The Incubator Podcast

How many ribs do you count before you call a chest film well inflated?

Daphna and Dr. Charles Roehr discuss a 2025 JAMA Pediatrics study from David Tingay's group that compared diaphragm position on the radiograph with aerated lung volume on CT in 218 infants. The correlation was weak, Kendall tau 0.23. Put two babies side by side and the rib count ranks their lung volumes correctly about 62 percent of the time. A coin flip gets 50.

We have been reading a three dimensional lung off a two dimensional picture, and it shows.

Charles wrote the accompanying editorial. His point is not that the film is useless, but that it gave us a false sense of security. Worth remembering the next time rib eight decides a PEEP change.

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Join us at Hot Topics in Neonatology 2026 on Monday, December 7th, for the Fisher & Paykel Healthcare Lunch Symposium: Pressure, Flow, and the Gray Areas In Between. Dr. Manley, Dr. Roehr, and Dr. McEvoy live on stage, moderated by The Incubator team. Register and submit your questions: buff.ly/XGFeNC0

#nicu #neonatal #babies #medicine #podcast

Do you trust the pressure number on the CPAP screen?

In this clip Dr. Charles Roehr explains why he does not, at least not completely. Neonatologists, nurses, RTs: we like to operate in a system of security, and numbers give us security. But as soon as the interface meets the baby, leak enters the picture and the pressure we set stops being the pressure delivered. Modern ventilators correct for some of it by increasing flow, but nobody at the bedside can say how much.

Reduce the leak, consider a slightly higher setting, and stop fooling yourself about the number.

Next time a baby looks uncomfortable on seven, ask what seven means for that baby, with that interface, with that mouth open. The answer is rarely seven.

🎧 buff.ly/2hB8YiU

Join us at Hot Topics in Neonatology 2026 on Monday, December 7th, for the Fisher & Paykel Healthcare Lunch Symposium: Pressure, Flow, and the Gray Areas In Between. Dr. Manley, Dr. Roehr, and Dr. McEvoy live on stage, moderated by The Incubator team. Register and submit your questions: buff.ly/XGFeNC0

#nicu #neonatal #babies #medicine #podcast

When you dial a CPAP of 6, what pressure is the lung actually seeing?

Dr. Charles Roehr joins Daphna for the third conversation in our Hot Topics series and starts with a question most of us stopped asking years ago. Numbers give us security, he says, but the baby only has to open its mouth and the closed system we imagine is gone. From there: leak, interface cycling and skin injury, how to tell when a baby needs more pressure, and why a unit's familiarity with its own equipment may predict success better than the mode.

Just because the machine says eight does not mean the alveoli got eight.

For anyone who has ever adjusted a dial and felt reassured by the number, this one is a useful reminder of what the number can and cannot tell you. Charles joins Brett Manley and Cindy McEvoy on stage at Hot Topics in December.

🎧 buff.ly/2hB8YiU

Join us at Hot Topics in Neonatology 2026 on Monday, December 7th, for the Fisher & Paykel Healthcare Lunch Symposium: Pressure, Flow, and the Gray Areas In Between. Dr. Manley, Dr. Roehr, and Dr. McEvoy live on stage, moderated by The Incubator team. Register and submit your questions: buff.ly/XGFeNC0

#nicu #neonatal #babies #medicine #podcast

What would you do with 82 mL of extra lung at six months?

That was the difference in alveolar volume between stable preterm infants randomized to two more weeks of CPAP and those taken off to room air, in Dr. Cindy McEvoy's 2025 trial of 100 infants at OHSU. 500 mL versus 418. Diffusing capacity and expiratory flows were higher too, with no delay in time to full feeds or length of stay.

Mechanical stretch, the same force that grows a lung in utero, applied for two more weeks.

Single center, so generalizability is an open question and Dr. McEvoy says so herself. But if your unit weans the day the baby meets criteria, this is the trial to read before the next one.

🎧 buff.ly/t8YJq8P

Join us at Hot Topics in Neonatology 2026 on Monday, December 7th, for the Fisher & Paykel Healthcare Lunch Symposium: Pressure, Flow, and the Gray Areas In Between. Dr. Manley, Dr. Roehr, and Dr. McEvoy live on stage, moderated by The Incubator team. Register and submit your questions: buff.ly/XGFeNC0

#nicu #neonatal #babies #medicine #podcast

What if where a preterm infant starts on the lung function curve is where they stay?

In this clip Dr. Cindy McEvoy explains why her team measured lung function at six months, not just at discharge. Babies randomized to two extra weeks of CPAP had larger alveolar volume, better diffusing capacity, and better forced expiratory flows. Start lower on the curve and you tend to stay lower, with more respiratory disease as you age. Bump the starting point and the whole trajectory may shift.

We spend a lot of energy getting babies off support. This is a reminder that the goal is an optimal lung at six months, at six years, and well beyond the day of discharge.

🎧 buff.ly/t8YJq8P

Join us at Hot Topics in Neonatology 2026 on Monday, December 7th, for the Fisher & Paykel Healthcare Lunch Symposium: Pressure, Flow, and the Gray Areas In Between. Dr. Manley, Dr. Roehr, and Dr. McEvoy live on stage, moderated by The Incubator team. Register and submit your questions: buff.ly/XGFeNC0

#nicu #neonatal #babies #medicine #podcast