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Neonatal sepsis physiology, steroids, vasopressors, and moms.gov. A full week on The Incubator Journal Club.

Adrianne and Nim open with a retrospective study from Toronto challenging the assumption that hypoxemic respiratory failure in septic preterm infants is driven by elevated pulmonary vascular resistance. The data points instead to left ventricular dysfunction as a key contributor, raising questions about the reflex to reach for nitric oxide first.

Nim then reviews a double-blind RCT from northern India evaluating early hydrocortisone versus placebo in neonatal fluid-refractory shock. The primary outcome did not reach statistical significance, but an 11 percent absolute reduction in mortality and a 70 percent open-label crossover rate tell a story of their own.

Adrianne closes the journal club with a double-blind RCT comparing norepinephrine to dopamine for neonatal septic shock, finding no significant difference in shock reversal at 30 minutes, though significant methodological limitations make the findings hard to act on.

Eli and Ben close the week on Neo News with a look at the newly launched moms.gov and what clinicians should know before their patients bring it up.

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Enjoy!