#114 - Dr. Shetal Shah MD

Hello friends 👋

This week we have the pleasure of hosting on the show Dr. Shetal Shah, or NICUBatman, as you may know him on social media. Dr. Shah is the first of a series of guests we are having on the podcast to discuss the subject of advocacy in the NICU. We hope you enjoy this episode. Happy Sunday!

Do not forget to register for our upcoming conference March 27-29 at www.delphiconference.org. We are encouraging our listeners to register by offering a 30% discount by using the code INCUBATOR at checkout.

-----

Bio: Dr. Shetal Shah is a practicing neonatologist and researcher, and a Professor of Pediatrics in the Division of Neonatology at New York Medical College, the academic affiliate of Maria Fareri Children's Hospital, a member of the Westchester Medical Center Health Network (WMCHealth). His research focuses on understanding the role of the neonatal intensive care unit in providing public health measures, particularly vaccinations to parents of admitted infants. He also aims to conduct research, which through sustained advocacy, can be translated to policy.

Dr. Shah’s work on providing parents influenza and Tdap immunization in the neonatal intensive care unit has resulted in two New York State public health laws. He was the principal advocate for the 2009 Neonatal Influenza Prevention Act and the 2012 Neonatal Pertussis Prevention Act. His work on the cost-effectiveness of donor milk for high risk neonatal infants resulted in co-authorship of a legislative measure mandating New York State Medicaid provide insurance payment for this vital resource. His current work focuses on the safety of administration of live rotavirus vaccine to preterm, NICU-hospitalized infants, bedside adult pneumococcal immunization and point-of-care smoking cessation referral.

From a basic science perspective, Dr. Shah’s current work examines the anti-inflammatory properties of stem cells on lung recovery from pulmonary hemorrhage and hyperoxic injury, focusing on cytokine biology and fibrosis. He is a recipient of many honors, including the American Medical Association’s Leadership Award, the National Physician Advocate Award, the New York State L. Stanley James Award for Perinatal Medicine and the March of Dimes Excellence in Advocacy Award.

----

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

Ben 0:54

Welcome Hello, everybody. Welcome back to another episode of the incubator. It is Sunday, we have an interview scheduled for you this week. Daphna, how are you?

Daphna 1:06

I'm doing great. I told you, I'm on vacation. Alright. Enjoy yourself, and you're coming back from vacation. So we're, we're like to two ships in the night, as they say

Ben 1:16

staggered, staggered competition, as we would say in organic chemistry.

Unknown Speaker 1:21

That's true. That's true. Remember that. It's back there somewhere.

Ben 1:28

Thank you to everybody who registered, we are almost out of seats. For the Delphi conference. We're very excited to see everybody there. If you haven't yet registered, there's a few seats left, you can use the discount code incubator at checkout to get a listener only discount. We're very much looking forward to seeing everybody there. We have other projects going on in the worst, which will tell you all about after the conference has passed. And for now, I think we should probably just introduce our guests because today we have the pleasure of having on with us Dr. Shuttle Shah, who actually many of you know probably from Twitter and from his work in advocacy, and he spearheaded this idea of maybe us doing a series of episodes on advocacy in pediatrics and neonatology. And, and this is what we will do. We've we've we've recorded already a few episodes and they're going to be released in the coming weeks. And so look out for them on various aspects of of newborn and perinatal care. They're very interesting. We're talking to very interesting individuals that we were fortunate enough to be connected with through Dr. Shah. So yeah, this is this is all very exciting. So I'm just gonna go through Dr. chars bio, he's a he's a practicing neonatologist and researcher, a professor of pediatrics in the Division of neonatology at New York Medical College, which is where my brother studied at and which is the academic affiliate of Maria fareri Children's Hospital. He is a member and a member of the Westchester Medical Center Health Network in New York. His research focuses on understanding the role of the neonatal intensive care unit and providing public health measures particularly vaccination to parents of admitted infants. He also aims to conduct research which through sustained advocacy can be translated to policy. Dr. Shaw's work on providing parents influenza anti gap immunization in the neonatal intensive care unit has resulted in two New York state public health laws. He was the principal advocate for the 2009 neonatal influenza Prevention Act and the 2012 neonatal pertussis Prevention Act. His work on the cost effectiveness of donor milk for high risk neonatal infants resulted in CO authorship of a legislative measure mandating New York State Medicaid provide insurance payment for this vital resource. His current work focuses on the safety of administration of live rotavirus vaccine to preterm NICU hospitalized infants bedside adult pneumococcal immunization and point of care smoking cessation referral. From a basic science perspective, Dr. Schatz current work examines the anti inflammatory properties of stem cells on long recovery from pulmonary hemorrhage and hyperoxic injury focusing on cytokine biology and fibrosis. He is a recipient of many honors, including the American Medical Association Leadership Award, the National physician advocate award, the New York State L. Stanley James award for perinatal medicine and the March of Dimes excellence in Advocacy Award. He is a superstar. We're very honored to have him on the show. Definitely join us and you all join us in welcoming to the show Dr. Shadow shot. Cheryl, thank you so much for being on with us today on the podcast.

Speaker 3 4:34

Oh, thank you guys so much for for having me. I feel honored and worthy. I mean, you had you had Ravie on and then when I heard that Ravi was on I was like, Robbie's on I gotta get on.

Ben 4:46

Is that Yeah, the peer pressure is strong on the podcast. It's no

Speaker 3 4:49

it's Robbie was one of Ravi was one of my rugby was a resident at NYU, and I was his. I was his fellow. So I see. So we've known each other. We've known each other for years.

Daphna 5:01

that's how that's how we get a lot of guests word of word of mouth. So we'd

Speaker 3 5:04

love it. It's also one of the great things about our field. Right? Which is that your Yeah, the field is only about what 4000, maybe 4500 or so neonatologist across the country? That's right. Yes, here and here in the States, right? So you're, it's, you're really never more than one or two degrees of separation away from away from anyone. Yeah,

Daphna 5:23

I think I didn't notice that as a, I didn't understand that as a trainee as a fellow, that how small the community really is. And I didn't think we really felt it until we started doing this podcast. And so, you know, we're, that's what we were trying to do with the podcast is make the community feel even smaller, you know, so that people really could get to know each other get to know people like you. That's why That's why we have you on

Speaker 3 5:48

today. Nobody, it's really amazing, right? That you can pick up the phone pretty much across the country, and get in touch with one of your colleagues, particularly about a sick patient, and, and run something by them, not just your colleagues, of course, your your sort of first round of colleagues, the people in the office is right next to you. And they'll pick up the phone and they will troubleshoot a patient with you. And they'll they'll teach you they'll give you a different perspective. I don't know of a lot of other fields that are that close knit. And I think it really is just because, you know, a lot of neonatologists I think just because of the nature of the training, that and the nature of our perspective, we all tend to have fairly similar personalities. We're very, I mean, we're different people, of course, but but we're sort of all united in this sort of field of like, if it's for the babies, we'll do pretty much anything, right. So I once joked about it, I said, you know, someone came out with a neonatal study that if you rounded in, you know, Pokeyman costumes that it reduced the rate of BPD, suddenly, everyone would dress like Pikachu. Right? It's still proud. It's just what we would do. Right? So I love the fact that, you know, if, if I can't, you know, if we have an incredibly difficult patient, I have colleagues here, but I also have colleagues around the country who, in many ways could be in that Niki with me if I called them up, and I really needed their help.

