#366 - A European Approach to Neonatology: Individualized Care, Empowered Families, and the Future of Education with Mario Rüdiger

Hello friends 👋

In this episode of the Incubator Podcast, Dr. Mario Rüdiger, a prominent neonatologist from Germany, shares his journey into the field of neonatology, discussing the differences between European and American practices, the importance of flexibility in adopting new therapies, and the role of evidence in neonatal care. He emphasizes the significance of empowering parents in the NICU and advocates for a family-centered approach to care. The conversation also touches on the future of neonatal education, the impact of podcasting in the field, and the challenges of work-life balance for healthcare professionals. Dr. Rüdiger's insights provide a comprehensive view of the evolving landscape of neonatal care and the importance of advocacy in shaping policies that benefit both patients and practitioners. 

Link to episode on youtube: https://youtu.be/pSzFcRM5PpI

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Short Bio: Mario Rüdiger, MD, W3 Professor for Feto-Neonatal Health at the Technical University of Dresden, is the Director of the Saxony Center for Feto-Neonatal Health and Head of Neonatology and Pediatric Intensive Care at the University Hospital Carl Gustav Carus in Dresden. Trained in Berlin and Innsbruck, his research focuses on preventing chronic lung disease in preterm infants, delivery room management, and regenerative therapies. His lab collaborates internationally on stem cell treatments for newborns and adults with severe sepsis. He serves on the Neonatal Task Force of ILCOR, contributes to European resuscitation guidelines, and is President of the German Society for Perinatal Medicine. In 2024, he was named an Honorary Professor by the Uzbek Ministry of Health.

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

Ben (00:01.222)

Hello everybody. Welcome back to the incubator podcast. We are back this Sunday with a special interview. Daphna is here in the studio with me. How's it going Daphna?

Daphna Yasova Barbeau, MD (00:09.795)

I'm doing really well. We're having fun having other podcasters in our studio with us. It's a whole new experience.

Ben (00:18.894)

Absolutely. We are joined today by Dr. Mario Rüdiger. Mario, welcome to the podcast and thank you for making the time.

Mario Rüdiger (00:26.616)

Yeah, hi Ben, hi Daphna.

Ben (00:29.094)

Mario, for people who are not familiar with who you are, are a neonatologist. You're coming to us from Germany. You're the director of the Saxony Center for Phytonioletal Health at the Technical University in Dresden. You're the head of the Department for Neonatology and Pediatric Intensive Care Medicine at the Children's Clinic of the University Hospital Carl Gustav Karras in Dresden. And you're the president.

of the German Society for Perinatal Medicine. You trained at the famous University Hospital Charité in Berlin. And you have worked as a consultant in Innsbruck, as we were talking a little bit before off coming on air. you're a man of many talents, many interests. You're interested in

in BPD, chronic lung disease, you're interested in regenerative therapies, you are involved in delivery room management, and you're actually actively involved in that latter process through ILCOR. You're involved in the European Resuscitation Council, and you are, like we said, the president of the German Society for Perinatal Medicine. You're the founding chair for the German Foundation for the Sick Newborn.

One of the connection points that we have with you is obviously that you are a podcaster and you run two simultaneous podcasts. The one that our audience may be familiar with is Neonatology Now, which is done in English, but you also have another podcast in German called NeoCast. I think somebody had asked me one day like...

We're doing the incubator in multiple languages. And some people were asking me, like, have you considered German? said, no, there is already a podcast in German that's doing a very good job. So you're a very well-accomplished neonatologist. And yeah, so thank you again for taking the time to be on with us.

Mario Rüdiger (02:21.207)

you

Daphna Yasova Barbeau, MD (02:21.756)

It's already being done very well.

Mario Rüdiger (02:34.5)

Yeah, it's a great pleasure to be here.

Ben (02:37.602)

Same, it's a pleasure to have you on. I I guess one of the questions we'd like to ask from our guests, especially as an initial question is, where did this passion for neonatology come from? What pushed you as a student and as a learner to pursue a career in neonatology?

Mario Rüdiger (02:54.436)

Actually, I have to admit that was by accident. So I even became a doctor by accident. Because there... Yes, yes, yes. So I didn't know what to study during my high school time and then everybody was asking and so we had to decide. And then my father was in hospital as a patient and he said, oh, you can become a doctor. And I said, well, it's a good idea. And then everybody said...

Daphna Yasova Barbeau, MD (03:02.499)

Those are our favorite kind of stories. The accidental.

