Support teaching, research, and patient care.
National Health Service Corps
World Health Organization
vaccination and nutritional survey
Ministery of Health, Quito, Ecuador
My research interests include persistent pulmonary hypertension of the newborn, hypoxic respiratory failure, inhaled nitric oxide therapy, ECMO, congenital diaphragmatic hernia, neonatal clinical trials, and the use of aEEG and NIRS to detect brain injury.
Cool Prime Comparative Effectiveness Study for Mild HIE
To determine effectiveness of therapy to improve neurodevelopmental outcomes in infants with
mild HIE. To determine the adverse effects of Therapeutic Hypothermia (TH) in mild HIE on the
neonate and his/her family. Determine heterogeneity of the treatment effect across key
subgroups obtained in the first 6 hours after birth prior to the decision to initiate
Stanford is currently not accepting patients for this trial.
For more information, please contact SPECTRUM, .
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TIME Study: Therapeutic Hypothermia for Infants With Mild Encephalopathy
The TIME study is a randomized, controlled trial to evaluate impact on early measures of
neurodevelopment and the safety profile of therapeutic hypothermia in term neonates with Mild
Hypoxic-Ischemic Encephalopathy who are < 6 hours of age. Neurodevelopmental outcome will be
assessed at 12-14 months of age. The study will enroll 68 neonates randomized to therapeutic
hypothermia or normothermia across 5 centers in California.
Management of the PDA Trial
Estimate the risks and benefits of active treatment versus expectant management of a
symptomatic patent ductus arteriosus (sPDA) in premature infants.
Cycled phototherapy (PT) is likely to increase survival over that with continuous PT among
extremely premature infants (< 750 g BW or <27 weeks GA).
Milrinone in Congenital Diaphragmatic Hernia
Infants with congenital diaphragmatic hernia (CDH) usually have pulmonary hypoplasia and
persistent pulmonary hypertension of the newborn (PPHN) leading to hypoxemic respiratory
failure (HRF). Pulmonary hypertension associated with CDH is frequently resistant to
conventional pulmonary vasodilator therapy including inhaled nitric oxide (iNO). Increased
pulmonary vascular resistance (PVR) can lead to right ventricular overload and dysfunction.
In patients with CDH, left ventricular dysfunction, either caused by right ventricular
overload or a relative underdevelopment of the left ventricle, is associated with poor
prognosis. Milrinone is an intravenous inotrope and lusitrope (enhances cardiac systolic
contraction and diastolic relaxation respectively) with pulmonary vasodilator properties and
has been shown anecdotally to improve oxygenation in PPHN. Milrinone is commonly used during
the management of CDH although no randomized trials have been performed to test its efficacy.
Thirty percent of infants with CDH in the Children's Hospital Neonatal Database (CHND) and
22% of late-preterm and term infants with CDH in the Pediatrix database received milrinone.
In the recently published VICI trial, 84% of patients with CDH received a vasoactive
medication. In the current pilot trial, neonates with an antenatal or postnatal diagnosis of
CDH will be randomized to receive milrinone or placebo to establish safety of this medication
in CDH and test its efficacy in improving oxygenation.
Generic Database of Very Low Birth Weight Infants
The Generic Database (GDB) is a registry of very low birth weight infants born alive in NICHD
Neonatal Research Network (NRN) centers. The GDB collects observational baseline data on both
mothers and infants, and the therapies used and outcomes of the infants. The information
collected is not specific to a disease or treatment (i.e., it is "generic"). Data are
analyzed to find associations and trends between baseline information, treatments, and infant
outcome, and to develop future NRN trials.
Follow-up Visit of High Risk Infants
The NICHD Neonatal Research Network's Follow-Up study is a multi-center cohort in which
surviving extremely low birth-weight infants born in participating network centers receive
neurodevelopmental, neurosensory and functional assessments at 22-26 months corrected age
(Infants born prior to July 1, 2012 were seen at 18-22 months corrected age). Data regarding
pregnancy and neonatal outcome are collected prospectively. The goal is to identify potential
maternal and neonatal risk factors that may affect infant neurodevelopment.