Ben 7:16

What do you think that says about? The, the, the bond that's being forged during fellowship? It's something that I've spoken to many people about where it's like, these types of have, you get to fellowship with people, you've you've usually most of the time, you don't know. So the three people that I went to fellowship with, I didn't know before I started fellowship, and this bond is being created. I'm not exactly sure what that crucible, what are the pressures that are in this crucible, but you develop a bond that, like you said, if I haven't spoken to my friend Waleed, in three weeks, a month, two months, the fact that we were co fellows, I can call him day or night, and he can call me day or night. And and we will talk right. And I'm wondering, you are in an academic institution, you you deal with trainees all the time, what is it about this, this, this Communitas that is happening in fellowship that creates this bond, you think?

Speaker 3 8:11

So I'm going to sound a little bit sort of crotchety old man. So I'm going to preface that when I say that, but I, I don't know if I see it as much with the residents these days. And I don't know if it's the 80 hour work week, or the fact that a lot of them. Some some of them have come to medical school with a lot more career and world experience. Or maybe it's because I'm just not in the trenches with them day after day after day after day after day. But, I mean, I can bump in, I could go to a conference and bumped into not just people from fellowship, but people from residency. And within five minutes, you know, we're back to being exactly the way we were when we were residents might my wife who's in the business world said something many, many years ago that I kind of remember what she said there's something about medical training, you know, a lot of people graduate from college, and then they go get, you know, jobs and then maybe go back to school or or, you know, follow their own career path. But we go, when we go to medical, we go to college, where we have a certain degree of sort of perpetual adolescence. Then we go to medical school where you can still get away with some of that perpetual adolescence. Then you go to residency where, yeah, you're a doctor, but you know, at night when you didn't have, you know, when you're working for, you know, when you're coming in on Monday and leaving on Wednesday, you know, your adolescence is kind of further prolonged, and then you go into neonatology. And you spend your whole day with babies, and your circle gets kind of smaller with just your fellows. So you develop all these inside jokes and all of this type of stuff. So, her whole concept is is I mean I granted her experience doing ontology is really only me so when she says that all it does is make you a perpetual adolescent. You know, that's pretty much what she's talking about. But I do think that there's a bond that is forged through all of our training that sticks with us, you know, really throughout our careers, and, and I don't know if other fields have that anything, and I think to some degree, it's it's neonatology, but then to some degree, it's also pediatrics. I do feel like if I bumped into a pediatrician, like on an airplane or something, you know, you kind of feel like, you give them the benefit of the doubt, right? Like, you just kind of assumed they're a good person. Right? They have to actively prove you wrong, right? Whereas if I'm in the, you know, like, whereas if I'm in the middle seat, and the person to my left is like, you know, some sort of corporate tread lightly.

Speaker 1 10:46

Yeah, no, I'm just saying you mean, not a pediatrician. Yeah. Somebody's not appealing to

Speaker 3 10:51

other, we'll just call them other. Right. They have to work a little harder. Right before I'm going to share my armrest. So,

Ben 10:58

but I think it's so true, what you're saying. I mean, I was fortunate enough to go to a residency program where, I guess, quote, unquote, the residents render render hospital, right. So if I was in clinic, and I needed to send a patient to the ER, I would call my co resident who was on service in the ER that time, and if the patient needs to be admitted, you would have gone to my other co resident who was staffing the inpatient unit. And if they didn't have to go to the PICU, then they would have been another resident who would have right and so I think that creates a tremendous bond where you, you, you've I think, what I guess I'm trying to say is, I think it's the patients that are creating these bonds, I think it's when we're all struggling together to try to get the best outcome for patients that you don't know there's like this unbreakable bond that gets created and I think you have an opportunity to do that in residency. I think it's, it's more variable, because again, if you're in clinic and you send it and it's like an attending who takes the patient over, it's like, okay, like, that's, it's out of my purview. But in fellowship, it's just you handing it off to another fellow. And it's like, I'm back tomorrow, let's and I think, I think it's an interesting bond. And and I've spoken to people in other specialties, and it it feels like it's, it's pretty consistent that the bone in fellowship from fellowship is sort of unbreakable. So yeah, I relate to that.

Speaker 3 12:15

It's this model, though, of like, completely shared responsibility, right. I would imagine that your when you graduated residency, let's not even talk about fellowship for a second fellowship, even amplified, I would think, right. And you're and you're maybe one year out of fellowship, and you're talking to your co fellows, there was part of you that just can't believe that the hospital is still running now that you aren't Yeah, now that you guys aren't there, right. We legitimately felt that I remember bumping in like at a conference, I think I was a first year fellow or a second year fellow, and we just could not believe the Children's Hospital where we did residency was still open, like, how is it? How is it going on when we're not there? Right?

Daphna 12:58

Yeah, you and you firmly believe that you're like the best class or group they ever had, right? The cohort that you and then

Speaker 3 13:05

you just realize, right, you realize, you know, over time that that residency is a train, right? You get on for three years or you same thing with fellowship, you get on for three years, and then three years later, you get off but the train still gonna move. But, but you're so invested in what you're doing, right? You know, the days are long, but the years are short. Right? And that when you're done, you've put so much of yourself into this, that you can't imagine that bliss can still work with you God.

Speaker 1 13:36

It's the cognitive dissonance. When your class is gone,

Unknown Speaker 13:39

the whole hospital has to fold right

Ben 13:42

down. So, so, you've you've taken us off track talking about training already, but I wanted to ask you first you How did neonatology become a passion of yours and and did it did it start from early in med school? This is something that came up during during residency. How did you become a neonatologist?

