Current Environment: Production

Medical Services

Programs & Services

Languages

  • English
  • Spanish

Education

Medical School

School of Medicine, Santiago de Guayaquil Catholic University

1992, Guayaquil, Ecuador

Internship

University of Florida, Schands Teaching Hospital

1995, Gainesville, FL

Residency

Pediatrics

University of Florida, Schands Teaching Hospital

1997, Gainesville, FL

Fellowship

Neonatal-Perinatal Medicine

University of Florida, Shands Teaching Hospital

2000, Gainesville, FL

Certifications

  • American Board of Pediatrics (Neonatal-Perinatal Medicine)

Publications

  1. Recent advances in NICU platelet transfusions. Semin Fetal Neonatal Med. 2025 Mar; 30(1):101609. View Abstract

  2. CDK8/19 inhibition triggers a switch from mitosis to endomitosis in cord blood megakaryocytes. Br J Haematol. 2024 Dec; 205(6):2481-2486. View Abstract

  3. The number of blood transfusions received and the incidence and severity of chronic lung disease among NICU patients born >31 weeks gestation. J Perinatol. 2025 Feb; 45(2):218-223. View Abstract

  4. Promoting Child Health by Protecting the Patient-Clinician Relationship From Politics. JAMA Pediatr. 2024 Oct 01; 178(10):969-971. View Abstract

  5. Implementing evidence-based restrictive neonatal intensive care unit platelet transfusion guidelines. J Perinatol. 2024 Oct; 44(10):1394-1401. View Abstract

  6. Sex differences in the association of pretransfusion haemoglobin and cognition in preterm infants. BMJ Paediatr Open. 2024 Jun 08; 8(1). View Abstract

  7. Clinical Practice Guideline for Red Blood Cell Transfusion Thresholds in Very Preterm Neonates. JAMA Netw Open. 2024 06 03; 7(6):e2417431. View Abstract

  8. Efficacy and safety of antithrombin supplementation in neonates and infants on a continuous heparin infusion. Res Pract Thromb Haemost. 2024 Jan; 8(1):102336. View Abstract

  9. Alport syndrome: A puzzling case of thrombocytopenia and giant unusual platelets in blood smear. Am J Hematol. 2024 06; 99(6):1168-1169. View Abstract

  10. Platelet Transfusion and Death or Neurodevelopmental Impairment in Children Born Extremely Preterm. JAMA Netw Open. 2024 01 02; 7(1):e2352394. View Abstract

  11. Quantitative label-free mass spectrometry reveals content and signaling differences between neonatal and adult platelets. J Thromb Haemost. 2024 May; 22(5):1447-1462. View Abstract

  12. Can Red Blood Cell and Platelet Transfusions Have a Pathogenic Role in Bronchopulmonary Dysplasia? J Pediatr. 2024 Feb; 265:113836. View Abstract

  13. Phosphoproteomics reveals content and signaling differences between neonatal and adult platelets. bioRxiv. 2023 Sep 13. View Abstract

  14. Hemostatic and Immunologic Effects of Platelet Transfusions in Neonates. Clin Perinatol. 2023 12; 50(4):793-803. View Abstract

  15. Neonatal Thrombocytopenia: Factors Associated With the Platelet Count Increment Following Platelet Transfusion. J Pediatr. 2023 12; 263:113666. View Abstract

  16. Prophylactic Platelet Transfusion: Is There Evidence of Benefit, Harm, or No Effect? Transfus Med Rev. 2023 10; 37(4):150751. View Abstract

  17. Associations of donor, component, and recipient factors on hemoglobin increments following red blood cell transfusion in very low birth weight infants. Transfusion. 2023 08; 63(8):1424-1429. View Abstract

  18. Platelet Transfusions in Neonates: Beyond Hemostasis. Arterioscler Thromb Vasc Biol. 2023 06; 43(6):886-888. View Abstract

  19. EBNEO commentary: Platelet transfusions in neonates and brain development: The new frontier. Acta Paediatr. 2023 08; 112(8):1826-1827. View Abstract

  20. Pitfalls and Limitations of Platelet Counts and Coagulation Tests in the Neonatal Intensive Care Unit. Curr Pediatr Rev. 2023; 19(4):357-365. View Abstract

  21. Immunologic effects of red blood cell and platelet transfusions in neonates. Curr Opin Hematol. 2022 11 01; 29(6):297-305. View Abstract