Mario Rüdiger (03:21.49)

no, you cannot become a doctor because in East German it was very difficult. And then I said, okay, I will show you that I can become a doctor. And that was the reason for becoming a doctor. And then I wanted to become a teacher. And then I decided, okay, combining being a doctor and a teacher, so it's pediatrics and go to university. And because it was very difficult to get a job in pediatrics, I was very lucky to find a job in neonatology initially. And then I said, it's good stuff.

I stay in neonatology.

Ben (03:53.414)

So it's always interesting. I'm curious about what you think about this, because I think that a lot of times in this particular climate, we are asking of trainees, what are your interests? What do you want to do? And we're almost forcing people to define their path before they even start walking the path. But there's truly a lot of room for people falling in love with a certain job, a certain passion, a practice as they are experimenting.

Mario Rüdiger (04:08.269)

and

Ben (04:21.262)

I think that's something that's getting lost. don't know if you, if you agree with that.

Mario Rüdiger (04:24.578)

Yeah, that's very true. So you introduced me as a man with many talents. I'm not sure about this, but I'm really sure about men of many interests. And so that's why I think it's very nice to be open minded and to start and then to decide what you want to do. so I'm very happy to be a neonatologist, but even to be more like a podcaster and so on.

Ben (04:43.814)

Mm-hmm.

Ben (04:49.478)

Yeah, start by starting as Dr. Timmy Turner likes to say. I wanted to maybe ask you about your perspective on European neonatology. mean, you have the unique perspective of working in Europe, being yourself a German neonatologist, but also speaking to so many people, both in Europe, but also through the podcasts from people outside the outside.

Mario Rüdiger (04:51.342)

Yeah.

Ben (05:17.83)

Germany, outside Europe as well. And I am just wondering if for us who are in the United States, do you think that the state of European neonatology is sort of similar to the state of American neonatology? I'm thinking of maybe we can, if we were to put together like US, Canada, and maybe North America together, do you think that...

Mario Rüdiger (05:39.812)

Hmm.

Ben (05:42.566)

they function similarly or are there specific differences that you think really characterize a uniqueness to a European approach to neonatal care?

Mario Rüdiger (05:54.776)

Yeah, think there are differences, at least if you look at the German system. So I think the American system is very much structured. You have many SOPs and flow charts and all this stuff. So in Germany or in many other European countries, you are not adhering too much to flow charts. You are more looking at the individual patient. And I think that's...

in some way an advantage and in some way an disadvantage. So it was very interesting because I was trained in the Charité and we had two neonatal departments. One neonatal department was very structured, had many SOPs, many flow charts. And so even as a senior, you had to adhere to the flow charts and you stopped thinking. And I was trained in the other department where we didn't have any flow chart. And my former boss always said,

explain what you are doing, then I'm fine with it. That's very good for more senior stuff and for more experience, but if you are a beginner, that's very difficult. But the point is that after leaving the charity, I knew what I was doing and why I was doing it. And then I came to a different unit and there it was very much adherence to protocols.

And when you ask people, why are you doing this? So it's in the protocol. So the thinking about it was less deep or less detail. And so I think that's, in my opinion, a big difference. And the second difference is in Germany or many European countries, neonatologists are...

generalists. So they are doing the ventilation, they're taking the blood, they are looking for feeding and all this stuff. if I know the American or Canadian system very well, you have someone who is coming for getting the ventilator, you have someone who is specialist in nutrition and so on. And I think that's very different in the European system. I don't know which one is better, but that's different, I think.

Ben (08:07.142)

Yeah, that's something that at least for myself through our French podcast, I've noticed talking to French speaking neonatologists that, yeah, the concept of respiratory therapist is not uniform. Like some institutions might have people dedicated, but very most often the neonatologist will set up their ventilator and they will sort of do the job of a respiratory therapist. And it is not routine for dieticians to round in the NICU with the team.

In the US as well, granted, not always like it depends on resources. would say larger institutions sometimes have that benefit. Others don't. But it is true that the expectations from the physicians, I would say in Europe, like you said, are probably to be more of a like a Swiss army knife of the unit.

Mario Rüdiger (08:40.792)

Okay.

Mario Rüdiger (08:55.428)

Yeah.

Daphna Yasova Barbeau, MD (08:56.461)

Well, we've learned that so many of our intensive care colleagues are also doing a lot of outpatient work or working in other units of the hospital, which I think is a little different than our practice here as well.

Mario Rüdiger (09:07.68)

Okay,

Ben (09:11.428)

Yeah, absolutely. I am wondering if, yeah, so I think one of the aspects also that you mentioned was the love that we have for guidelines and sometimes, unfortunately, even regulation. think to me, the newsworthy item of recent times is the probiotic saga, I think, where Europe seems to have been, least, and correct me if I'm wrong, by the way, Mario, maybe I'm wrong, has been much more nimble.