Speaker 3 14:10

Yeah, so I still feel like I'm becoming a neonatologist, right. I don't feel like any of us actually ever, ever get there except maybe the the true true luminaries in our field, Dr. de Gama. You know, being being one of them. But But no, I grew up in a very in a very medical family. So my sister is a physician, both my parents are physicians. All of my aunts and uncles are physicians, and most of my cousins are physicians. So, you know, the joke growing up was my parents who came came from India in the early 60s, were like the most my mom would walk around and say like, we are the most liberal Indian parents, you can go into any branch of medicine, you know, you don't have to be a surgeon. You know, because my dad was a surgeon. My mom was a surgeon, my sister's, you know, like I said, She's the anti, so Oh, So they thought that they were like super, incredibly liberal, because I could go into any branch of medicine I want. So but but that's just how I grew up. Like, I knew there were other professions out there. But to me, it was a very academic thing. Because every place we went to every friend's house, we went to every cousin growing up, you know, everyone's parents were physicians. So I always knew, you know, from the time I was in second grade, that this is what I wanted to do. Which is very funny, because when I, you know, I've heard people on the podcast and on other podcasts talk about how they loved their pediatrician growing up, or they really remember their pediatrician growing up. Yeah. I didn't have a pediatrician. I know it's so bad. But

Ben 15:54

my daughter hasn't seen her pediatrician in some time. I have to say, I'm searching that from home.

Speaker 3 15:58

So yeah, so. So I go to, I go to college, and I was definitely you know, all in on being on being pre med. I then went to medical school, and I knew that I wanted to do something with children. And at the time, Cornell had the Center for special studies, which was a clinic that was dedicated solely to caring for children with HIV. And so I, you know, back in those days, right before email became really popular. I wrote a letter with a little resume and I went to the Center for special studies, I found the attendings door and I literally taped it to his door.

Unknown Speaker 16:41

And he nailed now Yeah, exactly.

Speaker 3 16:42

And he called and left me a message. And we did our first our first project together, and I really fell in love with really all aspects of, of Pediatrics, and particularly pediatric infectious disease. So I kind of thought, really going into third or fourth year and even into the first year of residency that I was going to do peds ID, I did have the opportunity to see the NICU in my fourth year of medical school, and I really was just blown away by it. I think you sort of walk in to that first, the very first time you walk into the unit, and you just hear all the buzzing. It's like you're one you're overwhelmed until you're completely disoriented. Yeah, but I just loved the way that when we rounded people would take all of this chaos, and break it down into systems and, and make order from it. And to me, it was kind of like those pictures that when you look really far away, they look like all these different dots. But then as you get closer and closer and closer, the image begins to come into view. I really thought that was amazing. I thought what the neonatologist were doing, and the way they had sort of mastered physiology was really attractive. So I then of course, did a sub i in the neonatal intensive care unit, I went to residency where we did a lot of neonatal intensive care unit time. And then I realized that if I do NICU, I get all those benefits, but I don't have to give up infectious disease. I don't have to give up any one particular field.

Daphna 18:21

Now, in fact, she really knew how to use them all.

Speaker 3 18:26

And then, and then I applied and then spent the next three years after North Carolina back around home in New York, at NYU, where I had amazing, amazing mentors, I think at the you know, the best mentors are the ones that kind of let you do your own thing and basically just catch you when you get into trouble. Right. And I had a mentor who was following me Dr. Martha Caprio, who's still at at NYU and Pradeep Molly, who actually was a fellow at this at this program at New York Medical

Ben 19:02

Detroit and the crew at New York University is quite phenomenal. I remember interviewing there and meeting Dr. Molly and all those guys over there. They're just exceptional like that really, really exceptional.

Speaker 3 19:13

Dr. Molly was very funny, because back then there. Let's just say that the use of fellows was a little bit more liberal than then current rules. So I always joke about it one day, Dr. Molly is like shuttle What are you doing? I'm like, I'm reading like, yeah, because his office was right next to like the group of offices where the fellows were, and it's like dinner No, come with me. And like an hour later, we're doing a puppet show for his kids nursery school. about visiting about visiting the doctor and how a duck so you have Dr. Molly hiding behind a little stage going I'm telling me the turtle like oh my god. I was like this is not this is not in the fellowship contract. But still, we're still doing that

Unknown Speaker 19:57

the lines were blurrier than that

Ben 20:01

So the point you mentioned about your parents being physicians, and I relate so much, because I mean, I come from a very typical Jewish family where when my brother said he wanted to be a lawyer, my parents were like, hold on, like, what is like, what is like, what is what is that? And but I'm wondering if you perceive that growing up in a family of physicians Prime's you to be better than average at being a physician, because I have some thoughts on that. And unsurprisingly, like, for example, to give an example, outside of medicine, the World Cup happened not too long ago, and the French team had the player, Marcus jam, who's like the son of a former national French player, and then he's really, really good. But it's almost like, well, of course, he's really good. He grew up in a house that exposed him to competitive football all his life. And so that's why he has a leg up on everybody else. Do you think that applies in medicine as well?

Speaker 3 20:59

I think it's really very family dependent. Certainly, if you have two parents who are physicians, you're, you're not going in blind in terms of the time commitments and but I don't think anyone really goes in 100% fully prepared for what it takes, either. So I, you know, I remember growing up and I just remember, you know, Tuesday nights, my mom was on call, so we didn't see her till Wednesday night. And I never felt in any way like that was abnormal. Because the same way my own kids right? When they were when they were younger. They were, they were just like, oh, Dad's on call, okay. To them. It's all they've ever known. Right? So to be gone for 30 Something hours right? Now, they're adolescents. And they're like, be on call more dad. Call more. stopped bothering us. But I thought that was fine. Like I what I remember about Tuesday nights wasn't that my mom wasn't there because she was covering labor and delivery. It was that my dad was in charge. So we ate McDonald's for dinner. We got to stay up, not just watch who's the boss and growing pains, we got to stay up and watch moonlighting from nine to 10 and didn't have to go to bed until 10. That's what I remember. Right. The one thing that does stick out though, is that is not just sort of the immediate family, but all of the cousins and the aunts and the uncles right, because you really did have a network there of people who you could console not not medically, but just interrogate them more about what their field was like. So I think prior to maybe going into medical school, if there was real any real sort of benefit within sort of the medical sphere, it was they probably had more of a sense going in to what the differences between sort of academics and private practice. What academic head neck surgical oncology is like, versus private practice nephrology, versus, you know, general pediatrics versus adult critical care. So I think that might have been if there was if there was any advantage. I think that was that was it, but I don't think it takes long for everyone else to catch up.

Ben 23:22

No, that's true. But I also I mean, to me, my personal opinion on the subject is a bit exactly like the professional athletes were you. by osmosis alone, you you get that commitment that your parents are making to something of a higher purpose, I think, and I think it's probably the same if you're, if your father or mother is like a firefighter, a police officer, right. And you and you sort of say, this is sort of ingrained in you. And so like you said, I remember my dad like Sunday's when he was on call, like, if I wanted to go play ball, like I had to go and wait for him to round in the hospital. And then we just like kick the ball in the lobby of the or not the lobby, but like right outside the hospital where he used to work at, and it would wait for him. And that's what it was like, Yeah, of course, like Sunday morning. Yeah, I have to be patient and wait for my dad to finish rounds. And then we'll go play. And, and so today when I'm on call in on Sunday, like it's almost like since I grew up, it's like, yes, that's perfectly part of normal, normal life. And in the same way that the football players are being exposed to the, to the rigors and to the discipline of their parents in their training and the like, yeah. And if I want to be a professional, that's what it takes, and so on. So you're right. I think it doesn't, it's not something that's on. That's difficult to catch up to, but it does. It does provide a framework. I think that's interesting as a kid.

