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#042 - 👨🏻‍⚕️ Dr. Prem Fort MD


Prem Fort on The Incubator Podcast

Hello friends ! 👋


First and foremost, thank you for all your support. We have been hitting record download numbers these past few weeks and we are so grateful for our amazing community.

This week we are lucky to have a NICU celebrity on the podcast. Dr. Prem Fort, also known as The NICU doc on social media, is sharing with us stories about his background, his passion for research and the importance of social media as a medium for education and communication with the community at large.


We hope you enjoy this episode!



 

You can check out some of the work done by Dr. Prem Fort by following these links:







 

Short Bio: Dr. Fort is the chair for the research council at the Maternal, Fetal, and Neonatal institute at Johns Hopkins All Children’s Hospital. He is a board-certified pediatrician and neonatologist with a research focus in respiratory medicine in preterm infants. He attended undergraduate education at the University of North Carolina and continued his medical training with the School of Medicine at the University of North Carolina, pediatrics residency at Duke University Medical Center, and Neonatal-Perinatal fellowship at the University of Alabama in Birmingham. He has successfully presented research studies at the National Child Health and Human Development (NICHD), and has been and is currently involved in a multitude of multicenter, regional and national clinical trials. He has been the recipient of teaching awards as well as two prestigious awards from the Society of Pediatric Research for his study in vitamin D use in extremely preterm infants. He is recognized nationally and internationally as an expert in respiratory care with minimally invasive methods of surfactant administration, a drug that is needed for preterm infants to breath. He is constantly striving to improve the care of newborn, preterm infants through research and Best Practice in clinical care.


 

The transcript of today's episode can be found below 👇

Ben 0:46

Hello, everybody, welcome back to the podcast Daphna. How are you today?


Daphna 0:51

Good other than my tech, my technology and competence, chronic chronic condition, chronic condition, we let the listeners know that you know, even even the podcast team has some tech issues every once in a while. But our guest has been very patient so we're so grateful.


Ben 1:11

Yeah. Dr. Prem for it is with us today. He is the chair for the Research Council at the maternal fetal and neonatal Institute at Johns Hopkins All Children's Hospital. He is a board certified pediatrician and neonatologist with a research focus in respiratory medicine and preterm infants. He attended undergraduate education at the University of North Carolina. He continued his medical training at the with the School of Medicine at the University of North Carolina and completed his pediatrics residency at Duke University Medical Center. He completed a neonatal perinatal fellowship at the University of Alabama in Birmingham. He has successfully presented research studies at the NI CHD and has been and is currently involved in a multitude of multicenter regional and national clinical trials. He's been the recipient of teaching awards, as well as two prestigious awards from the Society of pediatric research for his study and vitamin D use in extremely preterm infants. He is recognized nationally and internationally as an expert in respiratory care with minimally invasive methods of surfactant administration. He is constantly striving to improve the care of newborn preterm infants through research and best practice in clinical care.


Prem Fort 2:17

From how are you very well, thank you. Thank you for having me both.


Ben 2:22

Know, thank you for being on the show. I mean, there's, there's so many things that that highlight who you are as a person, and as a physician, I don't know where to start. But you have you have dual citizenship, or you're originally from from Peru and Switzerland, you practice in the US, can you can you give us a little two minute on who Dr. Prem forte is?


Speaker 3 2:47

Sure. Okay. Yeah. So, um, so I was originally born in, in Peru, in South America, and, but I do have Swiss nationality from my grandparents. And so I actually my brother and his family, they live in Switzerland. So we do go visits with them in beautiful place, beautiful place. And but I did, I came to the States when I was a teenager, and have been here for well, many years, so and then became a citizen here in the United States is wonderful country, and have been here since then.


Ben 3:29

So these are two close countries geographically, it's not like you can quickly hop on a car and go from from Lima to Geneva.


Speaker 3 3:37

Yes, yes. You know, but again, they're very distinct countries. But you know, I love them both. I mean, all three are very different in their own way. But that's, you know, nowadays, the whole world, you know, it, we live in a world of globalization, you can really, now between the internet and between everything that you learn, there are so many so many different cultures. You know, the internet has really brought us all together.


Ben 4:02

And so was coming to the US something that you did on your own term, or is your whole your family move at the time?


Speaker 3 4:08

No, it was really my father, my father. He works in public health. He's also a physician, but he works more in the area of public health and decided that at one point that he wanted to do a PhD in public health and entered the School of Public Health at UNC Chapel Hill. And at that moment, I had started medical school in Peru and he basically gave me the decision you can stay here or you can come with us and you know, I thought it would be a good move. Initially, I was thinking of just coming to the states for education and to go back home after education, but I really fell in love with the United States. You know, the people here that's really why they call it the United States. There are so many different cultures, so many different peoples. Really, it's it's it's such a wonderful Okay, so after, you know, completing here, my, you know, undergrad training and medical school, I just, you know, I couldn't I couldn't leave. And here I am, you know, 20 some years later.


Daphna 5:13

You know, I have a special tie to Peru, actually, part of my medical mission work was was in Peru and I got engaged on top of Machu Picchu. So very, a very tight connection to, to Peru.


Speaker 3 5:32

So I can imagine the engagement was I take a couple of breaths. Take a couple of breaths.


Daphna 5:39

Well, I had been there a month so I had acclimated by my by guess became fiance, my husband had not acclimated stuff.


Unknown Speaker 5:50

That's an amazing story. That's wonderful. We have


Ben 5:53

been on one new for pulmonary for a while,


Daphna 5:55

for a while he's taking a break one knee, one arm. Yeah, no, he was a sport. But But anyways, I, I have had the privilege of visiting a number of countries. And I wouldn't say practicing because I was mostly a trainee at that time. But I you know, I feel like it changes your perspective on on medicine, being able to see you know, the different not just medical care, but how medical care is provided on a on a community level. And so I'm hopefully you'll share with us some of those kind of individual experiences.


