

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Norepinephrine versus Dopamine for Septic Shock in Neonates: A Randomized Controlled Trial.Mazhari MYA, Priyadarshi M, Singh P, Chaurasia S, Basu S.J Pediatr. 2025 Jul;282:114599. doi: 10.1016/j.jpeds.2025.114599. Epub 2025 Apr 17.PMID: 40252959 Clinical Trial.

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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 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 groups ultimately receiving hydrocortisone. The study highlights the difficulty of achieving equipoise when clinicians already believe strongly in a therapy, and raises important questions about study design in neonatal shock research.

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Early hydrocortisone verses placebo in neonatal shock- a double blind Randomized controlled trial. Dudeja S, Saini SS, Sundaram V, Dutta S, Sachdeva N, Kumar P.J Perinatol. 2025 Mar;45(3):342-349. doi: 10.1038/s41372-025-02222-3. Epub 2025 Feb 13.PMID: 39948354 Clinical Trial.

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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 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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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

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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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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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. The findings prompt an important conversation about the near-universal use of phototherapy in preterm neonates and whether current practice warrants reassessment.

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Phototherapy, Morbidity, and Mortality in Very Preterm Newborns. Deschmann E, Håkansson S, Söderling J, Norman M.JAMA Netw Open. 2026 May 1;9(5):e2614107. doi: 10.1001/jamanetworkopen.2026.14107.PMID: 42166159 Free PMC article.

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 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 underwent FEES, and tracheal aspiration in nearly 60%. Ben and Daphna discuss whether we are naming dysphagia for what it is, whether earlier instrumental assessment could change outcomes, and what it means for families to finally understand why their baby is struggling to feed.

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Incidence and factors associated with dysphagia in infants born very preterm or very low birth weight. Reynolds J, Suterwala M, Desai S, Chiruvolu A.J Perinatol. 2026 Apr 29. doi: 10.1038/s41372-026-02701-1. Online ahead of print.PMID: 42056238

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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