Daphna 24:38

What I'm kind of struck by though when you talk about your community really growing up and it sounds like you had both a large but intimate community is, you know, we were going to talk to you a lot about your work and advocacy. And I find that people who go into advocacy really have this understanding about how important community is and that when our, you know, society lacks the, you know, the structures, right to really bolster communities, you know, there you go out and you you're finding ways to create it for others, which I think is, is what really resonated me about your kind of childhood story. But before we talk about advocacy, you have quite a basic science resume. And so I think that's an interesting story, too. You know, probably out of fellowship, you were mostly in the basic science realm. No, you could speak to either or both of those things.

Speaker 3 25:41

Sure. Well, I think that if you're interested in vaccines and vaccination, you, by definition, are interested in immunity, for sure. And, and one of the things we were really beginning to understand at the time, which is much better understood now is the concept of hyperoxia, or the alternating episodes of hyperoxia. And hypoxia, on the immunity, both the direct immunity within within pathogens that are directly inhaled in the lung, but also the systemic immunity, that occurs when a premature neonate gets septic. So that was one of my initial interests was really beginning to understand how hyperoxia or excessive oxygen right can can predispose the lung to infection certainly predisposes lung to inflammation that's obviously well known. And to what extent that might facilitate pathogens that were inhaled or coming into the lung, from becoming systemic. So I spent some time figuring trying to figure that out or are working on that, in fact, one of the students in our lab, who is now a neonatologist at the University of Rochester, who's studying the impact of hyperoxia Andrew dialect, so that of course is one it makes you feel a little old. But, but to it's also great to know that there are people who've sort of taken that baton on, and are really beginning to decipher that incredibly complex network of molecular signals that are occurring as your body is exposed to higher levels of oxygen, and particularly to levels of oxygen that alternate with levels of hypoxia. And one of the things we actually were looking at initially was to what extent that might underlie some of the reduced immune responses that we actually see in babies who are receiving their standard immunizations, that would still sufficient immunity. But it tends to be a little lower than then full term infants. And we were wondering if hyperoxia may or may not have played a role in that. So that was one of the things we were trying to tease out. But, you know, that sort of begins to move you into, into the world of vaccines, which unfortunately, really moves us on, to some extent in this day and age into a political world. As much as I think some of us wouldn't want to be in that political world. The fact remains that, that even pre COVID And obviously, with the with the politics around vaccination, and particularly around vaccine mandates, independent of the data that suggests that they're perhaps the most effective thing we we have ever done to improve our public health infrastructure. Our now for almost 20 years, it's kind of intertwined. And you see it spilling over in different parts of society, right? First, it was just people weren't gonna get the MMR vaccine, right, because they thought there was this you know, fictitious relationship with autism, then it was other vaccines, then it was spreading out the vaccines then, for us it was Hepatitis B at birth, because it's just too early. Now, we're seeing parents over the past few years begin to refuse the vitamin K shot. So it really is beginning to spread in a very, very concerning way. And the thing that that really gets me about all this is that, you know, pediatricians and neonatologist for years, were saying that when our vaccine infrastructure is weakened, these diseases are going to come back. And while I'm you know, while while I'm not saying I'm, I'm, you know, obviously not in favor of people, not of people deferring vaccination but but if you're a mother, and you've never seen any of these diseases, right, we talked about this all the time about how people came to fear the vaccines more than they actually began to fear the diseases that they actually protected them from. I could have I could have sort of put myself in that person's shoes 20 years ago. But we kept on saying that these disasters are going to come back. And sure enough, right we have pertussis outbreaks now every year we 2019 We had a measles epidemic that spread to at least 34 states. Right now, as we're talking, there is a measles epidemic going on in Ohio. We had polio case, we had a case of polio in upstate New York, and polio is still being found in some of the water. So you would think that, well, someone would say, God, you know, they said these diseases, were going to come back. Now they're back. Now we really have to double down on the importance of vaccination. But because it's been so intertwined with this sort of concept of autonomy, and free, quote, unquote, free rights, which I just between you and me that that concept is total propaganda. It's, it's become harder and harder to get people to sort of see that the fact that look, we pulled back on vaccination, because the public, as a society did this, and the diseases came back, and that those two are directly related.

Ben 31:13

Yeah, I think it's a it's a mistake of not being a student of history. I think people tend to forget the impact that poll you had on our society. And I mean, we've spoke about this with Dr. Perry class on the podcast before short, there's

Unknown Speaker 31:32

a great at Edwards.

Ben 31:34

And we're Paul Offit, and there's a great book called The vaccine race where you can get a glimpse as to what that era was like, and people don't understand that, like, parents would leave their kids with polio in facilities and just hope that in a few months, they will be able to come back and pick up their child and they would not have died, because they used to write them in it was an epidemic. They separated parents and children. It's terrifying. And hearing the I mean, if you grandparents are still alive and talking to them about the polio vaccines, how people like we're crying. Yeah, yeah. I mean, it's just mind blown.

Daphna 32:13

I cried when the COVID vaccine. So So I, you know, it's funny that you that you mentioned COVID, though, because it's like the rest of the medical community started to see what pediatricians and certainly vaccine advocates have been working against for decades, right? This is not new. It just became more apparent to the rest of the medical community.

Speaker 3 32:39

They started feeling. Yeah, they started feeling our pain. I think it's one Yeah, you know,

Daphna 32:43

every day in clinic, it's like, you know, discussions about vaccines,

Speaker 3 32:48

right? But the difference is the psychology of it. And I'm not going to I don't want to blindly stereotype adult medicine because obviously, I don't want to do that. But But pediatricians, there's something about vaccination and pediatricians and public health and preventive care, that is just embedded in our training and in what we do, even even in neonatology, right. The adult medicine doctor can sort of say, okay, you don't want your COVID vaccines and can sort of choose not to go there. And then talk about the high blood pressure and the high cholesterol and everything else that we need done at sort of at that stage of the game. Right. But it's almost it's there's, it's like psychologically difficult for neonatologist and well, for pediatricians and to some degree meteorologists to disengage from the preventive care discussions. And I think adult medicine doctors do that better. And therefore, even though they're experiencing what they're experiencing, they're experiencing what we're experiencing in terms of vaccine hesitancy. I don't think it hurts them or bothers them as much. On an on a sort of, on a per capita basis. Of course there going to be individuals out there who are very upset. But I think that that's really something that makes us as a field. A little different. This