Mario Rüdiger (09:22.51)

Mm-hmm.

Ben (09:40.354)

in its ability to adjust and adopt this practice that has proven benefits to reduce NEC. And in the US, we're sort of stuck in the mud right now, not really being able to get this off the ground.

Mario Rüdiger (09:44.994)

Yeah.

Mario Rüdiger (09:55.096)

Yeah, that's true. So we are much more flexible, I think, in introducing new therapies and having therapies or interventions which are not proven yet in a fiscally efficacy, like videography of delivery room management. I think that's a very good example. So we are just starting it as a quality improvement approach. And so I do it for more than almost 20 years now. And so it's, I think it's

Ben (10:12.795)

Mm-hmm.

Ben (10:22.629)

Mm-hmm.

Mario Rüdiger (10:25.176)

would be very difficult to do it because of being afraid of becoming get caught by a lawyer or so. I could not do it in the States. And here it's just part of the quality improvement. And so we have several different aspects like bonding and the delivery room is very easily done because we are convinced it's beneficial. Of course, we try to do some studies as well and it's you're not providing any harm.

but sometimes you don't have the evidence yet. And so if there's no danger of harm, then I think it's worth to try it. And so I think we are more flexible about it.

Ben (11:03.238)

I'm going to let Daphne ask some questions, but I wanted to bring up one more thing. mean, we had on the podcast Dr. Anne Hansen, who is the medical director of the NICU at Boston Children. She's one of my favorite interview because she gives so many pearls about running a neonatal intensive care unit. And one of the things I remember she had mentioned was that when we have to adopt new evidence.

How do you decide when there's enough data? When do you do it? And I remember she said to us something that I was not expecting. She said, well, if the data is there, then I'll see. But I don't want to be the first, but I don't want to be the last. And so I am wondering if there is sometimes a little bit of anxiety saying, because I am an early adopter by nature, so I love to try new things. the excitement of being an early adopter is always mitigated by the anxiety of like,

Mario Rüdiger (11:28.804)

Yeah.

Mario Rüdiger (11:39.222)

Okay.

Mario Rüdiger (11:48.942)

Mm-hmm. Mm-hmm.

Ben (11:55.94)

What if there is not enough data and I am potentially going to find out something that I'm not happy to learn about because I tried this too early? And so I'm just curious if that's something that is a concern to you or to other neonatologists in your community or not in this early adoption, sort of very nimble agility of implementing new evidence.

Mario Rüdiger (12:17.092)

Hmm.

Mario Rüdiger (12:23.36)

No, I think we are not so much afraid of it. And see, the very good argument is always, there's currently random care, but a random care, but it should be randomized care. So currently, if you compare what everybody is doing, everybody has a very unique approach. And if you're born in one hospital, or if you're treated by one doctor, then you receive this kind of care. And by the other one, you receive a different care. And both are

Ben (12:26.982)

Mm-hmm.

Ben (12:50.67)

Mm-hmm.

Mario Rüdiger (12:51.972)

correct or incorrect and so the care is very random and we should include some more babies into randomized trials and a very good example is for instance Lisa. So it was introduced in Germany more than 20 years ago. I treated my first patient in 2002 with Lisa.

Ben (13:13.743)

Wow.

Mario Rüdiger (13:13.988)

2006, sorry, 2006. And so there was no study, no evidence. It sounds very useful. And so it was the first preterm baby, which was never intubated. And so I was very much convinced of doing it this way, because all babies before were intubated. And that was a kind stepwise approach. And I think that's the kind of atmosphere we have.

in some European countries, we have these, think these is an atmosphere which is very productive. But on the other side, I have to admit the big clinical trials are not performed in Germany or in Europe. Big clinical trials are performed in the States because you have a very good network of big units who are doing kind of randomized controlled trials. And so that's an advantage of the American system.

Ben (14:07.92)

Mm-hmm. Mm-hmm.

Daphna Yasova Barbeau, MD (14:11.859)

I have some thoughts about that and some questions that you've already touched on a little bit. it's interesting though. I mean, the whole field of neonatology started with people who were saying, let's take a risk, right? Let's try something new. And that's really been, where neonatology came from. And, and now I almost feel like the pendulum has swung so far. We at least, especially in the States, such a mountain of evidence before, you know, even suggesting a new.

opportunity that might impact our babies or that we have enough evidence for in other realms, but we say, is it the same in the NICU, especially at, let's say around child development, family centered care, those things that we have so much evidence for, do we really need to prove it in the NICU? I'm curious your thoughts about that.

Mario Rüdiger (14:57.592)

Hmm. Hmm.