  22. Postnatal treatment for children with fetal and neonatal alloimmune thrombocytopenia: a multicentre, retrospective, cohort study. Lancet Haematol. 2022 Nov; 9(11):e844-e853. View Abstract

  23. Endocytosis of the thrombopoietin receptor Mpl regulates megakaryocyte and erythroid maturation in mice. Front Oncol. 2022; 12:959806. View Abstract

  24. Fetal vs adult megakaryopoiesis. Blood. 2022 06 02; 139(22):3233-3244. View Abstract

  25. Platelets in the neonate: Not just a small adult. Res Pract Thromb Haemost. 2022 Mar; 6(3):e12719. View Abstract

  26. Platelet transfusions in a murine model of neonatal polymicrobial sepsis: Divergent effects on inflammation and mortality. Transfusion. 2022 06; 62(6):1177-1187. View Abstract

  27. Neonatal platelet transfusions: New evidence and the challenges of translating evidence-based recommendations into clinical practice. J Thromb Haemost. 2022 03; 20(3):556-564. View Abstract

  28. Iron status influences the response of cord blood megakaryocyte progenitors to eltrombopag in vitro. Blood Adv. 2022 01 11; 6(1):13-27. View Abstract

  29. Inhibition of transcription factor NFAT activity in activated platelets enhances their aggregation and exacerbates gram-negative bacterial septicemia. Immunity. 2022 02 08; 55(2):224-236.e5. View Abstract

  30. Sex Differences in the Association of Pretransfusion Hemoglobin Levels with Brain Structure and Function in the Preterm Infant. J Pediatr. 2022 04; 243:78-84.e5. View Abstract

  31. Transfusion Practices in Pediatric Cardiac Surgery Requiring Cardiopulmonary Bypass: A Secondary Analysis of a Clinical Database. Pediatr Crit Care Med. 2021 11 01; 22(11):978-987. View Abstract

  32. Association of Blood Donor Sex and Age With Outcomes in Very Low-Birth-Weight Infants Receiving Blood Transfusion. JAMA Netw Open. 2021 09 01; 4(9):e2123942. View Abstract

  33. Transfusion practices for pediatric oncology and hematopoietic stem cell transplantation patients: Data from the National Heart Lung and Blood Institute Recipient Epidemiology and Donor Evaluation Study-III (REDS-III). Transfusion. 2021 09; 61(9):2589-2600. View Abstract

  34. Neonatal platelet physiology and implications for transfusion. Platelets. 2022 Jan 02; 33(1):14-22. View Abstract

  35. Haematological issues in neonates with neonatal encephalopathy treated with hypothermia. Semin Fetal Neonatal Med. 2021 08; 26(4):101270. View Abstract

  36. Development of gates to measure the immature platelet fraction in C57BL/6J mice using the Sysmex XN-V series multispecies hematology analyzer. J Vet Diagn Invest. 2021 Sep; 33(5):913-919. View Abstract

  37. Embryonic MK activation: a delicate balance. Blood. 2021 05 20; 137(20):2714-2715. View Abstract

  38. Transfusion practices in a large cohort of hospitalized children. Transfusion. 2021 07; 61(7):2042-2053. View Abstract

  39. Sex-specific cytokine responses and neurocognitive outcome after blood transfusions in preterm infants. Pediatr Res. 2022 03; 91(4):947-954. View Abstract

  40. Variation in Neonatal Transfusion Practice. J Pediatr. 2021 Aug; 235:92-99.e4. View Abstract

  41. Implementation of a neonatal platelet transfusion guideline to reduce non-indicated transfusions using a quality improvement framework. J Perinatol. 2021 06; 41(6):1487-1494. View Abstract

  42. Hemostatic Challenges in Neonates. Front Pediatr. 2021; 9:627715. View Abstract

  43. Platelet-derived extracellular vesicles infiltrate and modify the bone marrow during inflammation. Blood Adv. 2020 07 14; 4(13):3011-3023. View Abstract

  44. Pooling, room temperature, and extended storage time increase the release of adult-specific biologic response modifiers in platelet concentrates: a hidden transfusion risk for neonates? Transfusion. 2020 08; 60(8):1828-1836. View Abstract

  45. Association of Bleeding Scores and Platelet Transfusions With Platelet Counts and Closure Times in Response to Adenosine Diphosphate (CT-ADPs) Among Preterm Neonates With Thrombocytopenia. JAMA Netw Open. 2020 04 01; 3(4):e203394. View Abstract

