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Papers by Giulia Remaschi

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Minerva pediatrica, 2013

New available immunologic tests for tuberculosis (TB) diagnosis are Interferon-gamma release assa... more New available immunologic tests for tuberculosis (TB) diagnosis are Interferon-gamma release assay (IGRA). In adults these tests showed a higher specificity than tuberculin skin test (TST) but their superior sensitivity compared to TST sensitivity has not been proved yet. In children, interpretation of results remains disputed, especially in those <5 years. Hereby we report the most recent literature data for use and interpretation of IGRA is results in children.

BMJ Open, 2020

IntroductionEarly treatment with caffeine in the delivery room has been proposed to decrease the ... more IntroductionEarly treatment with caffeine in the delivery room has been proposed to decrease the need for mechanical ventilation (MV) by limiting episodes of apnoea and improving respiratory mechanics in preterm infants. Thus, the purpose of this feasibility study is to verify the hypothesis that intravenous or enteral administration of caffeine can be performed in the preterm infant in the delivery room.Methods and analysisIn this multicentre prospective study, infants with 25+0–29+6 weeks of gestational age will be enrolled and randomised to receive 20 mg/kg of caffeine citrate intravenously, via the umbilical vein, or enterally, through an orogastric tube, within 10 min of birth. Caffeine plasma level will be measured at 60±15 min after administration and 60±15 min before the next dose (5 mg/kg). The primary endpoint will be evaluation of the success rate of intravenous and enteral administration of caffeine in the delivery room. Secondary endpoints will be the comparison of succ...

BMC Cardiovascular Disorders

Background Supraventricular tachycardias (SVTs) are common in the first year of life and may be l... more Background Supraventricular tachycardias (SVTs) are common in the first year of life and may be life-threatening. Acute cardioversion is usually effective, with both pharmacological and non-pharmacological procedures. However, as yet no international consensus exists concerning the best drug required for a stable conversion to sinus rhythm (maintenance treatment). Our study intends to describe the experience of a single centre with maintenance drug treatment of both re-entry and automatic SVTs in the first year of life. Methods From March 1995 to April 2019, 55 patients under one year of age with SVT were observed in our Centre. The SVTs were divided into two groups: 45 re-entry and 10 automatic tachycardias. As regards maintenance therapy, in re-entry tachycardias, we chose to start with oral flecainide and in case of relapses switched to combined treatment with beta-blockers or digoxin. In automatic tachycardias we first administered a beta-blocker, later combined with flecainide ...

Italian Journal of Pediatrics, 2016

Background: Henoch-Schönlein purpura (HSP) is the most common vasculitis in childhood; neverthele... more Background: Henoch-Schönlein purpura (HSP) is the most common vasculitis in childhood; nevertheless, its etiology and pathogenesis remain unknown despite the fact that a variety of factors, mainly infectious agents, drugs and vaccines have been suggested as triggers for the disease. The aim of this study was to estimate the association of HSP with drug and vaccine administration in a pediatric population. Methods: An active surveillance on drug and vaccine safety in children is ongoing in 11 clinical centers in Italy. All children hospitalized through the local Paediatric Emergency Department for selected acute clinical conditions of interest were enrolled in the study. Data on drug and vaccine use in children before the onset of symptoms leading to hospitalization were collected by parents interview. A case-control design was applied for risk estimates: exposure in children with HSP, included as cases, was compared with similar exposure in children with gastroduodenal lesions, enrolled as controls. HSP cases were validated according to EULAR/PRINTO/PRES criteria. Validation was conducted retrieving data from individual patient clinical record. Results: During the study period (November 1999-April 2013), 288 cases and 617 controls were included. No increased risk of HSP was estimated for any drug. Among vaccines, measles-mumps-rubella (MMR) vaccine showed an increased risk of HSP (OR 3.4; 95 % CI 1.2-10.0). Conclusions: This study provides further evidence on the possible role of MMR vaccine in HSP occurrence.

