Well Beyond Medicine: The Nemours Children's Health Podcast
Exploring people, programs and partnerships addressing whole child health.
Well Beyond Medicine: The Nemours Children's Health Podcast
Ep. 126: Hot Topics in Neonatology: A Retrospective
Neonatologists Benjamin Courchia, MD, and Daphna Barbeau, MD, co-hosts of The Incubator podcast, recorded a special series on-site at the latest Hot Topics in Neonatology conference.
Tune in for highlights from top neonatology experts!
The Incubator podcast featuring Dr. Nathalie Maître, Director of Early Development and Cerebral Palsy Research at Children’s Healthcare of Atlanta
Learn more about Hot Topics in Neonatology 2025
Guests:
Benjamin Courchia, MD, Co-host, Incubator Podcast, and NICU Director, HCA Florida University Hospital
Daphna Barbeau, MD, Co-host, Incubator Podcast, and Director of Neonatal Neurodevelopment at Envision Health, HCA University Hospital
Host/Producer: Carol Vassar
Views expressed by guests do not necessarily reflect the views of the host or management.
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Announcer:
Welcome to Well Beyond Medicine, the world's top-ranked children's health podcast, produced by Nemours Children's Health. Subscribe on any platform at nemourswellbeyond.org or find us on YouTube.
Carol Vassar, podcast host/producer:
Each week, we'll be joined by innovators and experts from around the world, exploring anything and everything related to the 85% of child health impacts that occur outside the doctor's office. I'm your host, Carol Vassar, and now that you are here, let's go.
MUSIC:
Let's go-o-o, Well Beyond Medicine.
Carol Vassar, podcast host/producer:
It's a first here on our podcast. Joining me for this episode are the co-hosts of another podcast, The Incubator, Dr. Benjamin Courchia, along with his colleague Dr. Daphna Barbeau. They are both neonatologists, and their podcast focuses on everything related to neonatal care. They brought their podcast on-site to the most recent Hot Topics in Neonatology conference in Maryland to record a series of episodes with their peers. And together, we're going to highlight some of those neonatology superstars. Hot Topics in Neonatology brings together neonatologists and other interested folks from across the world to present, learn, and discuss cutting-edge research trends and technology in that field. Ben and Daphna (they've asked me to call them by their first names) were incredibly excited about who they spoke with and what they learned. You'll hear that in their voices as they share their overall impressions of the event and what struck them as different and innovative. Right now on the Nemours Well Beyond Medicine podcast, here's Dr. Daphna Barbeau.
Dr. Daphna Barbeau, Podcast co-host, The Incubator:
We really had a blast. We know that every conference has a personality type, and this was really, I think, especially given the caliber of speakers and really big names in neonatology. It was a surprisingly refreshing, friendly, collaborative, cohesive kind of conference. I think for me, I was really impressed by the breadth of topics, this opportunity to really interact with some big names in neonatology, and of course, I was impressed by the international presence.
Carol Vassar, podcast host/producer:
We're going to talk about some of those big names shortly. Ben, what impressed you this year?
Dr. Benjamin Courchia, podcast co-host, The Incubator:
I think a lot of the things that Daphna mentioned resonate with my experience as well. I think the caliber of the speakers, the caliber of the attendees as well, I mean, we met some pretty big names in attendance as well, but what's really striking to me was the legacy of the conference. We've seen people who have been coming and returning to Hot Topics year over year for over 20 years, and I think that, to me, is a testament to the quality of the conference because it doesn't seem like people are getting tired of coming to Hot Topics year over year. And I think that for conference organizers, it's hard to achieve bringing fresh perspective and quality content every year. I think that was, to me, what struck out.
Carol Vassar, podcast host/producer:
I really want to start digging into some of the podcasts that you did...some of the people that you had on the podcast. I listened to all of them. They're all great. But one area of discussion that really caught my ear was the early detection of cerebral palsy. This is something that is not necessarily caught right away, and people can be as old as four before this is determined to be a diagnosis for them. Tell us about the importance of an early diagnosis of cerebral palsy and your discussion with Dr. Nathalie Maître from Children's Hospital of Atlanta.