Ben 34:14

episode is proudly sponsored by rocket meat Johnson. Recommend Johnson is dedicated to the research and development of nutrition products that help support baby development at every stage, including an extensive and female portfolio for premature and low birth weight infants learn more at HCP dot meet johnson.com. And this is something that I mean, I became familiar with your work, I think as a resident I trained in in the state of New York. So and I think I've met you on several occasions but I always found that it was a peculiar mental to pick up as a neonatologist because it really has there's no glory in in being a vaccination advocate in the NICU. Seriously. It's like, I mean,

Speaker 3 34:56

and it's a lot of work. So let's, let's just dissect that statement first. Second, my bet is like, there's no glory and being a vaccine advocate in the NICU, the inherent assumption is there's all this glory, it just

Ben 35:09

I disagree. I think if you are the BPD expert, like you can you can shine on rounds. But I mean, I remember it's when you round that it's like, oh, the vaccines, right? It's like, it's it's delayed gratification, like you most of the time, it's you're just setting the baby up for future success, but there's no immediate there's no immediate feedback on that, where it's like, well, like when you when the ventilator you feel like you've got like, sure. 1000 bowel and

Daphna 35:37

and unfortunately the way clinically, things happen, right? The vaccines often get delayed in the NICU, right for so many other reasons.

Speaker 3 35:49

Yeah, it's so it, I'll tell you what I tell my residents, right. Ben is absolutely right, right. extubation highs really exist, right? You pull the tube out, and you feel fabulous, right? Particularly when you come back the next day, and no one really intubated the kid at night. You're like, you're, you're you're feeling good, right?

Ben 36:09

Like it was all me. It's all Exactly.

Speaker 3 36:13

Which we know is not true. But you we feel that way, right. But when it comes to vaccination, I'll tell you what I tell the residents, which is that in this country, in Europe, in South America, in Asia, pretty much prematurity remains the single greatest risk factor across the world, right? For delayed immunization. And for kids not being up to date by age two. And that is not just a US thing. So we can't say this as Oh, it's because of the fracture US health care system or something like that. It is something that happens across the world, Canada, Italy, Switzerland, Brazil, Japan, everywhere. So we each need to say that the only way that's going to change is if we wind up doing what we always do, which is taking care of the patient in front of us. So you know that that's one piece of it. And then of course, there's all the other pieces, right, which is that premature kids are more vulnerable, to see quality from vaccine preventable disease, just because of their the unique features of their biology. So the problem is the flip side of that is, it's just so easy to talk ourselves out of it. Yeah. And even though there are lots of studies about what truly is a vaccine side effect, even though there are tons of studies to say, you know, being on a ventilator is not a contraindication. To getting vaccinated being on CPAP is not, you always have this idea of we'll do it later. We'll do it later. The problem is when neonatologist across the world say that, and then these kids get discharged, you wind up having the situation that we have, which is worldwide immunization delay of babies born in the neonatal intensive care unit born and cared for in the NICU. And you were premature?

Daphna 38:21

I do think it also it does potentially, we aren't always cognizant of the nonverbal messages we spend send to families, which is that they can be delayed. Right. And you'll catch up eventually, but they don't catch up. Right. They tend to probably have ongoing delay even in the the outpatient sector. By the way, I disagree with Ben, when I have when I have when I have a parent who's been labeled as a as, I don't know, a homeopath who won't say yes to anything, and I just have a nice, casual five minute conversation with them about their fears of vitamin K. And they say yeah, no, I definitely want that. I say, you know, I am a super so I disagree with

Ben 39:08

but you know, I didn't say I want to clarify, I didn't say it in this manner where there's no there's no benefit. But I do think you know, when it's it's it's a tough mental to take on, you know, it's not the IEP, it's I think it's there's so many neonatology is such is still yet a field that has not been completely worked out. There's so many other avenues that you could easily choose and and no one would blink twice. So to pick that one, I think is is is noble, noble, respectable, and also and also helps underscoring an issue that we tend to often forget because it's like, it's again, it's deferred. It's like, oh, I have bigger fish to fry than just worry about vaccination. Right. It's true and that's not that's not the right approach.

Speaker 3 39:53

Look, I you know, I understand, right, we all understand right? The most important patient is the patient in front of Have you right? That's sort of our that's that's just the way we approach life. Right? And the most important time is right now. Yeah. So, so it's a little bit harder sometimes to start thinking down the road. But for other things like neurodevelopmental outcome, we think down the road all the time. Right. So, if we really believe that the whole purpose of neonatology is to save the brain, right, then the last thing we want to do or to save the child, right, the last thing we want to do is to have that child bounce back from something preventable. Yeah, micromanage Adas. There's a there's enough stuff out there that we can't control that we want to at least handle the things that we can handle. So that's, that's kind of why I think that it's, it's obviously it's important. I also think that it's really tall just need to remember that as much as we and you know, this is almost a separate conversation as much as we really feel like you bumped into a, a neonatologist, they always say I'm a neonatologist. I did my training in pediatrics, and then I did my neonatal fellowship, we identify as neonatologist first, which is absolutely fine and appropriate, I do it too. But we need to make sure that we never forget that we started out in general pediatrics, and the general pediatrics really is right the medicine of prevention. Right, right.

Ben 41:24

Right, for sure. So I think Is it is it wrong to think then that this work with vaccination really lead the way to advocacy?

Speaker 3 41:37

No, it's 100% the way it happened, right? So I started out doing my fellowship project, which was looking at immunizing parents against flu, and then later teed up at the bedside, right, in the neonatal intensive care unit, they were a captive audience. You know, it was it was a different time Daphna. It was, it was 2000 to 2003. cocoon immunity was all the rage, right. And so. So we were trying to see what we could do to promote cocoon immunity. And we had these parents here, we absolutely had them invested in what we were saying. We had them visiting all hours of the day at a unit that can provide care all hours of the day. And we had the most potent reason to get vaccinated, which was the baby at the bedside. And I used to tell parents that I still tell parents all the all the time, right, I'm glad this vaccine is going to protect you. But I'm the baby doctor. And I'm doing this to protect the child. And that argument, actually, when you're saying it at the bedside is actually from on a statistical basis, one of the most strong one of the most potent arguments you can make to get parents who are not extremely vaccine hesitant, but sort of on the fence and motivate them towards towards yes, there's always going to be the two to 5% vehement deniers, who, who, whenever you talk about a vaccine, just assume you're an agent of the government or something like that. And assume that there's a microchip in there or something, you know, you're not going to you're not going to talk those people out of that corner. But we still have to remember that there are large majority of parents who are on the fence, both about immunizing their own child and about receiving those vaccines themselves.