Speaker 3 6:36

Absolutely. And this is obviously something that when I left, Peru, since I had already started medical school, when I left Peru, I always had the idea of you know, initially again, going back to work in Peru, but as I left Peru, and as I came here to, to the United States, I always had the idea of being able to help out initially with the idea of going to help out in Peru, and then the idea just kind of broad and just kind of help at a global level. And that's I know, we'll probably talk a little bit about this later. And that's sort of what got me into the passion of global health and helping out you know, more, you know, being able to assist and educate at a global level.


Ben 7:25

What made you go into prom what made you go into neonatology in the first place? How did you? How did you? I guess everybody falls in love with the NICU but what was what was your story?


Speaker 3 7:34

Now, there's probably several things, I think one of the sort of innate or one of these all these memories in that probably got me into the anthology, there were a couple of things. One of the first things and this was probably crazy, my dad to do, but as a physician, when I was about four or five years old, the story goes, that my dad was unable to leave me with somewhere else. And so he took me to the morgue, because he had been called for some reason. And I have this very old flashback memory of essentially, being at the morgue, and seen the table in the morgue and seeing a lady or a woman and a child post mortem. And having the smell of formal I still have the formaldehyde. I still remember that very strong smell as a child. It's amazing. However, the memory, remember that? You know, story memory. Yeah, right. It's incredible. I still remember that and just having that flashback memory. And that's all I remember. But, you know, according to what discussions that I've had with my parents is that, you know, basically asking them what happened, and my father saying, you know, this mom and the baby, you know, unfortunately died. And, and the conversation going something like, well, I want to be a doctor. So I can say this mom and the baby. And then obviously, I grew up and probably went through the I want to be a fireman, I want to be a policeman. I want to go through all of these kinds of, of different things. But actually at the age of 12, for those that media, they know that actually I have a sister who was born premature, and she was born in England, and we're 12 years apart. So I vividly remember going into the NICU and she'll probably be my sister Andrea will be embarrassed to say that I remember seeing her very hairy chest and back. I remember seeing her in the incubator and seeing the nurses and doctors as heroes and really doing all the things that they would do for my sister. And just as a child, you think this is amazing, you know the what they can do for premature babies. dBs, I want to be able to do something like this. And I think that was really the first time I thought this is something that I would probably want to do. And then I kind of went through medical school then thinking CD surgery and thinking OB GYN, but there was always that thing inside of me that you know, NICU is pretty cool. NICU, saves lives, NICU, and it really kind of cemented sort of, at the end, my fourth year of medical school, when I rotated as a sub i or sub intern. That's when I really said no, this is super cool. And I definitely want to do this.


Daphna 10:40

Very neat. Very neat. I you know, we've talked a lot about families on our, on our show, and siblings actually are, you know, really siblings of NICU infants are really becoming a hot topic, right, an area of study and how does NICU admissions affect siblings, and here you are a sibling of a NICU and a baby. And so I just wonder if you have any, you know, you know, memories of things that that would have been valuable at that time, you know, as a child, kind of on the periphery of the NICU admission, now that you now that you've seen both sides?


Speaker 3 11:20

Yeah, one of the things that I am so grateful for both through studying and research and Qi, and one of the things that I know, we clinicians have really pushed now, can we push now in our clinical practice, is skin to skin, you know, back in the days, it used to be do not touch the preemie. You know, we leave them in the incubator, do not touch them, you can only watch them through the glass. In fact, there was very little visiting time, you know, you may only get an hour in the morning, an hour in the evening. And if you get to be in there, the siblings could only maybe watch them from an outside point of view. The parents were the only ones that allowed it and, and I think, you know, it's it, this culture has been changing, and I'm glad it is. And the culture is now changed to a point where we're trying to do the opposite. We want the parents to be inside, we want the parents to hold we want them to kangaroo we want to do skin to skin. And we noticed that this is physiologically very positive. There is no as you guys know, there are studies showing actually improve instead of improvement, you know, let's add noseless, these, these add events, there's less of these, you know, severe events, when you have the baby being held are actually within kangaroo care. So all these things are, are signs that, that we have shown improvement through our research through our Qi, that's something that I would have loved to go back as a sibling, I would have loved to have the opportunity to have to have held my premature sibling, my premature sister a lot more than I did, you know, back then because again, the culture was we don't want you to, you know, we want minimize to minimize any any holding at that point.


Ben 13:18

So one of the one of the cool things I mean, one of the one of the ways that I really got to know you is through this, this social media account that you created, where you, your, your, I think your Instagram handle is the NICU doc, right? That's correct. So, as I was looking through social media, for people doing anything related to neonatology, I quickly stumbled upon your your social media account, on Instagram, Youtube everywhere, and it's quite amazing. What I'm wondering first and foremost is what prompts you to do something like that because for the people who have not yet checked out your your social media account, and especially on Instagram, it's not it's not really meant to be a social media account really for advanced professional, right? You you create content on social media that is accessible to anyone, which is That's correct for us doing I mean, what we are doing as the incubator is the easy part. It's easy to just talk to providers and doctors, but to try to create information that is accessible to everyone requires a lot of work. My question is what prompts us to one day say I want to do this