Mario Rüdiger (15:04.034)

Yeah, that's true. But you have also to think about the limitations of randomized controlled trials. So a very good example for me at least is the sustained inflation. If you look at the sale trial, I'm still very much convinced that sustained inflation has some benefit.

but you need the right population. So if you have a baby which has never taken a breath and the lung is still liquid filled, then I think it's beneficial because from physiological point of view, you have to get the liquid out. But if you do the same procedure a minute later in a baby which was already crying, then it's much more difficult and much more harmful. And so that's the point of having these kind of individual care.

is very difficult to translate sometimes into clinical studies and to have real good randomization and have the same in and out criteria. Another very good example is the very recent ABC3 trial where you can see if you have a lot of experience then you have a benefit but if you do it just a few times then there is no benefit of the method.

Daphna Yasova Barbeau, MD (16:16.503)

Yeah, I love your discussion on individualizing care. And I think we're all trying to thread the needle between having non-random care, standardized care, and still being individualized. And I think a great place to have that discussion, to your point, is in the delivery room. You've touched on that a little bit.

Mario Rüdiger (16:23.908)

.

Daphna Yasova Barbeau, MD (16:38.947)

And I want to take advantage of your expertise. You've been part of teams that have written the European resuscitation guidelines through the ERC and ILCOR, the International Liaison Committee on Resuscitation. And some of the resuscitation guidelines are different in Europe compared to North America. Can you speak to some of those differences?

Mario Rüdiger (16:55.918)

Mm-hmm.

Mario Rüdiger (17:02.37)

Yes, that's my biggest experience I ever had because in ILQOR you are kind of checking for the evidence and then you summarize the evidence and then it's very interesting to translate these into guidelines and the same evidence is very differently translated into guidelines.

A very good example was about suctioning. There is no evidence that suctioning is beneficial. And some colleagues argue, okay, but we don't have any evidence of harm. And since we did suctioning all the time, why should we exclude it? And some other people have the same evidence and they say, okay, we don't have any evidence for benefit. Why should we do suction or recommend suction? And it's a very good experience for me.

to have these discussions, have this experience. The second point is, and we have many discussions in the European Resuscitation Guidelines about it, whom are we addressing with the guidelines? Is it the neonatologist? Then we can write long, big textbooks. Or is it the non-experienced first caregiver who has no experience with the newborn? And that's very different approach.

But the aspect I like very much about the European guideline was, and I was very much fighting for it, in 2015, we changed the title from resuscitation guideline into support of transition and resuscitation. Because I think that's a very big difference in the concept or in the approach you're going in the delivery room. There's very rarely a need for resuscitation, but mainly for supporting transition, and then you can prevent resuscitation.

Daphna Yasova Barbeau, MD (18:49.283)

I love that concept because what the babies are going through is a normal experience. They need to go through some of those changes and you're right, just, most of the time, need a little bit of help to get through those stages. I think it changes our concept when we go to the delivery room about what our role is. And I think that probably is perfectly to your point about bonding in the delivery room. I think we take...

Mario Rüdiger (18:54.062)

Yeah.

Mario Rüdiger (19:01.636)

Right?

Daphna Yasova Barbeau, MD (19:16.575)

I'll say my colleagues here in the States take a very clinical approach to resuscitation, quote unquote, in the delivery room. We come in, we do our job, and then we hand the baby off to the nursing team, which may or may not have the same goals as us. But I think in general, the European countries have embraced this concept of bonding, especially starting in the delivery room in a different way than North America has.

Mario Rüdiger (19:42.094)

Mm-hmm.

Daphna Yasova Barbeau, MD (19:44.556)

And I'll say that's probably true into newborn care, into neonatal care in the NICU. I know that this is a professional personal interest for you that there, you know, there are obviously some societal differences between say the States and most of Europe, like paid parental leave, which impact families at the bedside. But tell me a little bit about this approach to families in the NICU, your approach to the expectations for parents at the bedside.

Mario Rüdiger (20:12.024)

Hmm.

Yeah, but just first one more aspect about delivery room management. That's a very good example because we are doing video recording of our management in the delivery room. And we have an annual meeting on delivery room management and then we are showing the videos. And that's amazing to see how many colleagues from the states are watching the videos and get very nervous because we are doing almost nothing because we are supporting

the baby during transition and they say it's already one minute later or two minutes later you should start this you should start this one and at the end they're always surprised to see the baby is doing fine it's not ventilated and so on and that's very I think that's very important not only to talk about what you are doing but also to watch what you are doing and to have really a look on it and then to start discussion about it but about the the parents in the NICU

We also had some kind of discussion. Is it involvement of parents or is it empowerment of parents? Because I think that's a different approach. I like involvement of parents, but I like it very much more to empower parents to be parents. Because there is a concept of intuitive parental competency. And so every parent who has a newborn knows what to do.