Pediatric Research

Background Enteral feeding induces mesenteric hemodynamic changes in preterm infants, which may v... more Background Enteral feeding induces mesenteric hemodynamic changes in preterm infants, which may vary according to the milk used. Our aim in this study was to evaluate changes of splanchnic regional oxygenation (rSO 2 S) measured by near-infrared spectroscopy (NIRS) in infants fed with mother’s own milk (MOM), fortified human milk (FHM), or preterm formula (PTF). Methods Infants born at 25–31 weeks of gestational age ( n = 54) received a bolus of MOM, FHM, or PTF. rSO 2 S and splanchnic fractional oxygen extraction ratio (FOES) were recorded 60 min before ( T 0 ), and 30 min ( T 1 ) and 120 min ( T 2 ) after the beginning of bolus feeding. Results In the MOM group, rSO 2 S and FOES did not change during the study period. In the FBM group, rSO 2 S decreased from T 0 to T 1 and increased from T 1 to T 2 , while FOES changed in reverse. In the PTF group, rSO 2 S decreased from T 0 to T 1 and from T 1 to T 2 , while FOES changed in reverse. Conclusions Splanchnic oxygenation was not affected by MOM feeding, was transiently decreased by FBM feeding, and was persistently decreased by PTF. These results suggest that preterm infants who received PTF has higher splanchnic tissue oxygen extraction compared to those who received MOM or FBM. Impact Human milk feeding is associated to a lower splanchnic energy expenditure than preterm formula feeding. Fortified human milk transiently increases splanchnic energy expenditure. Preterm formula should be used only in the absence of human milk.

The Journal of Maternal-Fetal & Neonatal Medicine

Journal of Pediatric Gastroenterology and Nutrition

The Journal of Pediatrics, 2016

To review new scientific evidence to update the Italian guidelines for managing fever in children... more To review new scientific evidence to update the Italian guidelines for managing fever in children as drafted by the panel of the Italian Pediatric Society. Relevant publications in English and Italian were identified through search of MEDLINE and the Cochrane Database of Systematic Reviews from May 2012 to November 2015. Previous recommendations are substantially reaffirmed. Antipyretics should be administered with the purpose to control the child&amp;amp;amp;amp;amp;#39;s discomfort. Antipyretics should be administered orally; rectal administration is discouraged except in the setting of vomiting. Combined use of paracetamol and ibuprofen is discouraged, considering risk and benefit. Antipyretics are not recommended preemptively to reduce the incidence of fever and local reactions in children undergoing vaccination, or in attempt to prevent febrile convulsions in children. Ibuprofen and paracetamol are not contraindicated in children who are febrile with asthma, with the exception of known cases of paracetamol- or nonsteroidal anti-inflammatory drug-induced asthma. Recent medical literature leads to reaffirmation of previous recommendations for use of antipyretics in children who are febrile.

Journal of Perinatology, 2015

This article reports the recommendations for managing neonatal tuberculosis (TB) drawn up by a gr... more This article reports the recommendations for managing neonatal tuberculosis (TB) drawn up by a group of Italian scientific societies. The Consensus Conference method was used, and relevant publications in English were identified through a systematic review of MEDLINE and the Cochrane Database of Systematic Reviews from their inception until 31 December 2014. Group experts concluded that if suspicion is aroused, it is necessary to undertake promptly all of the investigations useful for identifying the disease not only in the newborn, but also in the mother and family contacts because a diagnosis of TB in the family nucleus can guide its diagnosis and treatment in the newborn. If the suspicion is confirmed, empirical treatment should be started. Breast-fed newborns being treated with isoniazid should be given pyridoxine supplementation at a dose of 1 mg kg(-1) day(-1). Mothers with active-phase TB can breast-feed once they have become smear negative after having received appropriate treatment.Journal of Perinatology advance online publication, 13 August 2015; doi:10.1038/jp.2015.99.

American Journal of Perinatology Reports

This is an open access article published by Thieme under the terms of the Creative Commons Attrib... more This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon.

Archives of disease in childhood, Jan 15, 2015

The International Journal of Tuberculosis and Lung Disease, 2015

Expert Review of Anti-infective Therapy, 2015

Tuberculosis still represents a big global public health challenge. The diagnosis of tuberculosis... more Tuberculosis still represents a big global public health challenge. The diagnosis of tuberculosis and the differentiation between active and latent tuberculosis remain difficult, particularly in childhood, because of the lack of a gold standard test for diagnosis. In the last decade, novel diagnostic assays have been developed. Among immunologic tests, new assays based on the measurement of different cytokines released by specific T cells in response to Mycobacterium tuberculosis antigens, other than INF-γ, have been investigated. Promising results rely on nucleic acid amplification techniques, also able to detect drugs resistance. Innovative research fields studied the modifications of CD27 expression in T cells as well as different host gene expression in response to M. tuberculosis. Further studies are needed to assess the diagnostic value and the accuracy of these new assays.