Speaker 3 14:35

well, first of all, Ben and Daphne, you guys are way too humble. What do you guys do? I know it takes a lot of work and in speaking with professionals and with the guests that you guys have, I know it takes a lot of work so you know, don't sell yourselves to short and it takes a lot of work we'd like to do and we really we really appreciate it. I love the medium you guys set up for us. But But I but again, I appreciate your time. Ain't words, then, when I was thinking of I've always loved education. And I've always wanted to educate. And obviously we do a lot of that. I know, you're all involved in education at the bedside, when I was thinking of how can I bring this education because I kept on having the same conversations with parents, I had the same conversations with nurses, the nurses would ask the same things that parents would ask the same things, I thought, well, how can I bring this to a broader medium? At first I was thinking writing a book. But then really, nowadays, especially this seemed to happen when when we went through the COVID phase in 2020, that I realized, you know, because things change so quickly, writing a book, by the end of 2020, things would have changed so quickly that I realized, you know, really, the internet, and social media was the fastest way to be able to get information out, and then to be able to continuously, you know, in vitro and in vivo, essentially, change that information and keep updating that information. And a lot of it really arose from again, the trying to get information on COVID. A lot of families were asking, What do I do if my baby is COVID. And that's not something you can write a book about, that had to be continuously updated. And that's where the idea of creating an Instagram account, because there's some that you can quickly post one day, and then if the information changes in the CDC the next day, or who the next day, you can update it very quickly. It's instant. Yeah, therefore, the Instagram account. And and so that's what got the idea of creating this Instagram now, never in a million years, did I ever expect the social media accounts to grow to where they have, and I've been really blessed with a following. Because, again, the the community that has been created my social media accounts, it really is a wonderful family. Because I did this, to be able to teach others. And to be honest with you, I am selfishly learning myself, because every day I am receiving messages from Australia, from Africa, from China, asking questions, you know, from physicians, from nurses from families, and I, they're really smart questions. So now I'm having to go in read articles, relearn about things, maybe I haven't, you know, seen in a while, or maybe somebody's using a different type of ventilator in another part of the world I had never heard of. So I'm having to now look at different type of ventilators. So I have honestly, my growth in knowledge has been exponential since I started the social media account. Same thing for the YouTube account, which is the same thing that Nicki dog on YouTube has been the same thing, I never thought I would get into learning in editing programs, I have now learned how to professionally edit videos, and do this to a point where it really does, it's rewarding. I can really, you know, edit, edit things not to a professional level, obviously, like real, sensitive and cinematography, but you know, enough that it looks, you know, fairly good enough. So it's been really rewarding. And all accounts,


Ben 18:40

your videos are well or well produced. Your thumbnails are always very cool. And I from Yes, for us having had to learn how to produce podcasts, we can see the work that goes into these videos. So I totally don't need to justify much more than that.


Daphna 18:56

I appreciate it. Yeah. And what's so neat, I mean, you have this whole collection of videos for families and a whole collection of videos for health care providers, which is neat.


Speaker 3 19:11

Yes, it's it started out really, for families, and then suddenly, more, you know, other health care providers. Were asking, Can you teach me how to put an umbilical line? A lot of this like you said, like you were saying, Ben, is definitely you know, more basic than you know, for neonatologist. But I do find that a lot of different health care providers. I think we take as neonatologists we take things for granted the knowledge that we have. We really have accumulated through practice through our medical school training through everything. We really have accumulated so much knowledge and you know, it's so refreshing to them. Get the Get get folks. Pediatricians asking me all the time. Can you kind of explain to me is, you know, some of the, you know, some of the basics of hyperbilirubinemia. When it gets to a certain point, what should I do? And it's really nice and refreshing just to go back to some of the basics, and then actually relearn some of the things that we have learned through medical school.


Ben 20:21

And while I agree with you that having questions from a medical audience is always fun and interesting. I feel like there's 90% of neonatologist who would say What do you mean, like taking questions from patients? Families? Online? Heck, no. And so how? Why, first of all, why do you think that is? Why do you think that we're so fearful of interacting with families outside the NICU and particularly on social media?


Speaker 3 20:51

Well, the one thing I will say, and and obviously, this is, this will be my disclaimers, you know, I, I have to be very careful on social media, we do not take any individual patient, you know, information. So obviously, I cannot, you know, discuss any individual patient cases. And that's, you know, very true mostly because it's unfair to be able to try and discuss a patient when you know, you don't have you haven't set in the eyes, you don't know any, any of the backgrounds, and so on and so forth. So I always tell the families, you know, if they do send me information specifically about their babies, I tell them, Look, unfortunately, I could not discuss any individual cases, because it would be unfair to your baby to discuss one gas or one set of labs when I don't know the whole history of your child. So that's essentially, you know, what I try and tell them but I actually truly enjoy being able to help out families who may have, I actually truly enjoy helping families because a lot of the things about the NICU is they are really scary. And so I try to make the NICU just a little bit less scary. You know, a lot of the lingos a lot of the things even though we tried to communicate with the family, we try to let them know on rounds, we try to let them know after rounds, sometimes we forget, you know, even the basic stuff to us may sound really scary. Your baby has some jaundice and has sudden high bilirubin, we're going to go ahead and just add some phototherapy, everything's going to be fine. Well, all that may seem very basic to us may sound really scary to families. So some of the messages that come back to me, I try and really pay, you know, tone it down, to really get them to understand the basics. And once they understand the basics, it brings the fear down. And that's really, it. That's actually honestly on my Instagram account. One of the quotes that I have on on my account is really trying to make the NICU a little bit less scary. So that's always my goal. I enjoy getting messages from families, because if it can help them make the NICU a little bit less scary, then that's, that's my job.


Ben 23:16

I am I think this is this is great. I mean, I could not agree with you more. And I do think like you said, I think there's a way to navigate interactions with individual families online without really getting into really uncomfortable stuff, as you said, like there's no need to discuss a specific set of values like you can give general principles and ideas about how to manage certain things without really getting into the nitty gritty of day to day care for a patient. Correct. But I guess my I kind of thought you were gonna answer something like that. And so then my follow up question to you is, I think you do you put your your personality really out there. One of the one of my favorite posts, I guess, or videos is your is your salsa dance stuff. And I think this is great. I mean, for the people who haven't seen it, you basically you dance and with music and basically explain the different components of breast milk and, and I think this is super novel, I think this is this. I mean, I guess what my question to you is, how do you find the courage because it does take courage to put yourself out there with the fact that the your your peers could also view it right? Because you do this and I enjoy it and I'm watching in my bedroom and then the department is like I would never have the guts to do that. And and so I'm super amazed. What What is your thought process when when you is it? Is it an obstacle like do you have to like, sort of you have to prep yourself up to work or no or is this like just pouring out of you?