And the problem of preterm babies is that they are not prepared to be a parent. And then you need to give some support to the parents. And that's the entire philosophy. Not only involvement, but supporting parents to learn what are the signs of their preterm baby. Or even to give feedback, video feedback. So we have an approach where we do video recording of mothers bathing the baby. And then a psychologist is watching the video together with the parents.

Mario Rüdiger (22:11.492)

And the psychologist is not saying, did a good job, but he's asking. So what do you see? And then the parents realize, yes, I did a good job. Or in this point, I was not so good. And so you have kind of self-empowerment because they can reflect and they can say what I'm going to do next time better or what should I change next time. And I think these many different small parts of supporting parents and empowering parents...

Parents are very different and it's very important. I'm very happy if the parents go home and say, I want to see you never again. Because I have a baby and if I have a term baby, I don't see my doctor again in the hospital. It's a very, very simple description. But that's idea. So I don't want to have dependent parents if they go home, but they should take care of their baby.

Daphna Yasova Barbeau, MD (23:11.979)

I that. think that there's so much we can learn from that. I mean, what you described about having an opportunity for parents to have this kind of guided self-reflection on their role of parenting. I'll say, I think we're so far from that in the States. Our tasks right now are just getting parents into the bedside. That's a major problem, but we do have parents who are at the bedside and we kind of have this forcing of the-

the medical tasks on the parents when really the steady show, they want to do those parenting tasks like bathing, like dressing. And I think potentially flipping our paradigm to have those opportunities for doing the things the parents really want to do, I think are so valuable. And in family-centered care or family-empowered care has always been a part of your professional interests.

Mario Rüdiger (23:49.348)

Mm-hmm.

Mario Rüdiger (23:56.578)

Mm.

Daphna Yasova Barbeau, MD (24:10.595)

in and above what is routine in the European countries. So tell me a little bit about that. Why is it so important to you?

Mario Rüdiger (24:13.774)

Hmm.

Mario Rüdiger (24:18.648)

I think if you look at the data, long-term outcome data of babies, so the Bavarian long-term study is very impressive, you see the biggest impact at age 25 or 30 is the social demographic parameters. And so you can find term-born babies being 25 years of age having the same development.

like preterm babies, which are at a high socioeconomic level, the preterm babies and the term babies on a low socioeconomic. So the development is very similar in both groups. So it depends very much on the socioeconomic level. But socioeconomic level is not only money, but it's parent-child interaction, bonding and so on. And that's very early determined.

immediately after in the delivery room, after on the unit or even prenatally. And so if you keep in mind that parents are very much afraid, point one, and parents are in a process where they become parents during pregnancy and these processes interrupted. And they are not prepared to be parents.

Because at 25 weeks of gestation, they are not thinking about a baby, they are thinking about a boy, which is 4 years, playing football and so on. That's a concept, internal concept, during the development of becoming a parent. And then they are confronted with a very tiny baby. And so they are not very much prepared. And if you know this theory, then you can start to support parents appropriately.

Ben (25:59.61)

Mario, I would love to segue into then your role as a medical educator. And specifically, I think the initiative that you took, it's actually not very surprising anymore. You've really described this sort of model for tinkering in the NICU. So I'm not surprised that you were tinkering as well with medical education. am wondering about...

the idea for your podcasting and using podcasts as a medium to augment education. You, as we said, you're the host of Neonatology Now done in English and Neocast done in German. When did this adventure of medical podcasting begin for you? And can you tell us a little bit about what have been your goals with these outlets?

to satisfy your curiosity.

Mario Rüdiger (27:00.78)

So actually I had a very good teacher and he told me always, he was inviting me to medical congresses and to hot topic meetings and so on. And he always supported me to come into contact with the most famous people in neonatology. And I learned quite a lot. And I learned by talking to them, but also by listening how they discussed each other, the research and so on. And I was very much surprised and I said, okay, I want to have a very similar

to have a very big discussion or very intense discussion with experts. And so 15 or 17 years ago, I introduced the Dresden Symposium and invited people from all around the world, having a lot of time to discuss initially delivery room management in very much detail and with clinicians, with scientists. And that was very interesting. And then I realized that some people cannot come to Dresden, obviously from the States or from...