Daphna 43:24

It's actually why I was so surprised that more neonatologist aren't invested in things like right now, that COVID vaccine, the flu vaccine for parents, because it does impact our

Speaker 3 43:38

according to bench theory, it's because there's no there's no glory or glamour. Too much work to delay,

Ben 43:46

you know, I'm gonna I'm gonna then press on this because I'm not leaning out of this argument. But I do think that we have so many so many battles to fight in the NICU on a daily basis, it's going to be advanced, am I going to advance the feeds on this 1am I going to win to transfer this baby from oscillator to conventional ventilation? Am I going to pull the plug and do discharge this patient that we're all on the fence about discharging that when when the time comes on rounds for the vaccine conversation, you're like, I'm not going to I don't have the cognitive real estate to add this on when I write. So I think I think it is something that definitely from an advocacy standpoint deserves it deserves to be tentative,

Daphna 44:25

it does require a little much larger time investment, right? Because there are lots of decisions that we don't ask parents about that we do. But this does require a parent decision, right and

Ben 44:40

time investment. And I want to say that it's also the fault of the neonatologist sometimes because I'm generalizing but I am sure we always say Oh, I'm going to breach the subject and then all the floodgates are going to open and I'm not ready to deal with this when in truth you don't know you really do not know and and they Like you said, Maybe parents were just on the fence, and it's going to be a three minute conversation and you're going to make a huge impact. But we are so reluctant to I don't even want to open that can of worms. Let me just walk by and just push the can kick the can down the road. So yeah, I mean, it's an important subject. Yeah.

Speaker 3 45:16

Well, I think Ben is right. I mean, you obviously there is so much there is only there's only so much, you know, bandwidth that we have for any given patient. And then you have to multiply that times 60. Right, when you're on when you're on service, and you're covering the whole unit. So I mean, I guess my advice are two to two things that I found have worked. One is just bring it up a little bit each day, as you begin to approach the time, right? Oh, we're gonna get ahead of time, right, we're gonna get consent for vaccines, because your baby as a premature baby is incredibly more vulnerable to these types of things, and we can prevent them. We'll talk a little bit more about that, you know, the next day. And, and then, of course, you know, if you have to call them up, or if they're available at bedside, then you can continue the conversation. The other thing, of course, and I learned this, I think pretty much like the first week, I was doing a vaccine project at NYU, I was talking as a fellow to a parent, I known the parent fairly well, about the importance of getting flu vaccine and getting to that vaccine. And they said you didn't want you know, let me let me think about it. Right. And as soon as I walked away from the bedside, before I had even gotten out of earshot. The first thing that parents said was, yes, the nurse was like, what did you think about what Dr. Shah just said, and the nurses, of course, are our greatest how much power? Yeah, they're our greatest allies, because they're at the bedside 24/7 they develop, particularly if you have primary nursing, right, they develop these really longitudinal relationships with the family members, and they have a lot of sway. So if you spend a lot of time educating your nurses about it, then then at the very least, they will, they will sort of at least, you know, perpetuate it. Right. That takes time, because that's a cultural change for a lot of intensive care, intensive care units. But it is one that that is important. And there are models to help right. I mean, the Center for Disease Control has all of these sort of, you know, like Part Four moc approved improve your on time vaccination QI projects with a great built in applications that we helped put together that with, you know, that can add the EMR alerts, depending on what EMR you have to remind people five days before, you know, vaccines are coming, the vaccines are coming right? Little education modules, but that are like five slides long that nurse educators can give to the nursing staff in very small, little digestible pieces about each vaccine that you can even keep at the bedside. So if a nurse says oh, this kid's gonna be, you know, eligible for his pneumococcal vaccine, let me just Oh, yeah, like five really important things about pneumococcal vaccine. So they're all all of these resources are out there, you just need to find, you know, like anything, right, you need to find a local champion who's willing to sort of take that on.

Ben 48:10

I wanted to make sure that we that we got into a little bit of the weeds in for regarding advocacy, because I think this is a topic that your your, on which you're an expert, and and that I think can be very difficult.

Speaker 3 48:24

You're using the term expert, like really loosely.

Speaker 1 48:27

Right, you're you're you're letting me have a ward speaks. supports our case, I think so I'll

Speaker 3 48:34

tell you what I said, when I got when I got if I get an award, I'm always like, I was like, clearly they couldn't think of anyone else. So that's what happens. But but the Yeah, I would definitely not say like we're all learning, right. I mean, and like I was like we were talking about sort of before, right? There's an advocacy, just like in research, there's always something new coming. Because, you know, children are not viewed equally on when it comes to medicine. They're not viewed equally in society. They're certainly not viewed equally in the, in the medical community. And so the the, the sort of pressure to do that, and the battle to make them equal citizens, is really never ending. And, and you see that across the landscape of medicine, right, the more I was having a conversation with a friend of mine, we were talking about disparities in medicine. And I was saying, you know, people forget that the biggest disparity in medicine. Yes, there are racial disparities. Yes, there are ethnic disparities. Yes, there are socio economic disparities. I'm not denying any of those things. But probably the biggest disparity in medicine is the difference between how we treat adults and children.

Daphna 49:42

Maybe for some of our listeners, give us some examples of that, for example, maybe somebody has never worked outside of Children's Hospital, right. And they they don't, they don't feel some of those pressures.

Speaker 3 49:53

I would say, I would say do do three things. Sometime when you're in call at night, walk over to the adult ICU, if it's a conjoint hospital and realize that a lot of those patients are probably not as sick as the patients were taking care of. Yet there's the hospitals are paid more for those patients and the physicians are paid more. You, you can't really value children unless you value the doctors and the institutions that care for them. Right? That's just the sort of a basic thing. Look at general pediatrics. Right? When a pediatrician, at least in New York gives a vaccine, they receive 43 cents on the dollar for compared to an adult, who gives the same exact vaccine. Right. And last time, well, I was gonna say not last time, because last time I did run around the room screaming before I had to get a shot. But the time before that, you know, I usually stand still, when they give me my shot, right? I still demand the sticker. I really, I, I put my foot down on the sticker. But, you know, the pediatrician has to chase the toddler around the room has to calm that child down, has to worry about getting the consent beforehand, right, and then has to give the vaccine. So we're really talking about not even, we're talking about less money for more work, which our adult colleagues as a group I don't think would ever really tolerate. Right? You see this? Really, you know, there's so many examples, right? Talk to a pediatric cardiology colleague, right, an adult reads, and an echo on an adult, right, looking at a heart that one would hope by the time you're an adult, they know whether or not you have an abnormality, so at least at least you know where the plumbing is, right? That's, that's the size of our fist. Right? And oftentimes would be paid more than a pediatric cardiologist, who has to go through a mother go through amniotic fluid, go through a baby, right, to read to read, a fetal echo for a heart, that's the size of a walnut. Right? If you just think about those two things, right? It's very clear. That yeah, you know, that that we're not treating, at least from from, from the system standpoint, children the same way we're treating adults. And that's just sort of one one piece of it. Right. You know, we do a good job insurance insuring children. But we are not at universal child health insurance. Right? We don't we don't insure every child. Right? Whether you're insured now depends, frankly, on the politics of your state. Depends on the economy of your state, we tend to do better than most in New York. But you know, there are other states out there that that don't do as well. And that's part of this ongoing battle that we talked about. So and there's so many examples, we talked about this, the triple Demick, everyone's been talking about the triple DES MC, and they're saying, Well, why are there so few pediatric beds? Well, there's so few pediatric beds because hospital systems made the decision that if there's only one bed, they're gonna give it to an adult. Yeah, because the hospital and the system is designed to reward financially that decision more than it is to reward the system for children. So they're so we could spend another hour just talking, just talking, just talking about all the inequities in

Daphna 53:33

the system. It's a silly sometimes it just seems like even when you're speaking to I don't know, administrators that because your patient is smaller, and we have the smallest patients, right, they must need less stuff. And that's like at the bases like extraordinarily false.

