The care of critically ill infants and toddlers in neonatal intensive care units across Italy and Europe: our proposal for healthcare organization

Abstract

Numerous studies have shown that critically ill infants and toddlers admitted to paediatric intensive care units (PICUs) have a lower mortality than those admitted to adult ICUs. In 2014, there were only 23 registered PICUs in Italy, most of which were located in the north. For this reason, in Italy and elsewhere in Europe, some neonatal ICUs (NICUs) have begun managing critically ill infants and toddlers. Our proposal for healthcare organization is to establish “extended NICUs” in areas where paediatric intensive care beds are lacking. While some countries have opted for a strict division between neonatal and paediatric intensive care units, the model of “extended NICUs” has already been set up in Italy and in Europe. In this instance, the management of critically ill infants and toddlers undoubtedly falls upon neonatologists, who, however, must gain specific knowledge and technical skills in paediatric critical care medicine (PCCM). Postgraduate residencies in paediatrics need to include periods of specific training in neonatology and PCCM. The Italian Society of Neonatology’s Early Childhood Intensive Care Study Group is supporting certified training courses for its members involving both theory and practice.Conclusion: Scientific societies should promote awareness of the issues involved in the intensive management of infants and toddlers in NICUs and the training of all health workers involved. These societies include the Italian Society of Neonatology, the European Society of Paediatric and Neonatal Intensive Care, and the Union of European Neonatal and Perinatal Societies. They should also act in concert with the governmental institutional bodies to establish the standards for the “extended NICUs.” What is Known:• The mortality of critically ill infants and toddlers admitted to PICUs is lower than that for those admitted to adult ICUs.• In Italy, there are only a handful of PICUs, located mainly in the north. What is New:• Critically ill infants and small toddlers can be managed in “extended NICUs” in areas with a lack of paediatric intensive care beds.• “Extended NICUs” is our proposal for healthcare organization to compensate for the paucity of paediatric intensive care beds, but neonatologists must be trained to provide them with specific knowledge and technical skills in PCCM.

Organizational Characteristics of European Pediatric Onco-Critical Care: An International Cross-Sectional Survey.

“…This could partly be explained by some traditions of anesthesiologist leading ICUs or joint NICU/PICUs or adult ICU/PICU. 19 In our survey, the nurse-to-bed ratio in most PICUs was 1:1 or 1:2, which is in line with the ratios found in a large survey among PICUs in the USA. 12 In adults, it has been shown that a higher nurse staffing was associated with improved survival.…”

Nasopharyngeal SARS-CoV-2 load and perinatal outcomes after maternal infection diagnosed close to delivery

“…The distribution of their basic data between recruiting centers is described in Table 1 . The studied population consisted of 339 (86.9%) and 51 (13.1%) women affected by mild and moderate-to-severe COVID-19, respectively; their ΔCt was significantly different (mild: 27 [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , moderate-to-severe: 22 [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , p =0.006). No maternal death occurred, and no patient needed extracorporeal life support.…”

“…Abbreviations: COVID-19: Coronavirus Disease-2019; ICU: intensive care unit. Maternal data (n=390 pregnancies) Maternal age (years) 30.7 (5.5) Cesarean section 152 (38.7%) Cesarean section for COVID-19 17 (4.3%) Gestational diabetes 134 (34.1%) Systemic hypertension 12 (3%) Asthma 20 (5%) Gestational age at diagnosis (weeks) 35.7 (5.4) Time between diagnosis and delivery (days) 3 [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] Hospitalized for COVID-19 65 (16.5%) Need for supplemental O 2 42 (10.7%) ICU admission for COVID-19 18 (4.6%) Nasopharyngeal ΔCt 26 [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] Newborn data (n=393 neonates) Gestational age at the birth (weeks) 39 [38; 40] Birth weight (grams) 3145 [2790; 3530] Birth weight Z-score -0.22 [-0.93; 0.49] Male sex 178 (45.3%) ...…”

“…Furthermore, it is important to avoid NICU beds shortage since the number of neonates and infants needing critical care for reasons unrelated to COVID-19 is not decreasing. [ 28 , 29 ]…”

Organizational characteristics of European pediatric onco-critical care: An international cross-sectional survey

“…This could partly be explained by some management traditions i.e. anesthesiologist leading ICUs or joint NICU/PICUs or adult ICU/PICU ( 20 ). In our survey, the nurse-to-bed ratio in most PICUs was 1:1 or 1:2, which is in line with the ratios found in a large survey among PICUs in the USA ( 14 ).…”