Dr. Daphna Barbeau, Podcast co-host, The Incubator:
Ben's nodding his head. That means you did a good job with the French pronunciation. And this was a personal favorite for me, and this interview, it's a personal area of interest for me, but Nathalie is just such a charismatic person to be with, and we really talked about what I think is actually pretty revolutionary. She really highlighted that there are things we can do in the NICU already before discharge to start screening for signs of cerebral palsy. She talked about across the country, across the world, how people are using some standardized exams. The HINE, which is the Hammersmith Infant Neurologic Exam, and the general movement assessment, which they can easily be done at bedside. It's easy to train people, it's easy to document, and this can really help us improve early detection.
We also discussed really changing our mindset from, I think in the past we've really not wanted to, quote, unquote, "spook parents" about a cerebral palsy diagnosis, but rather she encouraged us to create this space for shared discussion and decision-making with parents about what were their infant's cerebral palsy risk factors, their infant's own neurologic exam, because now we are doing it as a standardized way, and what their follow-up after discharge should look like. And she really shared that. I mean, the data shows this is what families really want. They already suspect; they worry about cerebral palsy even if we don't discuss it with them.
Dr. Nathalie Maître, Children's Hospital of Atlanta:
We know there's been good evidence, a lot of research studying how parents react. First of all, they've said they want this as early as we suspect. They're accepting of something that's called high risk for cerebral palsy designation, which is something the Canadian network and US practitioners have said, this is a good thing. Starting conversations early in all honesty, integrity, and with the purpose of shared decision-making between a family and the medical team is really, really important. So, parents, we know, want this. There are systematic reviews that show it international practice guidelines that show it, but then there's the other burden of evidence, which is what happens when we don't do it, and that's really hard.
If you suspect and you don't tell a parent, they actually suspect. Parents know their children better than we do, and so they suspect. And when we don't confirm that suspicion, when we don't openly talk about it, they start to lose trust, not just in us, but in the entire medical system. And it's been shown to have consequences for the mental health of the family and for the outcome of the child as well, who doesn't then get into targeted interventions for CP, not just generic early intervention, but targeted interventions for CP.
Dr. Daphna Barbeau, Podcast co-host, The Incubator:
She also highlighted how we can really be hopeful about the future of children with cerebral palsy because the identification and interventions for cerebral palsy are really kind of rapidly improving. That really left me one with something to take home to the bedside change in my practice. And again, remembering that while this is a difficult discussion to have with families, that there's plenty to be hopeful about.
Carol Vassar, podcast host/producer:
Absolutely. I'm going to move on because there's a lot that we want to highlight here. Ben, one of the things I want to talk about is that parents and researchers and physicians are often looking at the lifelong physical aspects of preterm birth, such as cerebral palsy. One of the doctors, one of the stars that you talked with, was Dr. Klaus Rabe, who presented at Hot Topics on the Lifelong Implications of Bronchopulmonary Dysplasia, BPD. It's a common diagnosis among preterm babies. Fill us in on what is BPD, its effects on babies, and Dr. Rabe's work in this area.
Dr. Benjamin Courchia, podcast co-host, The Incubator:
Absolutely. So, a brief, cursory introduction to BPD is that it's also known as chronic lung disease of prematurity, and it is a direct product of arrested development of the lungs secondary to preterm birth. We see this in more babies than we would like, and obviously, the association BPD is associated with infants in an inverse relationship with gestational age. So the smaller a baby is at birth in terms of their gestation, the higher the risk of developing bronchopulmonary dysplasia is interestingly enough, it is a histopathological disease, meaning that there are truly changes to the lung structure that define bronchopulmonary dysplasia.
However, we don't really do lung biopsies on preterm infants to try to understand BPD. So we tend to categorize BPD based on clinical definitions. And there's been such a discussion and a debate within our field about how do we define BPD. Currently, BPD is categorized at 36 weeks of post-menstrual age depending on the amount of respiratory support a baby is on. And so this is really brief review of BPD. What was really interesting in interviewing Dr. Klaus Rabe was the fact that he is not a neonatologist and that he's an adult pulmonologist from Germany. And so it was really interesting for us to talk to him because he provides a unique perspective on what are the long-term outcomes of babies who have developed bronchopulmonary dysplasia deep into adulthood.