Ben 53:50

But so what so when we're talking and I think that conversation really blends in nicely with with the the idea of advocacy, I think there's I think maybe for for neonatologist and UNIDO provider who are working, I think in pediatrics, we understand the concept of advocacy. But then in the NICU, it feels like well, the baby is confined within these four walls. I advocate every day on rounds from my patient, what does that mean, to advocate beyond that point? So for for, you know, like the for for people who are not familiar with the lingo and the concepts of advocacy in the neonatal ICU. What does that look like? What does that entail?

Speaker 3 54:28

Well, it didn't it entails, you know, doing, you know, making the best case for children and we do this all the time, right? You just talked about advocating for your patient in the NICU. We all do that right? That's how many times have we had to pick up the phone and talk to an insurance company about keeping a kid with these death defying A's and B's and you're talking to an adult geriatrician, right, about? Right, that's that's advocacy, right. And we all have done that. I'm sure we Well done that. I can't be the only one right. So.

Ben 55:03

So no, you're not. You're not the only one. So.

Speaker 3 55:07

So that's so that that's advocacy, all we're talking about is taking that passion for the baby in front of you, and expanding it slightly. And I really think there are issues where we really are the ideal voice. So, you know, a classic example is, is newborn screening, right? We're talking about reauthorizing the Newborn Screening Saves Lives act, hopefully, sometime in the next year. But I think neonatologist are really strong advocates for newborn screening, because we experience it, because we are often the ones who have to sit down and talk to the parents about what these weird disorders are, and what we need to do to confirm the diagnosis. Right? We also are the people who have the stories that really tend to resonate with the people who are actually going to be voting on these issues. Right. You can give people statistics, but they'll tell you, you know, when you go to, you know, advocacy trainings and other things that the this statistics set the stage, right, but the story is the sort of the showstopping number in that performance. Right, right. So if you think of a Broadway show, right, all of the statistics is kind of the framework, it's the overall story, right? But the defying gravity for wicked or the you know, The Phantom of the Opera, right music of the night. And that showstopping number is the story. And we cultivate those stories, a because we live them and be because, you know, they stick with us, right? All of us probably can recall at least one time that a disease was caught by newborn screening. And we all know, none of us would have had it. And then you do the CONFER and you know what happens, right? The first thing is like, this can't be real. Then you said, Oh, really, then you send the confirmatory testing, you're like, oh, better called genetics, right. So.

Unknown Speaker 57:01

So thank goodness for geneticists,

Speaker 3 57:04

but But it's, it's true, right? So we, you know, legislators have so many different things that they need to know about. Right? They don't have the luxury of being experts in neonatology. Mm hmm. But the fact of advocacy is that if we don't talk, someone else will. And that's the real problem, because what you don't want is people filling that void, with stuff that's not in children's best interests. And I think that's one of the things we can really do a great job on.

Ben 57:41

And so for the neonatologist, who don't know what they don't know, right? I mean, I think there's also this concept of like, I'm in that category, where you're like, Well, I go to the NICU every day, I have my set of tools, and I'm doing a decent job, then how do you expand your horizon to understand how things could potentially be better for you and your patients? Because I think it's like, I wouldn't even know what to advocate about. I mean, I get my I get the meds I need to take care of the patients I have. How do you swim in those waters to find out more?

Speaker 3 58:12

Yeah, the good news is if the, the real, the sort of silver lining to the vaccine hesitancy, and to some of the policies that have sort of been pushed out over the past. So you know, eight to 10 years or so, has been that there's been this incredible surge in the interest of serving children through advocacy. At the trainee level, at the early career level, whether that's early career neonatology or early career pediatrics, there has been this real surge of interest and the good thing about that is there are people who are there to meet that interest with different resources. Right. So I sometimes you know, I'm, you know, mentor, people who aren't even at my institution, right, who sometimes email me and just ask for advice or help. And the first thing I tell them is, do three things. One is, there's an email that you can sign up for from the American Academy of Pediatrics. That gives you a weekly advocacy update. And you can go through that email, really understand what's going on, both at the federal level and then at your state level through if you can get one from your your AP chapter. And that really is a great way to sort of passively begin to follow, you know, to follow what's going

Daphna 59:38

on, and it frequently has opportunities to get involved. Sure, they have links,

Speaker 3 59:43

they have, you know, scholarships, they have trainings, they have a whole host of, you know, links to fact sheets, links to other resources that that you can use. So I think that's sort of the way you can sort of cautiously dip your toe in the water. I also think that you And if you, you know, joining up with your with your AAP chapter is a great way to begin to do this because they've been doing it for years. And they're open and welcoming. For the most part, I got involved sort of, you know, I started wanting to do advocacy, because I thought there needed to be a law based on my fellowship project, which is immunizing, and offering parents, T DAP and flu vaccines, when they're, you know, right after they deliver, because I thought that that would have a much bigger public health impact than, you know, doing this at one hospital. But after that, I decided to, it was actually quite funny, I then had to link up with my AP chapter, which initially I didn't even want to do. And, you know, 20, some odd years later, you know, I'm still doing stuff with the chapter every day. So I always tell people, it's a great place to go, it's a great place to go get advice, it's a great place to get these resources. And then from there, you can begin to sort of integrate advocacy into whatever time you have, right? Maybe you only have five minutes or so well, you can read that email and at least be be somewhat knowledgeable, maybe maybe you have 10 minutes, okay, well, well, then when when the chapter or the Federal Office of AP sends out one of those legislative alerts, like contact your person today, because this is a very important key piece of legislation that's moving, that might relate to children. Or that definitely relates to children, but may even relate to babies, you know, take the take the 10 minutes to take that email and personalize it a little or pick up the phone and, and and call that office. Right? That only takes a few minutes. If you go to a conference, right, so I always tell people that if there is if there is some huge seismic discovery in neonatology one way or another, you know, we started off talking about how small the community is one way or another, we're all going to hear about it. Right? We may not hear about it at times zero, but by time 10 We're all gonna know about it. It's just gonna be too explosive to keep a lid on, right? So spend your time at conferences wandering over to the parts of the world that we don't spend any time in. Right. So. So I people joke about this, right? I'll go to you know, so I've gotten involved in tobacco cessation, right, and I'll be like, I'll go to the immunization meetings. And I'm like, the only mean ecologist there. Right, then I'll go to the neonatal meetings. And I'm like, the only neonatologist or one of two or three, that really are kind of doing a lot of vaccine advocacy. But, you know, it's okay, right, because you're learning all of these other things that you're going to wind up taking back, you really are expanding your horizons, because something that's really big in neonatology, we will all come to know it very, very quickly, just by virtue of the communities in which we operate. So that's always been my, my kind of take, take on it. And then, you know, do the legislative visits, right? The formula is really well known you you, you go to your, your local legislators, if you have time, you are on the phone, or now we'll resume and you talk to them about why these things are important. And you don't need to be an expert with all the facts in the data. And, you know, they're 2.5 million kids in New York covered by Medicaid and 600, you know, almost 700,000 kids now covered by the Children's Health Insurance Program in New York State, like you don't need to know those things. They'll get them from someplace else. But what you need to let them know is that the kids you're taking care of are insured by Medicaid. And if their Medicaid is threatened, your ability to deliver the care that they need, is going to be impaired, that's what they need to hear. Right. And you can talk about how that might happen. And let's be honest, for many of us, in neonatology that itself is hidden because we just take care of the patient in front of us and you know, we do our billing and stuff happens, right? But it's certainly something that they need to hear.