  46. Changes in megakaryopoiesis over ontogeny and their implications in health and disease. Platelets. 2020 Aug 17; 31(6):692-699. View Abstract

  47. Screening With Reticulocyte Hemoglobin Increased Iron Sufficiency Among NICU Patients. Pediatr Qual Saf. 2020 Mar-Apr; 5(2):e258. View Abstract

  48. Developmental Differences in Platelet Inhibition Response to Prostaglandin E1. Neonatology. 2020; 117(1):15-23. View Abstract

  49. Megakaryocyte emperipolesis mediates membrane transfer from intracytoplasmic neutrophils to platelets. Elife. 2019 05 01; 8. View Abstract

  50. Association Between In Vitro Bleeding Time and Bleeding in Preterm Infants With Thrombocytopenia. JAMA Pediatr. 2019 04 01; 173(4):393-394. View Abstract

  51. Anemia induces gut inflammation and injury in an animal model of preterm infants. Transfusion. 2019 04; 59(4):1233-1245. View Abstract

  52. Anti-apoptotic BCL2L2 increases megakaryocyte proplatelet formation in cultures of human cord blood. Haematologica. 2019 10; 104(10):2075-2083. View Abstract

  53. Platelet Transfusions in Neonates - Less Is More. N Engl J Med. 2019 01 17; 380(3):287-288. View Abstract

  54. Platelet transfusions and mortality in necrotizing enterocolitis. Transfusion. 2019 03; 59(3):981-988. View Abstract

  55. Thrombocytopenia is associated with severe retinopathy of prematurity. JCI Insight. 2018 10 04; 3(19). View Abstract

  56. Intersection of phosphate transport, oxidative stress and TOR signalling in Candida albicans virulence. PLoS Pathog. 2018 07; 14(7):e1007076. View Abstract

  57. Developmental Stage-Specific Manifestations of Absent TPO/c-MPL Signalling in Newborn Mice. Thromb Haemost. 2017 12; 117(12):2322-2333. View Abstract

  58. Down Regulation of the Munc18b-syntaxin-11 Complex and ß1-tubulin Impairs Secretion and Spreading in Neonatal Platelets. Thromb Haemost. 2017 11; 117(11):2079-2091. View Abstract

  59. Eltrombopag: a powerful chelator of cellular or extracellular iron(III) alone or combined with a second chelator. Blood. 2017 10 26; 130(17):1923-1933. View Abstract

  60. Selinexor-induced thrombocytopenia results from inhibition of thrombopoietin signaling in early megakaryopoiesis. Blood. 2017 08 31; 130(9):1132-1143. View Abstract

  61. Developmental differences between newborn and adult mice in response to romiplostim. Platelets. 2018 Jun; 29(4):365-372. View Abstract

  62. The immature platelet fraction: creating neonatal reference intervals and using these to categorize neonatal thrombocytopenias. J Perinatol. 2017 07; 37(7):834-838. View Abstract

  63. Assessing Initial Response to High-Frequency Jet Ventilation in Premature Infants With Hypercapnic Respiratory Failure. Respir Care. 2017 Jul; 62(7):867-872. View Abstract

  64. 2016 proceedings of the National Heart, Lung, and Blood Institute's scientific priorities in pediatric transfusion medicine. Transfusion. 2017 06; 57(6):1568-1581. View Abstract

  65. Eltrombopag, a thrombopoietin mimetic, crosses the blood-brain barrier and impairs iron-dependent hippocampal neuron dendrite development. J Thromb Haemost. 2017 03; 15(3):565-574. View Abstract

  66. Platelet Transfusion Practices Among Very-Low-Birth-Weight Infants. JAMA Pediatr. 2016 07 01; 170(7):687-94. View Abstract

  67. Neonatal Platelet Transfusions and Future Areas of Research. Transfus Med Rev. 2016 10; 30(4):183-8. View Abstract

  68. A missense mutation in TFRC, encoding transferrin receptor 1, causes combined immunodeficiency. Nat Genet. 2016 Jan; 48(1):74-8. View Abstract

  69. Innate immunity against molecular mimicry: Examining galectin-mediated antimicrobial activity. Bioessays. 2015 Dec; 37(12):1327-37. View Abstract

