#443 - Could NeoGuide Be the Answer to the NICU’s Variability Problem?

Every neonatologist has built a protocol or written a guideline, and most have done it completely alone. In this episode, Ben sits down with Dr. Christina Muffy Sollinger (UC Davis) and Dr. Sarvin Ghavam (CHOP), the co-founders of NeoGuide, a national collaborative dedicated to connecting clinicians around the shared work of clinical guidelines and practice pathways. Born from a single email that broke a listserv and generated over 120 responses overnight, NeoGuide has grown into a structured community offering a seminar series on topics like transfusion medicine and HIE management, and a curriculum series focused on implementation science. Muffy and Sarvin discuss how to build consensus without promoting cookie-cutter medicine, the moral distress of clinical uncertainty, and their vision for a living repository of institutional pathways. Whether you are at a level four academic center or a small rural NICU, you shouldn’t have to start from scratch.

Transcript

Ben Courchia MD (00:01.038) Hello, everybody. Welcome back to The Incubator Podcast. We're back today for a special interview. We have in the studio with us two physicians: Christina Muffy Sollinger and Sarvin Ghavam. Sarvin, Muffy, welcome to the podcast.

Christina Muffy Sollinger (00:15.298) Thank you, good morning.

Sarvin Ghavam (00:16.839) Thank you.

Ben Courchia MD (00:18.074) Muffy, you're the Associate Director of Quality and Safety for the Department of Pediatrics at UC Davis (University of California, Davis), in addition to being the Director of Quality and Safety for the NICU (Neonatal Intensive Care Unit). You're an Associate Professor and the Assistant Medical Director of the NICU at UC Davis Children's Hospital. Sarvin, you're an Attending Neonatologist at the Children's Hospital of Philadelphia (CHOP) Neonatal Care Network at Virtua Health, and you are the Director of Clinical Practice Guidelines for the CHOP Newborn Care Network, a network of 22 hospitals.

And despite all these titles, we're here to talk today about NeoGuide, a project that is very exciting and that you've both been working on. Can one of you tell the audience what NeoGuide is and how it came about?

Sarvin Ghavam (01:07.399) I can start, because I actually reached out to Muffy about a year ago — maybe a little over — because UC Davis had a really strong pathway for PDA (Patent Ductus Arteriosus) therapy and I wanted to pick her brain about it. After our meeting, Muffy said, "Hey, I think we do the same job." I said, "Oh really?" She said, "Yeah, I handle all the practice guidelines and pathways for our division." Turns out I do the same for mine.

I thought, there must be others out there — shouldn't we get together and talk about it? We were both on the CLG (Clinical Leaders Group) through the AAP (American Academy of Pediatrics), so I sent out a quick email saying maybe there were about 10 people we could connect with when we needed ideas.

Muffy and I drafted that email in less than 30 minutes and I posted it on the CLG listserv. It went nuts. We actually broke their listserv to the point where the group leaders had to stop the reply-all and take it down. We had over 120 people respond saying they wanted to be part of this pathways and guidelines work. It seemed like we had hit a huge nerve — everyone was working in silos, trying to recreate the wheel constantly. And it took off from there.

Christina Muffy Sollinger (02:56.982) Meeting with Sarvin really crystallized that feeling of working in silos. Finding like-minded people who share similar career goals and passions — whether it's PDAs, BPD (Bronchopulmonary Dysplasia), or golden hours — and being able to genuinely share information and collaborate was exciting not only to Sarvin and me, but to the 200-plus people on the CLG who responded so enthusiastically.

When that response came in, it really lit a fire underneath us. We realized this wasn't just something we desperately wanted for our own institutions and careers — so many colleagues across the country, whether at level four academic centers or small community rural hospitals, were needing the same level of support and wanting that same collaborative effort. Sarvin and I got back together quickly and said, "Okay, what do we do next?" We were fortunate to have great mentorship through the CLG and others, and we started developing a game plan for how to make this meaningful — not only for ourselves, but for our colleagues.

Ben Courchia MD (04:27.054) First of all, be careful — you've mentioned PDA twice already, and I feel like people are now going to flood the Incubator inbox asking about the proper pathway for PDA management. But what's interesting to me is that we talk a lot about variability being one of the big problems in neonatology. After speaking with you and thinking about NeoGuide from a more philosophical standpoint, it seems like the variability isn't intentional — it's that we're all trying to do the same thing in different places, and that process itself generates variability. As a cohort, we might actually be quite aligned. Is that something you've found — that people are less entrenched in their opinions than we might assume, and are actually practicing within similar ranges?