Dr. Klaus Rabe, University of Kiel, Germany:
What is happening now is that we increasingly see individuals, adults at the age of 40 plus, that are the first generation of survivors from ICUs of people that were really born premature. And in them, the signal is so clear that some of them have very bad lung function impairment in that. And so I got interested in this quite a lot, resulting it to something which I think was unimaginable in our discipline 10 years ago that I tell my students and young people, if there's someone with bad lung function coming into your office, one questions amongst others you have to ask them is, what is your birth weight? And it's absolutely amazing-
Dr. Daphna Barbeau, Podcast co-host, The Incubator:
You learn a lot.
Dr. Klaus Rabe, University of Kiel, Germany:
... how surprised people are said, "Wow, I've never been asked that question. Why do you want to know?"
Dr. Daphna Barbeau, Podcast co-host, The Incubator:
I don't even know.
Dr. Klaus Rabe, University of Kiel, Germany:
Well, funny enough, sometimes they say, "I have to call my mother."
Dr. Daphna Barbeau, Podcast co-host, The Incubator
Call my mom. Yeah.
Dr. Klaus Rabe, University of Kiel, Germany:
This still happens. But it happens also quite frequently that people said, "I'm glad you asked me that question because I've never asked it before. And I always had to defend that, I didn't smoke that much yet my function is not very well. I spent weeks and months in the ICU. Yes, I was premature. Yes, I didn't do any sports and exercise in it. Yes, I was always sickly with my lungs." And basically this is how they spark to some extent on the one hand, a clinical interest to pay the right service and tribute to this health course of someone. And it triggered a lot of research in our area, which is fascinating.
Dr. Benjamin Courchia, podcast co-host, The Incubator:
When we asked him, practically speaking, how do we take these lessons that he has learned in the adult outpatient setting back to the NICU, I think that's, again, the topic of smoking came back, and I think this is very interesting because we don't often have a lot of counseling to provide parents because the lungs unfortunately are the way they are. The lungs were born too early; they're immature, and they're not going to function as well as they should be if the baby had been born at term. However, what he mentioned to us was that we can provide counseling and say, "Hey, if there is one person that should not be touching a cigarette, that is this baby, because they don't have a lot of reserves and their lungs are already doing a tremendous work, they do not have the luxury of suffering more damage from smoking." And I thought that was very interesting because this is a bit that we can take directly to the bedside today and provide our patients with that kind of counseling. So I thought that was fascinating.
Carol Vassar, podcast host/producer:
Of course, you're going to get a rebellious teenager; you can't prevent that necessarily, but at least the parents have the knowledge. And again, circling back around and knowing your own personal history, how much did I weigh? Was I three pounds at birth? Did I have BPD? Those are the kinds of questions that are really important in the totality of looking at your family history for sure. Let's talk about other preterm babies, other conditions that they encounter when they are born preterm. Daphna, sepsis is one of those often requiring antibiotics, and I'm sure people are aware that the overuse of antibiotics is not a good thing for individuals and for society as a whole. And you were talking with Dr. Martin Stocker, who heads up neonatology and pediatric intensive care at the Children's Hospital of Central Switzerland. He talked about antibiotic overuse. He advocates a more nuanced approach to antibiotic use in preterm and even full-term babies. Talk about his approach. What makes it unique?
Dr. Daphna Barbeau, Podcast co-host, The Incubator:
Dr. Martin Stocker was one of those international names that we're really lucky to have the opportunity to interface with. And our discussion really centered around the magnitude of antibiotics that we use in the NICU. And truthfully, the rates of sepsis, even in our neonatal population, even in the low birth weight population, are actually quite low. And despite that, he really was focusing in on the late preterm and term population, and the sepsis rates in those babies are even lower, thankfully. But despite that, he quoted almost a number needed to treat that in this population, the late preterm and term population, we give a hundred babies antibiotics to prevent one case of early onset sepsis.