  70. Thrombocytopenia in Small-for-Gestational-Age Infants. Pediatrics. 2015 Aug; 136(2):e361-70. View Abstract

  71. Suppression of in vitro megakaryopoiesis by maternal sera containing anti-HPA-1a antibodies. Blood. 2015 Sep 03; 126(10):1234-6. View Abstract

  72. Platelet Transfusions in the Neonatal Intensive Care Unit. Clin Perinatol. 2015 Sep; 42(3):613-23. View Abstract

  73. BCL-2 is dispensable for thrombopoiesis and platelet survival. Cell Death Dis. 2015 Apr 16; 6:e1721. View Abstract

  74. Phlebotomy-induced anemia alters hippocampal neurochemistry in neonatal mice. Pediatr Res. 2015 Jun; 77(6):765-71. View Abstract

  75. Microtubule sliding drives proplatelet elongation and is dependent on cytoplasmic dynein. Blood. 2015 Jan 29; 125(5):860-8. View Abstract

  76. Mathematical model of platelet turnover in thrombocytopenic and nonthrombocytopenic preterm neonates. Am J Physiol Heart Circ Physiol. 2015 Jan 01; 308(1):H68-73. View Abstract

  77. Proteasome function is required for platelet production. J Clin Invest. 2014 Sep; 124(9):3757-66. View Abstract

  78. Expansion of the neonatal platelet mass is achieved via an extension of platelet lifespan. Blood. 2014 May 29; 123(22):3381-9. View Abstract

  79. The silent crisis: children hurt by current immigration enforcement policies. JAMA Pediatr. 2014 Feb; 168(2):103-4. View Abstract

  80. MiR-9 contributes to the developmental differences in CXCR-4 expression in human megakaryocytes. J Thromb Haemost. 2014 Feb; 12(2):282-5. View Abstract

  81. MiR-9 contributes to the developmental differences in CXCR-4 expression in human megakaryocytes. J Thromb Haemost. 2014 Feb; 12(2):282-285. View Abstract

  82. Primary hemostasis in neonates with thrombocytopenia. J Pediatr. 2014 Jan; 164(1):167-72. View Abstract

  83. Distinct differences in platelet production and function between neonates and adults: implications for platelet transfusion practice. Transfusion. 2013 Nov; 53(11):2814-21; quiz 2813. View Abstract

  84. Prognostic significance of low-grade intraventricular hemorrhage in the current era of neonatology. JAMA Pediatr. 2013 May; 167(5):487-8. View Abstract

  85. A de novo T73I mutation in PTPN11 in a neonate with severe and prolonged congenital thrombocytopenia and Noonan syndrome. Neonatology. 2013; 104(1):1-5. View Abstract

  86. Developmental differences in megakaryocyte size in infants and children. Am J Clin Pathol. 2012 Jul; 138(1):140-5. View Abstract

  87. The hibernating 13-lined ground squirrel as a model organism for potential cold storage of platelets. Am J Physiol Regul Integr Comp Physiol. 2012 May 15; 302(10):R1202-8. View Abstract

  88. Clinical and research issues in neonatal anemia and thrombocytopenia. Curr Opin Pediatr. 2012 Feb; 24(1):16-22. View Abstract

  89. Platelets in the neonatal period: developmental differences in platelet production, function, and hemostasis and the potential impact of therapies. Hematology Am Soc Hematol Educ Program. 2012; 2012:506-11. View Abstract

  90. Neonatal and adult megakaryopoiesis. Curr Opin Hematol. 2011 Sep; 18(5):330-7. View Abstract

  91. Cardiovascular disease and weight ... at birth. Blood. 2011 Aug 11; 118(6):1439-41. View Abstract

  92. Platelet transfusions in neonates: practices in the United States vary significantly from those in Austria, Germany, and Switzerland. Transfusion. 2011 Dec; 51(12):2634-41. View Abstract

  93. Effects of in vitro adult platelet transfusions on neonatal hemostasis. J Thromb Haemost. 2011 May; 9(5):1020-8. View Abstract

  94. Developmental differences in megakaryocytopoiesis are associated with up-regulated TPO signaling through mTOR and elevated GATA-1 levels in neonatal megakaryocytes. Blood. 2011 Apr 14; 117(15):4106-17. View Abstract

  95. Do red cell transfusions increase the risk of necrotizing enterocolitis in premature infants? J Pediatr. 2010 Dec; 157(6):972-978.e1-3. View Abstract