South America or even China or so. And then we already started in 2014 to have hybrid formats of our meetings. So it was transmitted into the world and people could participate. So long before COVID. And then I realized, okay, even if you are not at the place, you are very much interested. And then some people ask me, can we have a summary of the meeting and so on. And then...

step by step there was some ideas of recording the meeting or having these in much more detail. And then after COVID, I was thinking, yeah, now we can start some kind like podcast. And then we started with a German podcast. And I was very much surprised to go to congresses where people came to me and said, I was listening to your podcast. It never happened to any paper.

published. that was amazing to see how the response was. And that was kind of encouraging and so it supported me. And then I discussed it with the European School on Neonatology, because it's in different format of teaching young people. And I said, can we have these podcasts even as well for the European School on Neonatology? And then we started the Neonatology Now podcast.

Daphna Yasova Barbeau, MD (28:54.339)

I love that.

Mario Rüdiger (29:21.43)

And the idea is to have a very recent publication or very recent topic discussed in very much detail with the specialist in this field. And I think you can get many information out of this discussion by having or learning what is not written in the paper, but what is the idea behind it and so on.

Daphna Yasova Barbeau, MD (29:47.287)

I love that concept about what's not written in the paper. And there's so much that goes into neonatology and to research that's not written in the paper. The challenges are sometimes glossed over, the recruitment, some of the personal and professional obstacles that people have to go through. And that's something that I've loved in listening to some of your interviews.

Mario Rüdiger (29:51.844)

You

Daphna Yasova Barbeau, MD (30:16.707)

Now you've been doing neonatology for some time, but I wonder if there's something that you've learned from an interview or one of your favorite interviews that you can share.

Mario Rüdiger (30:29.22)

There are many different and actually I invite people I always want to talk with because I want to learn something. had once a podcast with a guy who is doing, who is an expert in elephants and he was talking about delivery of elephants. That was amazing to hear this one. Or the one with Dieter Wolke, he is a psychologist and he knows quite a lot about long-term development of preterm infants.

Daphna Yasova Barbeau, MD (30:35.523)

Mm-hmm. Hmm.

Daphna Yasova Barbeau, MD (30:46.883)

Mm-hmm.

Ben (30:48.261)

Wow.

Mario Rüdiger (30:59.174)

So that's always fascinating. Or to talk with Chris McKinsey from New Zealand about blood sugar. Why do we should give some blood sugar to term babies in order to keep the sugar stable and so on. It's always something new I can learn.

Mario Rüdiger (31:19.16)

Blood sugar. It's blood glucose. Sorry, to keep the glucose stable.

Daphna Yasova Barbeau, MD (31:21.027)

Blood,

Ben (31:21.291)

wow, okay, okay, I misheard.

Ben (31:29.306)

That's so interesting. I'm just wondering if through the podcast, you've been able to satisfy interests of yours that until then, through I would say quote unquote conventional medicine following the path of clinical work, research, and so on and so forth, you had not really.

you had not really satisfied. Is there something else that this brought to you specifically in your practice of neonatology that until then you really had not experienced?

Mario Rüdiger (32:07.268)

Let's say in the German podcast we are starting now to have some more discussion about political issues concerning medical care. Because in Germany we have no really very good centralization. And so I try to invite people from politics, from regulatory affairs and so on to get the reason or to learn more about why or what is needed to improve care and so on.

That's an interesting aspect for me. I've never dealt with it and was never thinking about getting some political involvement in order to improve your healthcare system. Or another issue is how to combine family and the job. So that's a very important issue for young doctors. So these life-work balance or how you call it, because there are many...

many very nice models which can be introduced in order to improve the combining work and family and all this research. That's very important. And so I had a very good speaker and she was speaking about this topic and I loved it very much because there were so many new ideas about it.

Ben (33:25.86)

That's so interesting. And then I guess that's a perfect segue to asking you about this. mean, you juggle so many different things. And it seems to us, at least from the US and for myself having lived in Europe for some time, that it would be much easier to potentially balance work and family because Europe has a much more robust social structure. But yet I know from experience that

Despite all that, it's not always so easy. And I know that the physicians in Europe are under a lot of pressure and they work a lot. And they do, like we said earlier in the episode, they do a lot more things that sometimes goes beyond the regular duties of a physician. And so can you tell us what are some of these difficulties that people are encountering and what are some of the clever solutions that you've heard from some of your guests on particularly work-life balance issues?