So that was really a reminder of how much antibiotic we're actually seeing in the NICU. And his discussion also really underscored that, like you mentioned, antibiotics themselves are not without risk. We really and rightfully so fear sepsis. So we want to, quote, unquote, "protect babies" with the antibiotics, but we know that antibiotics and especially a prolonged exposure to antibiotics can have detrimental outcomes down the road. So his take was really that we really bring ourselves back to the bedside and spend a lot more time observing infants for signs of clinical sepsis, specifically things like cardiovascular instability.
Dr. Martin Stocker, Children's Hospital of Central Switzerland:
What we have seen on clinical signs is really the cardiovascular instability. So this is a sign who is much more predictive for sepsis than respiratory distress. So I think that's something what I usually say, my junior, this is something what you have to look at, be careful here because that's critical, isn't it? And then, of course, the more premature the baby is, the more is the risk increasing. So I think, of course, with a 24-week-old, we have to be much more careful that with a term baby, just looking on the rate of sepsis and the potential outcome, isn't it? Mortality is much, much higher in the premature sepsis baby than in the term baby, but it's really this cardiovascular instability together with other signs, then maybe we'll have some risk factors, the GBS positive model without any antibiotics for example, and maybe it's a preterm baby, okay, then it's getting more-
Dr. Daphna Barbeau, Podcast co-host, The Incubator:
Additive.
Dr. Martin Stocker, Children's Hospital of Central Switzerland:
Yeah, additive. Yes. Yes.
Dr. Daphna Barbeau, Podcast co-host, The Incubator:
I think that sounds pretty obvious to people listening and the people who take care of sick babies and children, that cardiovascular instability is obviously a sign of sepsis, but it's really our responsibility to be at the bedside doing serial observations to catch these signs early. And for many of us in medicine, because of all these other things, administrative responsibilities, the EMR that pull us away from the bedside, I think this was a really good reminder that the babies will tell us if they're sick; they give us as much information as they can. And so going back to the bedside, really highlighting that any evidence of cardiovascular instability should be a warning sign for sepsis, and that we still are lacking other biomarkers that can help us identify either presepsis or early sepsis signs. And so we really have to continue to use our clinical acumen to help identify these babies.
Carol Vassar, podcast host/producer:
I'm guessing, and I could be wrong, that antibiotics are used for other conditions than sepsis or that antibiotics are used prophylactically to treat sepsis.
Dr. Daphna Barbeau, Podcast co-host, The Incubator:
So I think that's an interesting point. So we use sepsis, really a catch-all term for infection, but there are different types of infection. One is a bloodstream infection. We see pneumonia, we see intestinal infections, we see urinary tract infections, but this early onset sepsis is what we're trying to avoid. And babies that we're just meeting, I mean that's something we talked about. We don't know these babies. We have a little bit of clinical history about their risks for infection.
Many of babies come to the NICU because they have some signs of, say, respiratory distress or especially in this late preterm and term population, low blood sugar, temperature instability, difficulty feeding in the newborn nursery, so they come to the NICU. So, all of these can be signs of infection. They can also be signs just to transition to normal life from this really different fetal atmosphere to here in the postnatal environment. And we have gotten better, certainly as neonatal healthcare professionals at identifying, which feels to us to be signs of sepsis, but we haven't perfected it yet. And there are some babies who may have these signs and are not infected, and those are the babies where we're really trying to decide when and when not to give antibiotics for.
Carol Vassar, podcast host/producer:
Which is a tough decision to make because you don't want to be wrong.
Dr. Daphna Barbeau, Podcast co-host, The Incubator:
Yeah. We wouldn't want to miss it. Right.
Carol Vassar, podcast host/producer:
Exactly. We're going to step out of the NICU for a moment. Ben, I want to talk to you about the discussion you and Daphna had with Dr. Lehana Thabane, Professor of Biostatistics at McMaster University. He actually had some great advice on the principles of success for young researchers. Talk about that.
Dr. Benjamin Courchia, podcast co-host, The Incubator:
Yeah, I mean, we're always interested to talk to biostatisticians because they feel like such a rare breed. Whenever you want to talk to one, they're somehow nowhere to be found. So we were able to find one at Hot Topics. And Dr. Thabane is a wealth of information, and so we were very fortunate to speak to him. Our main question to him was, in his opinion, having worked with so many investigators, what are his takeaways? What are his principles of success that he tries to ingrain in young researchers? And he had this answer ready for us. It seems like this is something that he had thought about deeply and for a long time. And so he said to us that, to him, success can be summarized with five ingredients.