Speaker 3 24:59

Well I usually slap myself in the chest a few times and and then do some push ups. And no, it's well, it's like anything. I mean, I am sure for you, you know, definitely and Ben, this podcast must have taken you some courage to do to be able to talk to a mic and feel open and have a conversation and bring in guests and you guys have bring it, I have brought in some top guests. And to be able to have these conversations with people that you have read about with Arctic with people that you know that written on top, it takes some guts to do that. And so I appreciate what you're saying, Ben, but I think if we were to do things safely, then you you, you wouldn't be doing these podcasts, you wouldn't be doing the social media, right? If those that do you know, those that do put out, you know, great articles in medicine, those that do the really big studies, those that you know, are big actors, they all put themselves out there. And I'm not putting myself in that category category, by all means. But if you if you're going to do something that is meaningful, then you have to put yourself out there. If you're going to do something that is very safe, and in your comfort level, then you're just stepping on eggshells, and you're doing what 99% of the population does. So then you're not really putting yourself out there. So it was very uncomfortable. You know, my my all my colleagues have laughed at it. All my colleagues have had have commented on it. I still, I still to this day to this day, get comments about it. But yes, I you know, you just have to put yourself out there.


Ben 27:06

I know. But yeah, that's I mean, sorry, that I just wanted to say I think this is what I like about it is because I think a lot of the things that we put out there in today's day and age is so polished, but yet those videos are so you and that's that takes that takes, that's that. I mean, I'm I admire that. And it's not like something that you've polished, and it looks super clean, and like, does, it's gonna make you look great. No, this is you're doing something innovative. And it's, it's, it's fun. Sorry, definitely go ahead.


Daphna 27:35

No, that's exactly what I was gonna, kind of what I was gonna say is, you know, there was a need, right. And if sometimes we wait for everything to be just so then we don't feel that need. And so I just think what you know, because you were innovative, and you're willing to put yourself out there, we have all of that content, which is which is phenomenal. And one thing we haven't talked about yet is most of your content is also repeated in the Spanish version. And so that is exceptionally valuable. And actually, I hope you'll speak to that a little bit. And also, what are some other ways that we can, you know, mitigate some of those language barriers for our patients or families who are not English speaking?


Speaker 3 28:22

I appreciate you bringing that up. The culture and Spanish, specifically, yes, I actually appreciate you bringing that up, I need to do better. I, I challenged myself in the last three months, because I would like to do more Spanish posting. And in fact, I have a physician down in South America that reached out that we become friends who actually said, you know, go ahead and do the English posts and to me, we will, I will translate it and help you out in what I can. And she's been a helpful resource. But, you know, it's, we still have a full time job in medicine. And so it's been really challenging because I really want to put more content in Spanish and I made that my New Year's resolution for 22. So for those that have followed me on Instagram, beuter type on their math courses in Espanol, pero Steris. I'm going to try and put more Spanish stuff for you guys. But speaking now to you know, other cultures and cultural ethnicity, cultural sensitivity, and specifically specifically working with the Latino culture, or one of the things that we have to keep in mind when you're working with Latino with other cultures. But again, I can't speak to other cultures as well as I can speak to the Latino culture. And that is that when you were there Latino culture and again, I don't want to generalize but in general, now I'm saying in general Have you the with the physician is seen as the the Lord, when the physician says this is what we're going to do, the families will agree no matter if they really want to do it or not. And so a lot of the time, the response will be yes or yes, sir. Yes, sir. And so you have to be very careful. You know, when you're asking a question that you really want to, if you're really trying to gauge what the family wants to do ask it in that way. Look, we have these two options, there is this option A and there is this option B, you really do have a choice. As opposed to, okay, we have Option A or Option B, we can do Option A or Option B, we, you know, which one do you want to do? A? So or they'll say, which one do you want to do? Okay, so that the again, just because of the culture of the physician, the Latino physician is seen is seen is has such, it's such a high regard, it seems so highly regarded that sometimes the again, the Latino families will say yes to anything. If you really want to give them an option, make sure you pose that question like that, and emphasize that they really do have an option that there isn't a better one or a B is better, that they really do have an option. And that would be one thing. And then just because you speak Spanish doesn't mean you understand the culture. So really, if there is something you really want to get across, it's more cultural. And you know, some Spanish makes sure you bring in a Spanish interpreter. So that you really clarify the culture part or the cultural aspect. Because sometimes, again, there may be some culture behind some of these more complex decisions. If it's just about some general questions, that's fine. Use your Spanish. But if it's a little bit more of a complex question, you're trying to get around that there may be some cultural aspects behind that. Make sure you use a Spanish interpreter, even if you majored in Spanish.


Daphna 32:31

That's a point I think, you know, that's a good reminder. And you said not not just for one specific culture, but for you know, any culture and understanding? Or no, I'm understanding that you may not understand right, so being able to ask questions, asking for support. I think that's such a valuable message.


Ben 32:59

I wanted to get your take on on the concept of expertise. I think that you are a, you're a young physician, and you do all these things, right? I mean, we haven't yet talked about your involvement in global teaching and research. But for the young physicians who are listening to us, or even for older physicians, I guess it doesn't matter. But I think that in medicine, there's always the sense that you're you're always a learner, and you people may forego the idea that you're also an expert, and that you have valuable information to share. And many people I think, would not feel comfortable doing what you're doing. Because they would give themselves the excuse of oh, I'm not an expert. I can't I can't I can't educate people on this. Can you? Can you share with us a little bit as to? What does it take to become to reach this level of expertise that actually gives you the power and the freedom to to share some of the knowledge and do it in a comfortable and wholesome way?