  96. Neonatal thrombocytopenia and megakaryocytopoiesis. Semin Hematol. 2010 Jul; 47(3):281-8. View Abstract

  97. Increasing platelets without transfusion: is it time to introduce novel thrombopoietic agents in neonatal care? J Perinatol. 2010 Dec; 30(12):765-9. View Abstract

  98. Differences between newborn and adult mice in their response to immune thrombocytopenia. Neonatology. 2010 Jun; 98(1):100-8. View Abstract

  99. Neonatal respiratory failure due to a novel mutation in the surfactant protein C gene. J Perinatol. 2010 Feb; 30(2):151-3. View Abstract

  100. Correction for effect of cold storage on immature platelet fraction. J Clin Lab Anal. 2010; 24(6):431-3. View Abstract

  101. Closure times measured by the platelet function analyzer PFA-100 are longer in neonatal blood compared to cord blood samples. Neonatology. 2010; 97(3):242-9. View Abstract

  102. Testing platelet mass versus platelet count to guide platelet transfusions in the neonatal intensive care unit. Transfusion. 2009 Oct; 49(10):2034-9. View Abstract

  103. Hematologic Issues. Introduction. Semin Perinatol. 2009 Feb; 33(1):1-2. View Abstract

  104. Current approaches to the evaluation and management of the fetus and neonate with immune thrombocytopenia. Semin Perinatol. 2009 Feb; 33(1):35-42. View Abstract

  105. New insights into the mechanisms of nonimmune thrombocytopenia in neonates. Semin Perinatol. 2009 Feb; 33(1):43-51. View Abstract

  106. Platelet transfusion practices among neonatologists in the United States and Canada: results of a survey. Pediatrics. 2009 Jan; 123(1):278-85. View Abstract

  107. Effects of sepsis on neonatal thrombopoiesis. Pediatr Res. 2008 Oct; 64(4):399-404. View Abstract

  108. Platelet reference ranges for neonates, defined using data from over 47,000 patients in a multihospital healthcare system. J Perinatol. 2009 Feb; 29(2):130-6. View Abstract

  109. Megakaryocyte-derived microparticles: direct visualization and distinction from platelet-derived microparticles. Blood. 2009 Jan 29; 113(5):1112-21. View Abstract

  110. Improving platelet transfusion practices in the neonatal intensive care unit. Transfusion. 2008 Nov; 48(11):2281-4. View Abstract

  111. Type 2B von Willebrand disease associated with the release of platelet agglutinates from megakaryocytes in the bone marrow. J Pediatr Hematol Oncol. 2008 Sep; 30(9):708-11. View Abstract

  112. Neonatal thrombocytopenia: what we do and don't know. Early Hum Dev. 2008 Aug; 84(8):499-506. View Abstract

  113. Do platelet transfusions in the NICU adversely affect survival? Analysis of 1600 thrombocytopenic neonates in a multihospital healthcare system. J Perinatol. 2007 Dec; 27(12):790-6. View Abstract

  114. Sites and kinetics of donor thrombopoiesis following transplantation of whole bone marrow and progenitor subsets. Exp Hematol. 2007 Oct; 35(10):1567-79. View Abstract

  115. Platelet factor 4 is a negative autocrine in vivo regulator of megakaryopoiesis: clinical and therapeutic implications. Blood. 2007 Aug 15; 110(4):1153-60. View Abstract

  116. Megakaryocyte size and concentration in the bone marrow of thrombocytopenic and nonthrombocytopenic neonates. Pediatr Res. 2007 Apr; 61(4):479-84. View Abstract

  117. Umbilical cord blood produces small megakaryocytes after transplantation. Biol Blood Marrow Transplant. 2007 Feb; 13(2):145-50. View Abstract

  118. Differential effects of recombinant thrombopoietin and bone marrow stromal-conditioned media on neonatal versus adult megakaryocytes. Blood. 2006 Nov 15; 108(10):3360-2. View Abstract

  119. Thrombocytopenia among extremely low birth weight neonates: data from a multihospital healthcare system. J Perinatol. 2006 Jun; 26(6):348-53. View Abstract

In the Boston Children’s Hospital (BCH) Neonatal Intensive Care Unit (NICU) our philosophy is to ensure that every patient receives the best care for the best possible outcomes. We consider our “patient” to be the baby and the family; we are constantly striving to serve the needs of both. This requires a team based approach with all members being essential.

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