Dr. Lehana Thabane, McMaster University, Ontario, Canada:
Always think about collaboration. Collaboration is partnership. There's so much you can learn from other people. So collaboration is really the best way to not only make friendships and lasting partnerships, but that's a way to success. And the second thing is, I say, if you're going to go into collaboration, you are certainly going to have to be able to then think about how do I handle difficult situations. And I always say, you can always behave yourself to a successful outcome. Fake it until you make it.
Dr. Benjamin Courchia, podcast co-host, The Incubator:
Yes. Love that.
Dr. Daphna Barbeau, Podcast co-host, The Incubator:
I love that.
Dr. Lehana Thabane, McMaster University, Ontario, Canada:
That's how others make it, right? So that's the second one. And really the third one, which I also often tell people I see, be kind to other people. It's amazing how kindness can open doors for you. So I often see kindness is about sharing. When we grow up as kids, our parents tell us and teach us how to share. But as people grow older, they stop sharing and stop not being kind to other people. But I say kindness is the key to success, especially if you're going to be a clinical scientist. So that's three. Number four, which I also often say, a lot of your success depends on how well you're able to actually get to use the power skills that you have.
All the so-called soft skills, time management, managing people, and managing stress and all this stuff. A lot of our success doesn't necessarily come from a technical training, but it comes from how well we are able to acquire all the other skills that are important for us to succeed. But look, if you are an academic, a lot of your work is going to be judged by how well you can write, how well you can communicate. So it's about really improving your soft skills. Now, people don't call them soft skills anymore. They call them power skills because that's what gives you power, right?
Dr. Benjamin Courchia, podcast co-host, The Incubator:
That's fair.
Dr. Lehana Thabane, McMaster University, Ontario, Canada:
And lastly, I say get yourself a mentor. It's amazing how talking to somebody who has been there, who's made all the mistakes, could actually shorten your learning curve.
Dr. Benjamin Courchia, podcast co-host, The Incubator:
We talked also about some of the statistical approaches to clinical research, whether it is Bayesian approach and so on and so forth. But I thought these five takeaways: always think about collaboration, be kind to other people, behave yourself to a successful outcome, improve your soft skills and get yourself a mentor = were something that I wrote down and that I have saved on my laptop so that I can keep following in his footsteps.
Carol Vassar, podcast host/producer:
We're going to conclude today by learning more about the work of Dr. Dieter Wolke. Dr. Wolke is a professor of developmental psychology at the University of Warwick, and that's in the UK. He challenges traditional labels and advocates for a nuanced approach to fostering well-being and resilience in preterm children. Ben, talk about what he had to say.
Dr. Benjamin Courchia, podcast co-host, The Incubator:
Yeah, I think this was a very interesting conversation that we had with him. First of all, because I think it challenges our perception of what long-term outcomes should look like, or are we even looking at the right things. I think that one of the terms that he coined and that he presented at Hot Topics was this idea that we should look at outcomes for our preterm infants as their ability to have accomplishment of life tasks. And I think that's something that is really innovative.
Dr. Dieter Wolke, University of Warwick, Coventry, UK:
In biology, every species is born and has got a particular life cause. I mean, it's a life history. So you're basically born, then you get into a family, you're being weaned, and then comes a stage where you actually leave the family, you become sexually active, you find a partner, you reproduce, and then you see with the longevity of how far you go depending on how your life was and how stressful it was. And that's in every species. And then us in humans, of course, we define it also culturally. So what happens is we get born, we survive, we get born into a family, we get acquainted with our siblings, but we also as social beings have friends to build friends.
The next thing that comes that we have got awakening sexuality, like in adolescence, we want to find a romantic partner because we want to go and we want to become independent, get away from the parents, like economically independent, that we can do our own thing, and many still want to have children and go on, and then we go on the course that we become grandparents and then we die, hopefully happily. But how you master the [inaudible 00:22:56] sequence, and whether you actually do become independent, whether you find friends, whether you do find a partner, has a big impact on our life satisfaction, our well-being, and our health.