Ben 1:04:10

So yeah, I wanted to ask you a question that is a bit sort of being devil's advocate, but what do you say to people who think, well, I'm going to call my local representative, but that's not gonna make anything any difference? I'm just wasting my time.

Speaker 3 1:04:25

Yeah, so like I said, I think the answer is twofold. One is that if you're not talking someone else is, right. Number two, the way you engage, right, whether it it doesn't have to be legislators, right, sometimes you're calling up the Medicaid office, sometimes you're calling up other. You're calling up people who aren't in elected positions, right. That type of engagement will lead to you becoming more and more active in this space, which of course then leads to you potentially voting more in sort of local elections and other things right. There was a state Senator in Syracuse, just today was reported that he won his election on the recount by 10 votes. So don't think that every vote doesn't matter. Yeah, particularly in local elections, right?

Daphna 1:05:13

Yeah, it's incredible. It's incredible how many physicians don't vote. So I think that in and of itself is a step we can all take.

Speaker 3 1:05:20

Sure. And then the third, you know, sort of the third piece of that, right, is that if people don't think that it makes a difference, right, there's, there's a famous quote, and of course, I don't, I can't remember who said it, right. But it was like, it's like, when I feel the heat, I see the light. Right. And legislators, you know, that phone call is part of, you know, a group of our coalition of people who are calling. And that's the heat that sometimes makes them see the light. And sometimes they really need to be pushed in the, in the direction in that direction, when it's a child when it's, you know, when it's children's issues, because they know that there's no natural, quote unquote constituency, because the children don't vote. So we are their natural constituency, right. Parents, teachers, pediatricians. So, so I understand there's apathy, but you can always, you know, just like with vaccines, right, you can always talk yourself out of doing something. The goal is to sort of surmount that sort of initial activation energy, and do it once. And then if you do it once

Ben 1:06:24

activation energy since college, yeah, well, I'm just saying you don't

Speaker 3 1:06:27

remember, like, you know, that's the first part of energy to get that chemical reaction going. Right. So it's the same thing, you, you, you, you get over the activation energy, and then you wind up, hopefully becoming more and more engaged, I think the more neonatologist that are engaged, I mean, the better it is for us, but more importantly, the better is for babies, the better it is for mothers, right, who can talk about the importance of prenatal care. Right, obese and neonatologists. Right, let's you can talk about extending Medicaid coverage to mothers after they deliver for a full year after delivery. Right. obstetricians? neonatologists? So, you know, I think that it's, we're not asking people to do things that they don't already know how to do. We're just asking them to articulate things that they probably have already experienced, and certainly felt during the course of their practice. So absolutely. Absolutely.

Ben 1:07:25

So I mean, this, this was phenomenal. And, and we've we've, we've already teased it, but this is advocacy is something that we would like to promote, and bring awareness to on the podcast. So stay tuned for a series of episodes coming this year, about advocacy, and about how to think about these issues, how to get involved, and what kind of difference this can have in your patients and in your communities in your community as a whole. So, yeah, definitely. Any parting thoughts?

Daphna 1:07:54

No, I appreciate it. I think. I think we've touched on it so many times today that there are so many little ways that you can start doing, quote, unquote, advocacy that counts, and then that there are just so many extensions of our expertise that are really prime for helping get families and babies the care and support they need outside of the NICU which in in impacts long term outcomes, right. So if we really care about giving the the babies, we, you know, that we get to discharge, you know, the work really just starts there for their for their lives, you know, and so we really care about long term outcomes we can't not be engaged in in advocacy. One quick

Speaker 3 1:08:41

trick, I always remind people to sort of get them to be motivated is think about all the work it takes. That's right to get a 25 weaker to go home. Right? Think about all the hours of nursing, all of the hours of clinical care, all of the training it took to get all those nurses, nurse practitioners, residents, neonatologist, respiratory therapists, discharge planners all together, right? To be able to create an environment where, hopefully, you know, 15 or so weeks later, right? That 25 weaker can go home. And just think about how cheated you feel. Yeah, if that kid goes home and comes back with a vaccine preventable disease or can't get the medications because of an insurance issue. Right, think about how much we've put in write only to have it go to waste. And I think if you do that, for some reason, that tends to get neonatologist a little motivated, because we all know what it takes to get it 25 weaker to go home. And when we when we balance that against picking up the phone, right? It kind of becomes sort of a no brainer in terms of, of an equation. So are you

Daphna 1:09:55

looking we're looking forward to our our mini series on advocacy All right. Well, thank you. Thank you so much for your time

Ben 1:10:03

with us today. And we'll see you very soon.

Unknown Speaker 1:10:06

As my wife says, Thank you for putting up with me.

Unknown Speaker 1:10:10

Love it. I love it.

Ben 1:10:14

Thank you for listening to the incubator podcast. If you liked this episode, please leave us a review on Apple podcast or the Apple podcast website. You can find other episodes of the show on Apple podcasts, Spotify, Google podcasts, or the podcast app of your choice. We would love to hear from you so feel free to send us questions, comments or suggestions to our email address NICU podcast@gmail.com. You can also message the show on Instagram or Twitter, at NICU podcast or through our website at WWW dot v dash incubator that org This podcast is intended to be purely for entertainment and informational purposes and should not be construed as medical advice. If you have any medical concerns. Please see your primary care professional. Thank you

Transcribed by https://otter.ai