#403 - 🔵 [NEO CONFERENCE] - What defines high quality evidence in modern neonatal care (Dr. Wally Carlo)

Hello friends 👋

Join Ben and Daphna live from the NEO Conference as they welcome the 2026 Legends in Neonatology Award recipient, Dr. Waldemar "Wally" Carlo. In this inspiring conversation, Dr. Carlo discusses the driving forces behind his enduring passion for clinical care and the critical need for robust bedside research. They explore how full-time clinicians can actively shape the research agenda by turning everyday diagnostic uncertainties into innovative trials. Dr. Carlo also offers a preview of his highly anticipated lecture on neonatal oxygen targets, revealing why it remains one of the most rigorously studied—yet complex—areas in modern medicine.

Link to episode on youtube: https://youtu.be/HaKVOvZF4VQ

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Short Bio: Waldemar Carlo, M.D. is a Professor and Co-Division Director of Neonatology at the University of Alabama at Birmingham (UAB), where he holds the Edwin M. Dixon Endowed Chair in Neonatology. He completed his undergraduate training at the University of Puerto Rico, Mayaguez, followed by medical school at the University of Puerto Rico Medical Sciences Campus. He completed his pediatric residency, including a Chief Resident appointment, at the University Children's Hospital in Puerto Rico, and his Neonatology Fellowship at Rainbow Babies and Children's Hospital in Ohio. His research focuses on reducing neonatal and perinatal mortality through large-scale multicenter clinical trials in both the United States and developing countries, including the landmark First Breath, BRAIN-HIT, and SUPPORT trials. He leads UAB's participation in the NIH-funded Global Network for Women's and Children's Health Research and the Neonatal Research Network, and has developed several innovative neonatal devices.

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

Ben Courchia MD (00:00.142) Hello everybody. Welcome back to the Incubator Podcast live at the NEO conference in Las Vegas. We're joined by our esteemed pioneer, Dr. Waldemar Carlo. Wally, welcome back to the podcast. I was just asking you off-air, and Daphna made me stop you, and you answered because I was asking you whether you were still working clinically, and you said you're still full-time. I was going to ask you, how do you do it? What brings you back every day? And you were going to give us your perspective.

Wally Carlo MD (00:10.481) Thank you very much.

Wally Carlo MD (00:25.55) Yes, well, I love it. I love taking care of patients. I love interacting with the neonatologists and nurses, the whole staff. It's just a privilege, really, to be able to work in that environment where you're helping people. All you do is try to help people.

Daphna Yasova Barbeau MD (00:28.632) Yeah.

Ben Courchia MD (00:46.913) Yeah.

Daphna Yasova Barbeau MD (00:48.256) I love that. I love that. We have had you on the podcast before. I want people to make sure once they listen to you, I know they're going to want to hear more. Episode 40. I think one of our first Giants of Neonatology.

Ben Courchia MD (01:01.134) On the Giants of Neonatology, we had the pleasure of having you on. So tell us a little bit about what Dr. Carlo is going to be participating in at the NEO conference.

Daphna Yasova Barbeau MD (01:11.584) So on Friday, you're giving a lecture, "Oxygen Targets in 2026: Lessons Learned and the Road Ahead." But more importantly, you are being awarded the 2026 Legends in Neonatology Award. Congratulations.

Wally Carlo MD (01:29.838) Thank you very much, you're very kind. They're very kind to recognize the work that we as a team have done.

Daphna Yasova Barbeau MD (01:38.154) I love that. I love that. You'll give some remarks at that time. Do you get to speak?

Wally Carlo MD (01:43.766) I think I have a lecture after, so I'll say a few words.

Daphna Yasova Barbeau MD (01:48.16) Yes, sorry. Also, "Challenges of Clinical Research in Neonatology." Can you give us some pearls? What's the take-home on all of the challenges of clinical research?

Ben Courchia MD (02:00.942) You've been very innovative with your trial design and you've always leveraged as much of what clinical research methodology can provide, so I'm curious to hear your thoughts on that.

Wally Carlo MD (02:10.094) I have, yes. I have tried to do very innovative trials, from factorial design trials, for example, cluster randomized control trials, and comparative effectiveness trials. So I really have tried to put myself as a clinician and then ask the important questions of what will make the lives of these babies better. And thinking about that, I think then how to do a study.

And I will talk tomorrow about research to a group that is really mostly clinicians. This is not a research group, but they're clinicians who have many questions. As you're taking care of patients, you come up with so many questions, so many opportunities. So in fact, I will have a second title. The title is about challenges, but the second title is "Challenges and Opportunities."