Mario Rüdiger (34:24.324)

I think that's a very good point and I was already thinking about it when you were talking about parents because involving of parents, think it's much easier because we have a very good social system in Germany. So, parental leave is paid and all this stuff. So, I think in some aspects it's sometimes easier to involve parents and to get them in the unit and so on. And that's also an advantage in the...

for the professional life to have more or very strict rules for working hours and it has very much improved over the last decade so it's very strict 48 hours per week it's a upper limit you can work and so there's enforcement to do it and but nevertheless we have a shortage of stuff

And so in real life, it's getting more difficult. But I think there was a big progress over the last 20, 30 years in how you can combine personal life and business or work life. But there's still some need for improvement. For instance, having protected research time. I think that's a big problem in Germany at least, because research is not part of your...

clinical education and you don't have time for research. And if you're interested in research, it's mainly in the spare time you're doing it. And so it's part of the family time you have to spend for research time. That's a big issue, I think. And otherwise, I think there are new models of having the young people or the junior stuff, let them decide.

how they want to organize the work. Sometimes it's very top-down approach and I think if you give the power to the junior staff to organize the shifts and so on, there could be some more benefit and there is some more, how you call it, it would be more satisfied.

Ben (36:26.502)

Mmm.

Ben (36:39.302)

Yeah, this is something that we've seen in the US where we're moving to a model where people are working a lot more on the part-time basis, increased job satisfaction. And it's definitely a big difference where in the US a lot of the people who are doing research have protected time, meaning that it's incorporated into their 9 a.m. to 5 p.m. Well, I mean in Europe.

Mario Rüdiger (36:48.1)

Mm-hmm.

Mario Rüdiger (37:00.088)

Yep. Yep. Yep.

Ben (37:05.562)

funding for research is always very variable depending on where you are. It's not as centralized as potentially it could be in the US with the NIH, even though we're starting to see that there may be some changes to that coming down the pike. anyway, yeah, that's one thing that we don't do here on the podcast. We have tried to stay away from politics. We do talk a lot about advocacy, and we talk about policies. But it's interesting that somehow this was

Mario Rüdiger (37:08.425)

Mm-hmm.

Daphna Yasova Barbeau, MD (37:17.453)

Mm-hmm.

Ben (37:35.406)

something that you were brought to through the podcast.

Mario Rüdiger (37:39.844)

Hmm.

Daphna Yasova Barbeau, MD (37:41.667)

Well, that was partially my next question. Mario, what you've described, we would say is advocacy. And I think for so long, especially in the States, and I understand from Ben it's not uncommon in Europe, but I mean, people don't want to mix work and politics, but so much of medicine relates to the political climate. And so much of what we're allowed to do in medicine is through

other laws, regulations, and things that are determined by political policies. And so I'm so impressed by you for taking that step and saying, well, at the very least, community, our listeners need to know what's happening, need to hear from the people that make those decisions. And I think that's really a remarkable step forward in the right direction. So I wonder what does that look like next in terms of, you know,

Mario Rüdiger (38:13.572)

Mm-hmm.

Mario Rüdiger (38:26.35)

Mm-hmm.

Mm-hmm.

Daphna Yasova Barbeau, MD (38:41.537)

changing policy or advocating for units in your country so that you can optimize the care delivery.

Mario Rüdiger (38:54.756)

Yeah, so at the moment, we have a big problem in centralizing, at least in Germany, we're in centralizing care of very preterm babies. So we have about 150 units which provide high level neonatology. And so my unit, for instance, is one of the biggest in Germany, and we have about 120 very low birth weight infants per year. So that's a very small number for your conditions, but...

Daphna Yasova Barbeau, MD (39:00.483)

Mm-hmm.

Mario Rüdiger (39:22.328)

This one is very big in Germany because in Saxony we are more centralized. But you have units where you treat only about 20 or 30 babies every year, very low birth rate. That's very small units. And so I'm very much fighting for getting these more centralized. And the argument against it is always we need some specialists even for the term babies and so on.

But that's not a very good argument, I think. And so I'm also supporting the introduction of telemedicine support. Because you can support the pediatrician in the low-level care hospital with telemedicine support. And then he can provide care for the resuscitation or for the asphyxiated baby, just in case it is needed. But that's very difficult to convince politicians.

that you can reduce mortality by getting centralized. They have very good data. You could save every year 60 infants in Germany by driving the maximum or the minimal level of very low birth weight up to 50. So the lower border, you should have at least 50 very low birth weight infants per year. Then you would save 60 babies every year in Germany. But that's very difficult to convince politicians.

Daphna Yasova Barbeau, MD (40:50.019)

We struggle convincing politicians over here too, even with excellent data. So I feel you there.

Mario Rüdiger (40:53.421)

You

Yeah, or to pay some money for research. mean you have a lot of research money for cancer for I mean, it's important but the research money for for neonatology or fetal care so it's very very limited

Daphna Yasova Barbeau, MD (40:59.821)

Mm-hmm. Right to invest.