Speaker 3 34:01

That's a That's a great question. I think well, I'll also repeat what one of my research mentors said, when I was in college because I remember going in to give a talk when I was doing my biology course. And I said, you really want me to talk about this. I am just an undergrad. And he said Prem, nobody knows. You're giving a conference about the drosophila. Nobody knows anything about the Drosophila melanogaster. So you're the expert in the room. And so I started three years, I did genetics research on Joseph Illumina and a Gasser with with his Bob Rania at UNC Chapel Hill. And so this is I think anybody's an expert, when you are the most experienced person in could be A group of two people. And so that in itself should give you the confidence. If you know about a topic more than another person, then that gives you the leeway if you will, that gives you the idea that you are an expert. That doesn't mean that you know more, it gives you the expertise of a topic, that doesn't mean that you know, more than the other person. And that's where I think even the most knowledgeable person about a topic and this is something that you both I'm sure with your own mentors in your training programs. I've, I've had the wonderful experience of having great mentors, in my in my training programs at Duke Hospital in Alabama with Dr. Walley Carlo, where I've seen amazing people who have written the papers, who have you know, developed, you know, the most amazing technology or research, and then you see them and they're the most humble in a table. And they're the last people to talk, you know, and and, you know, everybody jumps on an answer first, and they're everybody's discussing, and they're the last people. And, and you I always wondered why and I remember asking, you know, you know, you know the answer to these wagers like No, no, because I'm gonna let everybody else discuss. Because I want to learn, I actually want to learn which everybody in the room is saying, that way I gather more information. And ultimately, I'll say, if I have if I have anything else to say, I'll add it at the end. But usually I don't everybody's already said I have very smart, I'm surrounded by really smart people. And so yeah,


Ben 36:57

I think that's, that's so that's so cool. What you just said, I think the idea that expertise comes with humility is is something that that is paramount, because it just means that you need the humility to understand you even if you are the person who wrote the textbook, there's still like, a wealth of knowledge you don't know. And, and that's that humility allows you to speak to other people about a topic with the humility of saying, hey, and I still don't know everything. I think that's, that's really, really cool. Definitely, we're gonna say something I'm sorry.


Daphna 37:30

No, I, I mean, not everybody with expertise has humility, but it's so true. Such an interesting perspective. And I'm hoping that we will have this opportunity to actually talk a little bit more about your areas of of actually expertise, because of your research. But I don't want to miss, especially for we have so many trainees who listen how prolific you were as as a trainee as a fellow. And if you have any tips for people, just starting out in research careers,


Speaker 3 38:08

that was, you know, lucky enough in my training to be able to during residency, and as I was looking for fellowship positions, I wanted to go specifically to a place that would that I would find a mentor, that we could continue to bring me along in my research path, if you will. And when when you start your, your fellowship you feel like you may have for those that have an inclination of where they want to go and research. I think that's great. Most people when they start fellowship, they have no idea. And one thing that I've realized is when you go to a place in your fellowship, it's really up to your mentor. And this is why it's really important where you choose your fellowship, your mentor is usually the one or a mentor in that program is usually the one that sort of finds you and will will help you mentor you into a research project. Sometimes it's something that you do just during your fellowship. Sometimes it's actually something that you suddenly do for the rest of your life. And for me, it was I was again lucky enough to have Dr. Wally Carlo from UAB one day walk in and he says, Look, I have this great research project didn't you know, the the NIC he wants to do something with caffeine, and I've got you know, they I think you could, you know, take this project on. I said I don't know anything about caffeine, except that I drink it every day. And he said great, well you got a few few weeks to start doing you know, reading and you know, lo and behold, I was lucky enough to be able to present that at the NIC HD and we had this project accepted and with with obviously He has wonderful mentorship. And you know, this is now what has become in his culinary currently recruiting. This is the Mocha trial that is kind of recruiting in the NIC HD right now. But again, this is all things do just wonderful mentorship. So this is just something that I always tell our trainees, you may not know what you want to do in research, but be open, when somebody comes to you and says, Hey, I've got this idea. It may not be something you even thought about, but you know, sleep on it, think about it, maybe it is something that, you know, you could be part of your future in, you just may not know it.


Ben 40:44

I love that. I could not agree with you more, I have seen so many trainees say no to opportunities. And it's like, yes, it may not be the topic you had envisioned in your dreams that it would be but like, there will be opportunities that will present themselves that will make this super exciting for you. And that will lead to even more interesting opportunity. So I think that's super, super true.


Daphna 41:04

I was the trainee who said yes to all of the opportunities, and that were in between.


Speaker 3 41:14

That's it and you're right. And you may say, you know, yes to 10. And we, you know, one of them pans out and that's suddenly happens to be your career. And, and, you know, again, I I never thought saying yes to caffeine would be what I eventually become an expert. And I thought, sure, you know, why not? It seems like a big undertaking, but let's do it. And they were rejections. You know, you just but you go with it, you stick with it. And like you said, your mentor knows. And that's why again, it's really important to have a good mentor, yeah, they wouldn't put this on your lap, if they would think this is not something that's going to, you know, it's going to give you an opportunity.


Ben 41:58

So since we're talking about research, I, I wanted to talk to you a little bit about your research, and most importantly, your perspective on research. I think I see the work, you're putting out on everything on every front, both from the academic standpoint, to the social media stuff. And really the key in my opinion, what drives you is always to try to have some form of impact. You're not trying to be popular, I think you're just trying to make a difference for like you said, if it's for two people, I feel like the videos you make on YouTube, if they impact two people, you will feel satisfied and feel like alright, that I've done something meaningful. And so then I want to get to salsa, right, which is this, this this term, I think that you coined where you, which stands for surfactant administration through laryngeal supraglottic airway. And I wanted to talk to you about this because it's a form of non invasive surfactant administration. And we know that there's others, right, we know about Lisa, and we spoke on the podcast about mist. But what I like about your perspective on this new technique is you're thinking about low and middle income countries, and you're thinking of global global ability to improve neonatal care. Can you just before asking any questions? Do you want to talk to us more? A little bit about that?