Daphna Yasova Barbeau MD (03:08.332) I love that.

Wally Carlo MD (03:08.718) Because I think day to day there are so many opportunities, and a big message that I give is that we don't have so much data. When you see the last talk today, there is a very low level of evidence for our practices. So when you see that, we realize, okay, we have to get the evidence. We have to work together to get the evidence. We have to learn how to communicate to the clinicians, have the equipoise necessary to do randomized trials, and then at the same time explain to the parents and let them understand that we don't know everything. We have to take care of the patient, but the evidence is uncertain in many, many situations.

Ben Courchia MD (03:59.118) Especially now as we have created so many different categories of the 22-weekers with these comorbidities, the 24-weekers with these comorbidities. They're all so different, and we try to put them together, but they're not really the same patients. So I think this idea of collaborating and just trying to gather more data together is probably the right philosophy.

Wally Carlo MD (04:19.022) That's right. Now we are taking care of so many 22-weekers and even 21-weekers at times. They all have common problems, but they also are unique and have special problems, and the rate of complications and morbidities can be quite high.

Daphna Yasova Barbeau MD (04:37.27) Yeah. I wonder, what is your advice to full-time clinicians who are seeing something in practice, but they're not researchers? They don't want to do the research. How can they still drive the research agenda forward? How should they work with people who are interested in doing research and saying, "I have a problem, I have identified this problem because I'm here at the bedside every day"?

Wally Carlo MD (05:04.364) Yes, I think we as clinicians are the best people to identify where we need evidence because we're there with the patient and we see the importance of details in the care of the patient. You recognize, for example, "Okay, this doesn't look like a baby with NEC and perforation. Could the baby have spontaneous intestinal perforation? How do we manage that baby differently from one with NEC?" So I think we at the bedside can recognize many times that...

We have a lot of questions and few answers, and we need more research. And as a clinician, to have the equipoise and to say, "Yes, we don't have enough evidence," we have to be willing to do research, participate in research, or support research. And there are opportunities in many NICUs these days to do research.

Daphna Yasova Barbeau MD (06:07.342) I think that's the perfect segue to hearing the pearls from your oxygen targets talk. It's another place that really is kind of dogma in neonatology, but we're revisiting those oxygen...

Ben Courchia MD (06:20.639) Target saturations.

Wally Carlo MD (06:22.83) I'd say it's a complex issue, okay? But I also say that there's not an area in neonatology that has such a high level of evidence. In fact, this is interesting. The medical librarians in the US have an association. They reviewed the evidence and they said there's no other trial in medicine of such a high level of evidence.

Ben Courchia MD (06:59.539) Interesting. I would not have suspected they would say that.

Wally Carlo MD (07:02.508) Yeah, they said that. They said they could not find any other that was a meta-analysis of harmonized trials. That's important because all the five trials were designed the same way. They followed the same protocol. Second, the outcomes were all harmonized. So we all put them together.

Daphna Yasova Barbeau MD (07:18.956) Right.

Daphna Yasova Barbeau MD (07:29.614) Well, it really makes you rethink everything, then.

Ben Courchia MD (07:31.822) So maybe we do know them.

Wally Carlo MD (07:32.12) Yeah, so there's a high level of evidence. I think the issue is how to interpret it and how to apply it. So I will be talking about that tomorrow.

Ben Courchia MD (07:44.451) Very nice.

Daphna Yasova Barbeau MD (07:45.58) I love that. What is your wish for the future of neonatology?

Wally Carlo MD (07:53.25) My wish would be that we have great evidence so we can provide excellent care to every single patient, every time. We try hard, but if we don't have good evidence, I think it's difficult. We're sort of the blind leading the blind. We don't know what to do. But I think there are many opportunities to do research in the future that will transform the field. And we have seen it. In our lifetime, we've seen surfactants, for example, and how surfactants reduce mortality so much. And I think as we keep improving, we can go to lower gestational ages, as we also have seen. Now 22-week babies receive care in many centers, and they have relatively good outcomes.

Daphna Yasova Barbeau MD (08:52.334) Love that.

Ben Courchia MD (08:53.326) Thank you, Wally, for dropping by. Congratulations on this great honor. People don't know, but in the hallway, there's this big board with your picture on it, so congratulations, it's very well deserved.

Wally Carlo MD (09:04.104) Thank you.

Daphna Yasova Barbeau MD (09:07.074) Thank you.