Christina Muffy Sollinger (05:21.282) Yes. One size doesn't fit all — and that's part of the beauty of NeoGuide. We all have guidelines addressing similar clinical problems or physiology-based issues, and we come together to share them and learn from each other about what's worked and what hasn't. These are evidence-based guidelines developed at real institutions, so they're grounded and supported — but one size does not fit all, and I think that's really important to keep in mind when developing a guideline. We can use each other's information, knowledge, and experience, but ultimately create something that works at our own institution — for our own patient population, our own nurses, our own trainees, our own faculty. We don't want to promote cookie-cutter medicine, but rather individualized, center-specific approaches.

Sarvin Ghavam (06:10.373) There was a recent article in the Journal of Perinatology on the moral distress of uncertainty. There's a growing body of research showing that newer trainees, newer faculty, and fellows experience real distress around not always knowing the right answer. Sometimes it's simply reassuring to know that 75% of your colleagues support the decision you're making, and that experts would back you up.

That's where the key lies. The goal isn't cookie-cutter medicine, and we're not planning on developing some massive nationwide consensus. This is more about learning from each other — and then, within our own workflows, whether it's a network, a single hospital, or a small hospital somewhere that doesn't have time to build everything from scratch, giving people the peace of mind that what they're looking at is vetted and reflects what major institutions are doing.

The biggest feedback we hear from nurses and families is that they get whiplash from inconsistency. One attending leaves service, and three weeks later someone changes the whole plan. That's not necessarily my way versus Muffy's way versus anyone else's — it's just that if we could come together and align, we'd avoid that roller coaster for the families we care for.

Ben Courchia MD (08:07.15) For people listening, can you expand a bit on what NeoGuide actually is today? Is it a website, a book? It's obviously a huge undertaking. Can you elaborate on where things stand in terms of development and what form it has taken so far?

Christina Muffy Sollinger (08:34.862) One of the core pillars we're building NeoGuide upon is collaboration and learning from each other. We're working toward that through two pathways: a seminar pathway and a curriculum pathway.

The curriculum pathway is really about implementation science — how do you take a clinical problem, put a solution into place, drive adoption, track your metrics, navigate culture change, and collect meaningful data to demonstrate improvement? We're bringing in experts from around the country to help build that curriculum, targeting about four sessions per year on varying topics.

The seminar series brings in experts from around the country who have developed stellar, evidence-based guidelines — some of whom are actually writing guidelines for COFN (Committee on Fetus and Newborn, AAP). In May, for example, we'll be discussing care of HIE (Hypoxic-Ischemic Encephalopathy) patients — what institutions around the country are doing, especially in light of the new guidelines recently released by COFN. The goal is not only to share guidelines but to discuss practical implementation: what were the sticking points, what worked well. Our goal is not to develop new guidelines within NeoGuide itself, but to be a place where we can collaborate, share, and learn from each other.

Sarvin Ghavam (10:26.299) To build on that — we have a listserv with an open sign-up link where anyone can enter their email and institution, and we reach out as we roll out new content. We're also housed within the CLG of the AAP, so joining that group gives you access to their community dashboard where we host our programs. All sessions are recorded video and easily accessible, and they're being archived within the CLG AAP group.

We're currently working on a dedicated website where people can find out how to join, access the listserv, and browse our collected work. The longer-term goal — as we build more support — is developing a repository where hospitals and groups can share their pathways and guidelines. There's already a subset of US institutions with public-facing consensus work and pathways, and one of our colleagues is building a comprehensive list of those resources specifically for neonatology, so nobody has to start entirely from scratch.

The broader vision is to get institutions that don't have public-facing pathways to share theirs in a protected space — with the understanding that content will be time-limited. If an institution doesn't renew what they've shared after two to three years, it will be removed or flagged as outdated. The goal is a place where you can look up what others are doing instead of sending mass emails to your network hoping someone has something useful.

Ben Courchia MD (12:58.682) For many people, the problem is they don't even know who to email. If you happen to know someone who's already designed an algorithm for a specific process, you're in luck — but most of the time, people just do a Google search and find whatever's out there, sometimes not very applicable, sometimes from other countries with different resources. Have you already launched some of these series? Can you tell us which ones have happened and what the community feedback has been?