Dr. Benjamin Courchia, podcast co-host, The Incubator:
One of his slides talked about partnering experience for very preterm and very low birth weight infants. Looking at outcomes such as having never dated, having never had sexual intercourse, never had a serious relationship, and comparing that for very preterm infants at 26 years of age, at 34 years of age, and comparing that with their full term, I would say counterpart. And I think it's very interesting that looking at former preemies never having a serious relationship, the numbers were 27.7% compared to 3% in the term population. And it's not like this got much better at 34 years of age, where close to 22% of the preemies never had a serious relationship compared to only 1.5% of the full-term cohort. I think this is something that definitely speaks to us as how our preemies are developing and how are they adapting to society.
There's also an interesting slide that he presented on independence and adult wealth, looking at areas where there's significant differences, again between preemies and full term about receiving social benefits, periods of unemployment. The fact that many of the preemies are still living at home or sheltered accommodation, the educational level, and the relative property. I think these are outcomes that are rarely mentioned in the literature but truly make a huge difference in how we tailor our care. And so I think that was a very interesting discussion, really rethinking how do we see success post NICU and how do we empower our patients and their families to pull on the resources that will foster proper accomplishment of life tasks.
The summary of what Dr. Wolke told us was that, at the end of the day, we should be optimistic. Most very preterm infants, most very low birth weight infants do develop really well, but there are still many very preterm infants that do not accomplish some of the most important life tasks such as social relationship, such as their ability to acquire wealth, and their ability to maintain their health. So the one thing right now that we are seeing is that they have an excellent relationship with their parents. And so, really, the question that Dr. Wolke is posing is, how can we use that to try to improve the other aspects of their life courses that could be improved. I thought that was fascinating. It is not something that I had given much thought to, and, again, something I would not have thought about if I had not been there at Hot Topics. I'm sure Daphna has some thoughts. Do you want to share?
Dr. Daphna Barbeau, Podcast co-host, The Incubator:
That's what we're learning. There are so many wonderful organizations of adults who were born preterm, who are actually advocating for themselves, saying, we have healthcare professionals who don't understand our history and what impact that has on our long-term health and social psychological outcomes. And so I think it's really through the work of those former preemies who are saying, we need this and collaborating with adult physicians, pediatrician, adolescent medicine, psychologists. I think it's this really new novel collaboration between these groups that's going to give us the answers that we're looking for. And that's really exciting for a number of reasons. One, it's going to help us take better care of preemies in the long-term realm, and they're living longer, they're living better, and so we need to focus on improving those long, long-term health outcomes, and it's going to allow us to better counsel families. I mean, families have these questions, and we really haven't been able to provide those answers in the best way that are based in data. It will be nice to have those answers for families as people continue to collaborate and this community grows.
Carol Vassar, podcast host/producer:
Neonatologist Dr. Daphna Barbeau is the co-host of The Incubator podcast, along with her colleague, Dr. Benjamin Courchia.
MUSIC:
Well Beyond Medicine.
Carol Vassar, podcast host/producer:
Thanks so much to Ben and Daphna for joining me to take a look back on some highlights of the most recent Hot Topics in Neonatology event. And as always, thanks to you for listening. Plans are already underway for the next Hot Topics in Neonatology, taking place in Washington, D.C., from December 7th through the 10th, 2025. Registration opens June 1st. Learn more about it at hottopics.org. We'll put that link in the show notes for this episode, along with links to The Incubator podcast episodes featured today.
Missed an episode of the Nemours Well Beyond Medicine podcast? I can help with that. Point your browser to nemourswellbeyond.org, where you'll find all of our previous podcast episodes. While you're there, you can subscribe to the podcast, leave a review, or even make a topic suggestion. That's nemourswellbeyond.org. You can also find the podcast on your favorite podcast app and on the Nemours YouTube channel.
This episode's production team includes Cheryl Munn, Susan Masucci, Lauren Teta, Steve Savino, Ben Courchia, and Daphna Barbeau. I'm Carol Vassar. Join us next time when we talk about the effects of trauma on the developing brain. Until then, remember, we can change children's health for good. Well Beyond Medicine.
MUSIC:
Let's go-o-o, Well Beyond Medicine.