Speaker 3 43:19

Of course, yeah, let me mention, and I do want to clarify. So this is a term that was coined. My with myself, with Carrie Roberts, Dr. Kara Roberts, and Scott Guthrie. This was coined last year, this is not a new method. This is a method that had been researched. Now, probably for the last 10 years, with several small studies, the biggest studies work, the biggest study was done by Dr. Kerry Roberts, who's part of again, one of the three that was that coined it. But we basically coined this term, because there has been all these different studies, and they had very small variations in how this was done. But we wanted to basically come up with a term that kind of came up with all the different small variations into just one big term that everybody could, could use and become familiar with. And we were, you know, really a blast. We had been talking about this essentially, for the last two to three years. We were now blessed that it was picked up now by the American Academy of Pediatrics. It was published in October, in, you know, it was journal, yeah, annual reviews. So we were really blessed that now it's gone into the American literature as a coined term. So that was really amazing. And so


Ben 44:36

for the people who are not familiar, it means that you're putting an LMA, you're, you're occluding, the esophagus pretty much. And then the, the the opening that's left in the oropharynx will be the trachea in which then you instill surfactin through


Speaker 3 44:49

that is correct, exactly. So it's basically given surfactin through a laryngeal mask airway. Again, that is a copyrighted term. So we're just giving it through an LMA. Right. Yeah, and so the the idea is a lot of the idea behind trying to give, we know that obviously giving surfactant through a plastic tube through an endotracheal tube is traumatic to the trachea. And obviously, in the last, you know, 1015 years, people have been looking for a way to cause less trauma caused less long term trauma, which is bronchopulmonary, dysplasia, chronic lung disease. And so different methods have been coming up of which I think most people are familiar with the Lysa method, obviously, given given the same level of surfactin, but obviously doing it with a thinner catheter or thin cathro administration TCAS. So it can be done that way, as well. And I think this has been sort of the biggest and most studied, it's been studied a lot in Europe, it's, you know, been studying has been sort of catching on lately in the United States. And I think what's really clear, and I really bring this out to the audience, is that salsa is not something that's going to overshadow. And it's not one thing that's going to cover all. And this is what we really wanted to emphasize to everybody because obviously, as we publish these things, and by the way, we're about to submit a paper actually today. Yeah, actually, just today, we were just submitting this today talking about Celsa in low to middle income communities. So look for that has something hopefully will be published. By the


Ben 46:34

time the episode airs. Hopefully it's published. Yeah, this is January 12. So So yes, I'm very hopeful.


Speaker 3 46:41

That's true. That's true. So the the idea behind using all these different methods is that there really isn't one method, as you know, we met already mentioned, cell. So we already mentioned like, there is also aerosolized surfactant. And I think sometimes as researchers, people try to focus down and find one magic bullet, right, when you do basic science research, you're looking for one protein that if you fix one little protein, suddenly everybody all the all the cancer is gone. And that's, you know, we'd love it if that was the case, but unfortunately, it isn't, there are so many variables involved. And so this is the same thing I would say, for when we're looking at non invasive, you know, surfactant delivery, there isn't really one thing that's going to work for all babies, I don't think Lysa is one method that's going to work for everybody. I think it's there's, you know, there's some variability, and for some babies, it works really well. But keep in mind, when you're doing Leister, you're still having to, you still require an expert to be able to visualize the cords, you're still essentially putting a plastic tube inside the trachea. Granted, it's much smaller. So you know, there's still that, but again, it's more so the expertise, you're still causing some trauma with the fact that you're using a laryngoscope, to be able to visualize, you're still causing trauma to the airway, so no to the artifacts. So there's still that the LMA has been shown, you know, when you're in the biggest study, as I mentioned with Dr. Roberts, you actually are decreasing the need for intubation on mechanical ventilation in the biggest study that was done in 2017, you're decreasing the need for mechanical ventilation or intubation. 38% versus I believe, 64%. So there's, you know, nearly half the need for that. And then if for unsuccess unsuccessful attempts, really the first unsuccessful attempt 8% versus 20%, when you're using the sales method, so it's something that's really proven. And the best thing really, is that you don't really need the expertise. There is no visualization needed, there is no laryngoscope needed. So this is where I think the use of salsa is something that we're trying to find as already, by the way, it's already been used. We actually have a Facebook group that you guys can go into and look at, look for salsa, salsa surfactant, and it's already been used in many countries, Egypt and Azerbaijan and Turkey and Israel. We already have videos sent from all these different folks, because if you're in an area that doesn't have a neonatologist right there, and you have to give surfactant, those babies have no chance. Or if you have to, or if you don't have the means to transfer a baby and you keep them there and you put them on CPAP but you have high high pressures or a Nivea and you have high pressures or you're intubated. You wouldn't If you keep them on high pressures, then you you know, transfer them eight hours, you know, that's time that you've lost when you really could have actually given surfactant, then transfer or maybe given that surfactant and kept that baby. And that financially is much better for that hospital or for that country, itself. So this is a way that we're trying to look at being able to hopefully decrease the cost. So it's both cost efficient, but more importantly, really, really good. Obviously, for the patients in these types of scenarios. It's not that big of a deal for you know, level fours to be able to, you know, us, for us, it's very simple for us to be able to intubate very quickly gives her fact and at this point, obviously, as you as you know, we can use an LMA for babies on extreme prematurity. So salsa is not something you can use for the smaller babies. So again, goes back to the fact that salsa is not for every single baby. Like, again, this is where you can choose different methods for different things.