Christina Muffy Sollinger (13:38.447) We started in October 2025. Our first curriculum session focused on how to choose a topic — thinking through the very first steps of how to identify a problem in your NICU. I put myself in the mindset of a trainee, because that's really where my own passion for this work began.

When I was training at the University of Rochester, my mentors instilled a real curiosity in me. I would look at a recurring problem on service and ask: why aren't we fixing this? Why are we approaching it the same way every time? Through great mentorship, I developed skills to tackle those questions and build new pathways and processes. So we built our first curriculum session around that foundational question: how do you even begin to tackle a problem in your NICU?

Our second session was in January, on practical approaches to consensus building. Sarvin led that with Rupali Bapat, John Ibrahim, and Gordon Gaya [name unverified], covering the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) method — thinking through different approaches to building evidence-based consensus.

In May, we're doing implementation science, and September and November dates are still TBD — topics will likely cover PDSA (Plan-Do-Study-Act) cycles, quality metrics, and data collection and presentation. We're aiming for about four curriculum sessions per year.

The seminar series has been really well received. The first was February 10th, on transfusion medicine — Dr. Kaufman, Dr. Oles, and [third speaker name unverified] presented on different aspects of transfusion care at their institutions. In May, as mentioned, we'll cover HIE and therapeutic hypothermia in light of the new COFN guidelines, with Courtney Wusthoff [spelling unverified], Sonia Bonifacio from Stanford, and Emily Steele [spelling unverified] from UC Davis. September is still being debated, and then probably another session in December or January — about four per year for each pathway.

Ben Courchia MD (16:11.876) Very interesting. What do you expect the next step to look like for people who join and say, "I'm actually working on a transfusion protocol for our unit"? The community you're building will naturally divide into two groups: those who already have a guideline for a given process, and those who don't — and people will go back and forth between those categories depending on the topic. How does the exchange of ideas practically happen within the NeoGuide community?

Sarvin Ghavam (16:59.067) During the transfusion medicine session — three 20-minute presentations followed by Q&A — the chat just exploded. I didn't realize people wanted the chat recorded and documented, and I started getting emails afterward asking for what had been shared there. That's something I need to address going forward, because the topic experts were fielding really specific questions in real time.

What was remarkable was Robin Ohls — she put a link in the chat for a monthly hematology club anyone can join, and said she'd look at your transfusion pathway and give you feedback. We have our own transfusion protocol, and I still came away thinking there were three things those presenters shared that we don't do.

I genuinely love this work — consensus building, pathways, giving teams the reassurance that there's an agreed-upon approach. Our field is still young, still pushing limits — 22-weekers, some centers doing 21-weekers, evolving approaches to skin care. There's so much happening that people don't realize others have already figured out. After that session, people naturally went off and made direct connections — Robin put her email in, others did too, David Kaufman, who contributed to the COFN cord blood paper, said, "Just email me."

You don't realize you have these resources until you're in a room together. Earlier in my career, I didn't know who to turn to to ask these questions. Hopefully we're creating that opportunity. And through the AAP community site, we're working toward building a NeoGuide sub-site that gives people an open, organized forum to discuss specific guidelines, protocols, and consensus work — a more structured space than the locked Facebook groups that currently serve this function.

Christina Muffy Sollinger (20:12.295) Similar to guidelines and clinical pathways themselves, we know these tools are only effective when they're accessible. We're building NeoGuide to be accessible to everyone — trainees, faculty, nurses, nurse practitioners. We want these resources to be easy to find and easy to connect with.

Ben Courchia MD (20:41.25) My follow-up question is about scope: this is a massive undertaking, and you're prioritizing topics based on demand and relevance. There could be hundreds — maybe thousands — of possible topics. How do you decide what to tackle first and what to save for later? Is this a committee decision? Is there community feedback driving it?

Christina Muffy Sollinger (21:20.361) We quickly realized that more minds and more help makes this better, so we solicited interest from the CLG responses — anyone who wanted to take on more of a leadership role. We built an executive committee with people from all over the country, at various stages of experience and types of institutions.

We meet one to two times a month and discuss what the hot topics are at our respective institutions, what's coming up at conferences, and what the national pulse is — what people need support with. With the COFN guidelines on HIE and therapeutic hypothermia just released, that was an easy choice: we're all asking the same questions — are we doing the right thing? How do we build guidelines that are consistent but not so prescriptive that they make clinicians uncomfortable?