Ben (41:14.182)

Yeah, especially since it's such a small percentage of the segment of the population. think that's where the funding is always so hard to convince politicians, policymakers about it, because when we talk about them, it's very difficult sometimes. What is it? It's very awful quote from Stalin that like, one death is a tragedy, but million deaths is just statistics. I think that it's very hard to convince policymakers that

we need to make a difference for these individuals unless it doesn't translate. That's exactly right, I agree with you.

Mario Rüdiger (41:45.07)

But it is an investment in the future. So it's very good invested money.

Daphna Yasova Barbeau, MD (41:47.565)

Mm-hmm.

Daphna Yasova Barbeau, MD (41:52.339)

I recognize we're getting near to the end of our time. I wanted to highlight, you mentioned the Dresden Conference. It's entitled Improving Phytoniomital Health this year, and it runs from the 13th to 15th of March. Though I think you have a symposium after that time, a hands-on workshop. But like you said, you guys have been doing the hybrid thing for a decade.

I'm very good at that and offer reduced pricing free for people even outside of Europe. So I hope people will take the opportunity to register and take a listen to some of the really important topics that you guys are talking about. And that brings me to my last question, which is you have always been an innovator in education, the things you've done for the conference.

are unique and interesting. Hopping onto the podcast game early is exciting. And I wonder, what do you think will be required in the future of neonatal education? What are some of the next steps for us to conquer? And how will we meet future trainees in neonatology where they are?

Mario Rüdiger (43:12.1)

I think it will be very interesting to look more in detail. very good example is looking delivery room management videos. So if you watch a video of what a person is doing and if you discuss it with different people from different units, then you get a better knowledge what can be done, what is really done and how you can improve care.

And also this videography and self-reflecting is very important. So just do a video for yourself, watch the video and then you realize there is some room for improvement. If you talk with parents, record the talking and then listen afterwards, you will learn there's lot of chances, many chances for to improve this one.

And just one comment concerning the Dresden meeting. It's always in March, every year in March. So if you don't come this year, next year, it's also the second week in March again in Dresden.

Ben (44:13.926)

Yeah, the point about the video is so good, especially considering that we have all the tools available today. I remember Daphne and I were visiting the Children's Hospital of Philadelphia where they have a few beds set up for simulation with all sorts of video equipment. And then I thought I was going to walk into like a movie studio, but it was just a bunch of iPhones and it was technology that I have access to as well. And it's just a good reminder that there's a very low barrier to entry in terms of getting that particular aspect of feedback for improvement done.

Mario Rüdiger (44:32.034)

Yeah. Yeah. Yeah.

Ben (44:43.974)

It's a very low hanging fruit when it comes to your ability to it. Which by the way, wasn't the case 20 years ago. I think that before the advent of iPhones, iPads and whatever, it was much more difficult. But today, I mean, there's no excuse. So I really appreciate your highlight.

Mario Rüdiger (44:48.302)

Mm-hmm.

Daphna Yasova Barbeau, MD (44:48.855)

Mm-hmm.

Mario Rüdiger (44:53.538)

Yeah.

Yeah. And people are getting used to it. So they are not afraid of video recording. And so I think the next generation, it will be like usual.

Daphna Yasova Barbeau, MD (45:03.267)

Mm-hmm.

Ben (45:08.347)

Yeah.

Daphna Yasova Barbeau, MD (45:08.579)

And I think some of those underlying messages, you talked about it with parents, you talked about it with trainees, of self-reflection. We're losing that sometimes in our, this is your grade, this is how you did. That's different than self-reflection where we know people learn better. And also this culture of, we can do the recording and we can talk about it we can get feedback and it's not punitive. It's really to make our systems and our teams

Mario Rüdiger (45:15.716)

Mm-hmm. Mm-hmm. Mm-hmm.

Mario Rüdiger (45:21.678)

Yeah, yeah, yeah.

Daphna Yasova Barbeau, MD (45:38.007)

better. I think that's a real culture change, but I just wanted to highlight what you said because I think that's so valuable, especially in a society as you highlighted, like ours in the States that is so litigious.

Ben (45:56.454)

Mario, thank you so much for making the time to be on with us. I really enjoyed our conversation. I think that one of the goals of the incubator is to build these bridges with our colleagues across the globe. Learning more about European neonatology was fascinating. And just to hear a little bit about how you guys prioritize, how you guys approach a problem is really interesting. Congratulations on all the work you're doing. We're going to recommend people go check out neonatology now, available on pretty much every podcasting platform. I think if you're using Apple Podcasts, Spotify. You just type it in. It's there. Or if you are German speaking, then go check out Neocast. so thank you again for all this work. And we'll put some links for people to find you online. Thank you again very much for taking the time. It was a true pleasure.

Mario Rüdiger (46:45.07)

Ben, definitely. Thank you very much.