Daphna 51:03

And I do think there, there are probably still communities in our country here in the states where this is certainly of value, especially, like you said, if they don't have access to someone who's a trained incubator, and it could potentially, you're right, decrease transfers, transports away from families, and be for some babies, the difference between life life and death. And this is such a good reminder that our neonatal community is worldwide and so many of the neonatal deaths are happening, you know, outside of level for NICUs. Right. And so I'm hoping you'll speak more about kind of the global community and what what you think are other ways that we can have impact on on the global network and, you know, reducing neonatal mortality everywhere, not just, you know, in our very advanced, technologically advanced NICUs


Speaker 3 52:08

Yes, and I appreciate, I appreciate that. And this is obviously, one of the things as we started talking about this at the start of this podcast, was that when I left Peru, I wanted to make sure that I would, you know, go back and educate and, and help my Peru. And in living in the United States, I realized that you know, what, my Peru is not just one country, but really it's the whole world. And, and it's not just about the babies and the children in one country really is about the whole world. And I was just really blessed to be able to, you know, be with, you know, at Johns Hopkins, all children's, they, we have a very big international presence. And with that, I've had the ability to be able to, you know, give a lot of talks and be able to go around the world giving talks and educating about different topics of neonatology. Some of the the interesting things that we've had is actually we've had before the age and the era of thought of COVID, we actually had nurses and physicians come to our unit. What's really interesting is when they come and they visit our NICU, which is one of the biggest NICUs in the country, and they walk around and they see everything and we talk to them and they spend the week with sometimes they would spend two to three weeks, I would always have a sit down at the start middle and at the end. And at the end the conclusion I always always tell them Well, what what are you going to take back to your country? And every single time was well, nothing because we don't have you know, $3 million incubators. And that was the that was the one thing they they would hold on to it was the we don't have the technology. And I said no, no, no. What else? What else that's not money related? Could you have learned from here to take back to your countries? Right? And that's, and that's what I try when I go and I've been, you know, down to Argentina and you know, been to Azerbaijan, and we've been to Israel and Turkey and some of the other countries in South America. When we go there. We don't give talks about aerosolized surfactant, because that's not going to help them. I don't talk about well, if pulmonary hypertension doesn't work, they go ahead and add nitric oxide. And if that doesn't work, go ahead and do ECMO. Because there are very few countries in South America, in fact, probably one or two that would be able to get to that level. So you have to think about what are the other things that you can do to minimize that. Things like setting up a delivery room checklist prior to the delivery. Do we Have all the implementations that we need everything ready, is the warmer, set up and ready. As opposed to arriving into the delivery room and nothing's set up is the baby somebody brought to a warmer bed and it's off, and there is no bulb suction? And, you know, the warmers not a, you know, do we have basic resuscitation equipment in the delivery room? Or do we need to call somebody to bring in an umbilical line, that may take a minute and a half into the delivery room, where you may not have a minute and a half. So basic, you know, things. And again, I, I don't know what other countries have set up. So I hopefully I'm not insulted in other countries. But I have seen some of this with my own eyes, where some of these basic things like like I said, like checklists, like basic equipment, like having a plastic bag, you know, as, as you know, to be able to warm that most countries now catching up to this. But before babies would get cold in the delivery room. And by the time they would come up to the NICU, they would be 3435 degrees, right? Luckily, again, we're not the countries caught up to this, and most countries have caught up to this now. But simple interventions like that. There are other countries on in South America, I'm sorry, in Africa, were part of the culture was to wash the baby, because it was a cultural thing. But obviously, right after the delivery, they would get immediately cold. So then that practice had to change. So a lot of the things that we try and do is sometimes we go down to other countries, I go to the into the hospitals with a team, and we see what is the practice, maybe they're using too low of peeps, and they're getting at like the trauma. Maybe they're using too high peeps. And they're getting. And they're having, you know, Barrow trauma, you know, how are they managing the events, things like that. Sorry, Ben?


Ben 57:06

No, I was gonna say, Do you think that there's a burden in this day and age now for journals and other publication outlets to provide to publish research that either studies or proves ideas and concepts that are applicable to a wider audience? Because I think sometimes we're really like, like you said, we're, we're working with millions of dollars in terms of equipment, and we're trying to perfect on top of super expensive equipment. And maybe, as you said, maybe more basic approaches for a wider population might be more beneficial on a global scale. I'm curious to see, to hear your take on that, from the standpoint of journals and publications outlets?


Speaker 3 57:48

No, I think that's a great point. And, you know, we are so lucky that we have a group such as the NI CHD, here, that, you know, always comes up with, you know, great information, and, you know, always coming up with a lot of information. But a lot of those units are level fours with a lot of money and the highest equipment available. So a lot of the data that comes out there is not applicable to Southeast Asia is not applicable to the mountains of you know, Peru. And right. And so, so that's where I go and give a talk. You know, I gave a talk a few years back in Argentina. And I didn't realize as I was, given this talk, I was going through some of the slides, and they they said, Well, when you're doing the nitric oxide, you know, the barrow metric. pressure here, is this in this, what do you have to do with nitric oxide? I know how to answer that, you know, of course, here in Colorado, I'm sure they have to deal with that. But I had never dealt with that in Florida. So So you know, some of those things, that's probably not the best example. But you know, these are I agree with you, I think, you know, we have such a an American view, sometimes the way we practice here, that for those that are interested in global health, we do have to open up our vision, we do have to think of medicine now at a global level, because it is our duty to do so when we're dealing with babies. And we can't be, you know, just focused on babies here. We need to think of babies and how they how other countries practice, but the only way to do that is to go out there. You can't, you can't imagine how that is you actually have to go to a hospital in Azerbaijan. Walk in there and see the setup so that you can take it back here and understand how that practice is. Yeah.


Daphna 59:52

Yeah. When we talk about, you know, accessibility, and that's something we really like to focus on is you know how Can we get information to people that is, you know, meets them where they are. That's why I think what you're doing on social media is so valuable. And because there's no necessarily a paywall, right, there's no subscription. And so I think we can reach more people that way. And I wonder, and in terms of, you know, people doing research, any recommendations for how to provide more access to the work so that so that everybody can be making improvements everywhere?