Our exec members include Julie Weiner, Nina Menda, Mary Fay, Mina Hanna, Catherine Rockamp [spelling unverified], Carly Cassano — who's also managing the IT side, which we're very grateful for — Jennifer Cohen, Lori Christ, John Ibrahim, and Rupali Bapat. A tremendous group of minds from across the country helping Sarvin and me build this out.

Ben Courchia MD (22:55.236) Thank you. In terms of evolution — you've mentioned that everyone works in different settings. What's your perspective on sharing practices when some practices maybe shouldn't be universally shared? A large level four NICU may approach things very differently from a 15-bed community NICU. How do you address that disparity in size, acuity, and resources when thinking about how protocols should be shared?

Sarvin Ghavam (23:39.911) That's a really good question, and honestly, we haven't fully run up against it yet — partly because the transfusion guideline topic was a bit less polarizing. Interestingly, we submitted a PAS (Pediatric Academic Societies) workshop proposal on the guideline development process for transfusion, and 50% of reviewers said, "Everyone already has guidelines," while the other 50% said, "Nobody has guidelines." We didn't get accepted, but that split itself was telling — nobody actually knows what anyone else is doing.

On the size disparity: our goal is really to find presenters and topics that are identifiable to both level two and level three NICUs. Level twos don't cool — but they need to know at what point a baby should be transferred to a level three or four for cooling. The goal is to present things that are practical. Some guidelines from very busy level four centers become inaccessible once you start adding too many decision points — unusable even for the hospital that created them. Nobody can run that many tests on a single baby; not every hospital has that subspecialty consultant.

The passion behind this work is taking the evidence coming out of clinical research — which I deeply value and which I think is becoming increasingly difficult to conduct right now — and making it practical and accessible at the bedside. And where the data isn't there yet, let's come together as a group of experts and identify what research we actually need.

Ben Courchia MD (26:49.114) How do you view NeoGuide's relationship with the rest of the world? So far you've described interactions with stakeholders mostly in the US. Is the hope to keep this national initially, with potential global collaboration down the road? Or is this intentionally an American initiative?

Christina Muffy Sollinger (27:30.863) There's always something to learn from institutions nationally and internationally — the goal of NeoGuide is really to learn from each other, wherever that is. Amazing work in neonatology is happening all over the world. Starting with a more contained scope and seeing where things go will always be the approach.

Ben Courchia MD (28:02.702) National is not small, but I take your point.

Christina Muffy Sollinger (28:05.824) [laughs] We started in California.

Sarvin Ghavam (28:07.783) I'm still somewhat stunned that this is happening, honestly. I assumed someone was already doing all this.

Ben Courchia MD (28:20.056) And there wasn't.

Sarvin Ghavam (28:21.253) And there wasn't. We're still getting the message out that we exist — come help us, come share. If you have a great protocol or guideline you've developed, please let us know. My biggest concern is tunnel vision. We have a diverse exec group — Midwest, Northeast, California, Texas — and that happened organically, which is remarkable. But I want to make sure we stay open, and I'm really hoping that an episode like this one will draw in people from parts of the country we haven't yet reached.

Ben Courchia MD (29:08.25) What you've described so far is really that NeoGuide is not yet offering a catalog of all protocols from every unit in the country, but rather that first critical step — a village square where you can go and connect with the right people. Instead of not knowing who to email, there's now a place to find someone and say, "I'm working on this — can you tell me what you're doing?" And then you iterate from there, standing on the shoulders of people who have already done the work, many of whom are genuine leaders in the field.

That's already a tremendous achievement before a single PDF starts flying between institutions. And it's probably a more sustainable goal logistically — because protocols are always at the mercy of the evidence. The recent COFN report on therapeutic hypothermia is a perfect example: new evidence is reshaping how we approach HIE, which means guidelines have to be adjusted. How do you foresee managing the constant need to update protocols given the pace at which evidence keeps evolving?

Christina Muffy Sollinger (30:56.383) The initial goal is really to serve as a landing spot for institutions' public-facing websites — and those institutions remain responsible for their own guideline updates through whatever review process they have in place. Most try to have a two-year review cycle, so guidelines are being revisited at minimum every two years.

We're not trying to create guidelines ourselves or manage their lifecycle in real time. That might be something for many years down the road with a much larger team. For now, we want to be the resource and the repository — the place where people know to look. As Sarvin mentioned, one of our exec members has already compiled a list of public-facing institutional guideline websites, and having been in neonatology for 15 years, I didn't know half of them existed.

