#453 - [Journal Club] - 📌 Should We Cool 35 Week Infants with Encephalopathy?

#453 - [Journal Club] - 📌 Should We Cool 35 Week Infants with Encephalopathy?

Cooling works at 36 weeks. At 35 weeks, nobody is sure. Ben brings a new Journal of Perinatology analysis of the National Inpatient Sample, covering 1.4 million infants from 2016 to 2022, asking what happens when therapeutic hypothermia is offered just below the evidence line. Cooled 35-weekers died at higher rates than cooled 36-weekers, but within the 35-week group, cooling changed nothing either way. Coagulopathy rose with cooling. Mediation analysis says it wasn't the cause. Ben and Daphna work through what that leaves us, and why shared decision making and careful documentation carry the weight here ---- Therapeutic hypothermia and in-hospital mortality in 35-week infants with encephalopathy. [https://pubmed.ncbi.nlm.nih.gov/42236997/] Aly H, Eltaly H, Mohamed FA, Saker F, Acun C, Mohamed MA.J Perinatol. 2026 Jun 3. doi: 10.1038/s41372-026-02738-2. Online ahead of print.PMID: 42236997 Support the show [https://www.buzzsprout.com/1739595/support] 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!

#453 - [Journal Club] - 📌 Can We Rewire a Preterm Baby's Brain for Language?

In this Journal Club, Daphna takes the reins with the MIND randomized controlled trial from Nathalie Maitre and colleagues in The Journal of Pediatrics. Can a multisensory bundle, combining infant-directed voice, a parent's scent, holding, and gentle containment, do more for a preterm baby's developing brain than recorded voice alone? Using event-related potentials to track how infants tell speech sounds apart, the team followed language outcomes all the way to age two. Daphna and Ben unpack the design, the Bayley and PLS-5 findings, and a takeaway every clinician can act on tomorrow. Talk to the baby, every single time. ---- The MIND Randomized Controlled Trial: An Intervention to Improve Neural Speech Processing and 2-Year Language Outcomes of Infants Born Preterm. [https://pubmed.ncbi.nlm.nih.gov/42250747/] Maitre NL, Kjeldsen CP, Jeanvoine A, Lukemire J, Slaughter JL, Key AP.J Pediatr. 2026 Jun 5:115187. doi: 10.1016/j.jpeds.2026.115187. Online ahead of print.PMID: 42250747 Support the show [https://www.buzzsprout.com/1739595/support] 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!

#453 - [Journal Club] - 📌 Should We Treat the PDA Based on Size Alone? (SMART PDA Trial)

In this Journal Club, Ben and Daphna dig into two new papers on PDA management in our smallest patients. First, the SMART-PDA pilot RCT from Souvik Mitra and colleagues, which uses comprehensive hemodynamic screening to selectively treat high-volume shunts in infants born before 26 weeks, and whose striking Bayesian signal for reduced pulmonary hemorrhage and NEC stopped the trial early. Then a companion JAMA Network Open comparative effectiveness study across four pharmacotherapy regimens. Along the way, Ben shares hemodynamics pearls from his Montreal training: why left ventricular output, LA:Ao ratio, and transductal velocity matter more than PDA diameter alone. ---- Selective early medical treatment of the patent ductus arteriosus in extremely low gestational age infants: a pilot randomised controlled trial (SMART-PDA). [https://pubmed.ncbi.nlm.nih.gov/42150872/] Mitra S, Hebert A, Castaldo MP, Disher T, El-Naggar W, Dhillon S, Alhassen Z, Koo J, Katheria AC, Hyderi A, Kumaran K, Ting J, Surak A, Larocque J, Pepper D, Hornberger L, Makoni M, Weisz DE, Jain A, Bacchini F, Cameron-Nola AJJ, Hatfield T, Dorling J, McNamara PJ, Thabane L.Arch Dis Child Fetal Neonatal Ed. 2026 May 18:fetalneonatal-2026-330462. doi: 10.1136/archdischild-2026-330462. Online ahead of print.PMID: 42150872 Pharmacologic Therapies for Patent Ductus Arteriosus in Extremely Preterm Infants. [https://pubmed.ncbi.nlm.nih.gov/42262753/] Mitra S, Jain A, Ting JY, Ben Fadel N, Drolet C, Abou Mehrem A, Soraisham AS, Jasani B, Louis D, Lapointe A, Dorling J, Khurshid F, Hyderi A, Kumaran K, Toye J, Harabor A, Weisz DE, Stavel M, Morin A, Bhattacharya S, Lalitha R, Afifi J, Augustine S, Castaldo MP, Hatfield T, Su YC, Shah PS; Canadian Neonatal Network Investigators.JAMA Netw Open. 2026 Jun 1;9(6):e2617477. doi: 10.1001/jamanetworkopen.2026.17477.PMID: 42262753 Free PMC article. Support the show [https://www.buzzsprout.com/1739595/support] 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!

#450 - [Journal Club] - 🫀 From The Heart - Is Dopamine Still Defensible as First-Line for Neonatal Septic Shock?

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. ---- Norepinephrine versus Dopamine for Septic Shock in Neonates: A Randomized Controlled Trial. [https://pubmed.ncbi.nlm.nih.gov/40252959/]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. Support the show [https://www.buzzsprout.com/1739595/support] 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!

#450 - [Journal Club] - 🫀 From The Heart - Does Early Hydrocortisone Actually Move the Needle in Fluid-Refractory Shock?

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. ---- Early hydrocortisone verses placebo in neonatal shock- a double blind Randomized controlled trial. [https://pubmed.ncbi.nlm.nih.gov/39948354/] 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. Support the show [https://www.buzzsprout.com/1739595/support] 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!