Speaker 3 1:00:37

Thank you. Yeah, that's a good. Yeah, I mean, there are different groups. You know, I'm actually part of a global health group. And there are different groups that are trying to do that the American Academy of Pediatrics has some working groups, they are some private groups that are trying to really understand the global health there's, there's a group through the through Atlanta as well, neonatology group there, I think we are recognizing, I want to give props to that. We are recognizing, really, in the last 10 years that we are not alone, that we're not siloed in the United States. And not only that, but also that the level four is not just the way we should practice, we are beginning to understand that community babies and community hospitals are different than our level four. So we have to give props to how that's been managed. But we're not there yet. And we do need to improve that. And I and I think that's why social media and again, it's, I'm just really the start of that there's really been a lot of there are a lot of other social media doctors and nurses that that you know, are way bigger and have I have had, and continue to have a much bigger impact than I have, that are really trying to get out to the periphery of the world. And I think that's really starts there. There's a lot of folks, not not even physicians and PhDs that are trying to get the specially and again, I don't want to get too much too deep into that. But especially with COVID, and a lot of disinformation out there. They're using social media as a platform to Trump that disinformation. And as far as research is concerned, to really try and get research out to those, you know, everybody has social media, everybody has smartphones, in all corners of the world. So this is something new now that we're trying to get research out through social media and actually maybe even through apps


Ben 1:02:54

Yeah, we're getting we're getting to the to the end of the of the show so I wanted to touch a little bit on on family life I know that your wife is also a physician, and you're doing so many things and you're so driven I'm wondering how do you keep work life balance homeostasis alive I mean, it's just it seems it seems like my wife is also a physician and it's always very difficult to think when all these competing interests are in the home what is your secrets to a healthy and happy household?


Speaker 3 1:03:30

Well, we we schedule our dates now. Great, right right. No, essentially what you have to really be it's funny to say this, but you have to make an effort to relax and you have to make an effort to find you know date times and define time with your family. And just like you do you know scheduled time to write a paper just like you scheduled time to you know, read an article or read a few things you need to do or be if you have an appointment you have to take family time and you know daytime with the with a significant other as serious as that why not it should be even more serious, if you have an appointment with the with your cardiologist you know, and you cannot miss that. Well you know, this these are matters of the heart with your wife. So that should be taken serious and you better not be late. So So you need to schedule that you you will really do with with with my wife, we really do set a date time and we say okay, all right, we're gonna do Friday from this time to this time, no matter what we are, you know, going out and you know, we right now with COVID Obviously we have some restrictions and going out by You know, we, we do what we can. Same thing with with the kids. Right now. It's a lot of soccer games and picking up here and there and all that. But you've got to have time for that for the family. And in time for yourself. I was talking to Ben, I'm learning Japanese. So I, yeah, so depressing for


Ben 1:05:23

me to hear that. It's just no,


Speaker 3 1:05:24

no, it Duolingo Duolingo app, there's my plug my plug for Duolingo it's really great. Five minutes, 15 minutes a day. Now it's, you know, because it's, you know, you just got a, you know, gotta do something for yourself as well.


Ben 1:05:41

I was reading this book by Jake Knapp and John Zaretsky called make time how to focus on every man on earth matters every day. And they're saying exactly what you're saying, like, put, put family time on the calendar. And yeah, and they were giving that and they were saying, and they were even giving this tip, which I'm following now, which is every day, try to say what's going to be the highlight of my day? Like, what is the one thing today that I'm looking forward to? And it could be something very menial like saying, I'm going to have dinner with my wife and kids today? Yes. And for us, we're working in the hospital. It's not always something that's available to us, right? Having dinner at home with wife and kid is not a given. So when you say you put that on the calendar, and you're like, oh, today, the cool thing is that I'm going to have dinner with my family. It's makes your whole morale like it boosted so much.


Speaker 3 1:06:27

It makes it exciting. Exactly. You look forward to it. You're like, Oh, my tomorrow I'm having dinner. I'm having a date or I'm going by you know, biking with my kids. Yeah,


Ben 1:06:36

that's exactly right. It's exactly. Anyway,


Unknown Speaker 1:06:38

how would you definitely what's your what's your secret?


Daphna 1:06:41

No, I was just saying this may be the most important thing we talked about. You is yes. Yes. Work. You know,


Unknown Speaker 1:06:51

that was the bonus tip. Bonus tip. Yeah,


Ben 1:06:53

exactly.


Daphna 1:06:56

Are my meeting with my daughter, it's always my daughter's idea. We we picked up gratitude journals this year. So and in she's working on writing, right. So we we write in our gratitude journals together. So but


Speaker 3 1:07:14

that's beautiful. Cool. That's beautiful.


Ben 1:07:18

Yeah, that's yeah, I mean, my, my, my new year thing with my daughter is that we've we're going to try to do something that neither of us knows how to do so so we're gonna try to do like some electrical engineering projects, which I think about. And so we bought a bunch of stuff and it's sitting now in her room, and we're going to have to like, work with we had early delights and strips and so we're going to do that together. That's going to be fun. But


Speaker 3 1:07:41

that's fun. Fun. Daddy Daddy daughter project, right? That's


Ben 1:07:45

exactly right. Yeah. Anyway, Prem, this was this was a lot of fun. I learned tremendously from you. And from what you do, I think everybody who hasn't already followed or checked out the NICU doc online and you're you're everywhere you have your website, which we'll link in the show description and on the website, go check it out. And and I think it's inspiring I think if you're a family if you're, if you're a NICU adjacent, or if you're a NICU provider, you there's a ton a ton to learn. And if you and even if you're a fancy physician, and you think you know everything, there's still things to learn about, like how to disseminate information. I think this is really valuable. So thank you for your work.


Speaker 3 1:08:23

It's been a real pleasure. Really, you know, the time has gone by so fast, because it's just so it's so fun talking to you about you guys do an amazing job with this podcast. I follow you guys every single time. Thank you for the time I've had with you all. Real fun.


Daphna 1:08:39

All right, everybody. Have a good one. Bye.





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