Like any good QI (Quality Improvement) project, Sarvin and I are focused on PDSAing ourselves: what's working, what's not, what's the feedback? Sarvin has been doing a great job sending surveys before and after each session and collecting direct input from the group. NeoGuide will keep evolving — the goals today might look quite different a year from now. But with strong engagement from colleagues across the country — and maybe abroad — we're hoping to make this something truly meaningful for our institutions and the families we care for.

Ben Courchia MD (33:02.008) You've taken on a project that many people would have found daunting just at the thought of it — and you've persevered. Your collaboration is clearly what keeps the engine going. In the early phases of a project like this, feedback loops matter enormously. Has there been a moment — a story, a piece of feedback — that made you think, "This is exactly why we're doing this"?

Sarvin Ghavam (33:36.699) The fact that we got these remarkable people from across the country to say, "We'll give you our time, meet with you once a month, and help build this" — directors at major centers with enormous day-to-day workloads — that alone was incredibly encouraging.

And then after the transfusion session, people forwarded the recording to colleagues who hadn't even been on the call, and those colleagues emailed me with very specific questions. Someone reached out and said, "I'm in a tiny NICU — this is amazing, how do I get more of this?" That made me genuinely happy.

There are detractors, and I'll acknowledge that. Some people feel their guidelines are their personal work product and don't want to share broadly — and I respect that opinion, even if my instinct is completely the opposite. Others argue that without strong RCTs (Randomized Controlled Trials) behind a guideline, we shouldn't be promoting it widely, since we risk elevating expert opinion above rigorous evidence.

I'd push back on that. Look at our NEC (Necrotizing Enterocolitis) data: it doesn't matter what your specific feeding guideline says — as long as you have one, NEC rates go down. Consistency and intentionality in care is itself a quality driver.

We just completed a consensus process at CHOP on PPHN (Persistent Pulmonary Hypertension of the Newborn) and vasoactive agents — which generated real controversy within our unit, because the literature is shifting what we use for vasoactive support. It's going to require a significant workflow change for our level three colleagues and pharmacists. But it resulted in a 32-page document that we condensed into a one-page quick reference — from echo findings all the way to recommended vasoactive agents. Why wouldn't I share that with Muffy, or with anyone who wants it? Not that you have to use it, but here's a vetted starting point. Academic medicine sometimes feels more siloed than it needs to be.

Christina Muffy Sollinger (37:41.347) I'd add that one of the most rewarding outcomes has been seeing people feel empowered to get started. Trainees at our institution have come up and said, "This is so cool — we didn't know we could have access to this or approach it this way." I remember as a trainee having that eureka moment where something I started actually began to have meaningful impact. We really want to give people at all kinds of hospitals and all levels of experience — whether you're a trainee or you've been in practice for 40 years — the tools to make good, evidence-based changes. Hearing people say, "We tried this and it worked, and it was because of this session or this presenter," has been genuinely exciting.

Ben Courchia MD (38:49.754) This actually happened in my own unit — I was preparing for this episode and watched the transfusion seminar asynchronously after you shared the link. My former medical director, who had been on the live call, came back and said, "You should have been there — it was a great session, the conversation was incredible." Seeing that loop of positive feedback was really something.

Christina Muffy Sollinger (39:23.535) Medicine is hard right now. We should all be supporting each other, lifting each other up, and being as resourceful as we can in this landscape. That's exactly the spirit we want NeoGuide to embody.

Ben Courchia MD (39:35.098) Absolutely. For those who've listened to this episode and want to join NeoGuide or stay up to date — what's the best way to get involved?

Sarvin Ghavam (39:57.371) You can email either Muffy or me — we'll share our contact information with the podcast. I'll also share a link to our sign-up spreadsheet, which is an open Google form where you can add your name, institution, and email, and we'll include you in all future communications. We're also working on building a dedicated listserv, and once we establish our community page within the AAP platform, we'll send that out to everyone. That's a project in progress.

Ben Courchia MD (40:34.83) And some of the content already produced — including the transfusion session — is publicly available through the AAP community platform at community.aap.org. People can start catching up there directly.

Sarvin Ghavam (40:48.731) Yes, it's public — just go watch it.

Christina Muffy Sollinger (40:51.908) Please do!

Ben Courchia MD (40:59.354) Muffy, Sarvin — thank you so much for joining us, and congratulations on building something that's truly needed. Looking forward to seeing NeoGuide grow and impact clinicians and the families they serve.

Christina Muffy Sollinger (41:15.247) Thank you so much, Ben.

Sarvin Ghavam (41:16.903) Thanks for having us.