Pediatric intensive care in Italy, the experts’ alarm: few and poorly distributed

Pediatric intensive care in Italy, the experts’ alarm: few and poorly distributed

Pediatric intensive care alarm in Italy. There are only 273 beds, compared to 9,788,622 potential patients aged 1 to 18. In practice, in our country there is one intensive care bed for 35,586 children and adolescents, far from the European indication of one bed for every 20-30 thousand children. Germany, for example, has one for every 20,000. According to recommended standards, there should be 482 in Italy.

Around 200 intensive beds are missing, with a shortage of 44.4%. Not only. Sixteen Regions have less than 25% of the necessary places, six do not even have a pediatric intensive care unit, with the striking case of Sardinia.

The census and the letter-complaint in the Lancet

A group of experts has surveyed resuscitations for patients from 1 to 18 years of age in Italy and has published a letter-complaint in the ‘Lancet’ magazine to draw attention to the “worrying situation of pediatric intensive care in our country”, he says Leonardo Bussolin, president of the Italian Neonatal and Pediatric Anesthesia and Resuscitation Society and one of the authors of the study. “Pediatric intensive care beds in Italy are few and poorly distributed, the difference between the various areas of Italy is intolerable”.

Six regions without even a single place

On the geographical map of intensive care units for children and adolescents, they range from 128 beds to Northcompared to a requirement of 222, to 55 of Southwhere 168 would be needed, and 90 of Center, only 2 beds below. The 3 pediatric intensive care units in Central Italy raise the average Lazio: Gemini, Baby Jesus and Umberto I. On the other hand, in Valle d’Aosta, Trentino Alto Adige, Umbria, Molise, Basilicata And Sardinia there is not even a single bed and if a small patient arrives at the hospital in particularly critical conditions, he must be immediately transferred to another region.

The situation in the regions

A desperate race against time. Until a month ago in this condition, with a 0 on the map, there was also theAbruzzo, where the first pediatric intensive care unit was inaugurated in early October, in Pescara. This is the situation in the other regions: 15 beds in Piedmont22 in Liguria46 in Lombardy15 in Emilia Romagna24 in Veneto6 in Friuli Venezia Giulia22 in Tuscany10 in Marche58 in Lazio21 in Campania4 Puglia6 in Calabria24 in Sicily.

The situation is truly critical, in the South it is dramatic. There are areas of Italy where children do not have the same chances of being treated in the same way compared to other areas – Bussolin underlines – And this, from an ethical point of view, is reprehensible. Unacceptable. As a scientific society, we have a duty to raise awareness. Our goal with this work is not so much to denounce, but to raise political awareness. We need answers and planning.”

No region up to standard: the case of Sardinia

From the map of pediatric intensive care it is clear that “if some Regions are better off than others, none is up to standard”, continues Bussolin. What particularly worries the experts is the total lack of resuscitation beds in Sardinia, “despite its geographical isolation from the rest of the Peninsula – they underline in the Lancet – and the difficulties in transferring a serious patient to an intensive care unit on the mainland”.

“Usually children who require intensive life-saving treatments are transferred by helicopter – explains Bussolin – to the Gaslini hospital in Genoa, sometimes to the Gemelli polyclinic in Rome. But it is clear that it is not such a trivial procedure, it also depends on the meteorological conditions and requires a great commitment, because transferring a critical patient by helicopter means that there must be superlative professionalism on board to guarantee maximum safety. Sardinia must have its own pediatric intensive care unit, colleagues bend over backwards but if structures and organization are missing, they become pseudo-heroes and we have seen with Covid what happens to heroes”, he comments.

Because we need more beds

“The intensive care units, both for adults and for small patients, must never be overcrowded – Bussolin points out – as we report in the Lancet. Occupation should not exceed 85% of the beds, precisely to also have a reservoir of reserve for any situation outside the normal. I understand that it is difficult for administrators to accept a concept like this, because intensive care, like emergency medicine, like the emergency room, are all loss-making sectors. I understand that it is difficult for those he has to make ends meet, but this is, it cannot be done otherwise. It is like a tank, which is expandable and compressible, depending on the needs of the moment. This can be done with adequate organization and adequate economic resources”.

Covid has taught nothing

One might say that Covid has taught us nothing. “After what we have experienced, this is an open wound – he comments – Not only that. Last year we had a pandemic of respiratory syncytial virus, practically bronchiolitis, which affects children under 2 years of age. We at Meyer we didn’t know where to admit them, because we were so full, but it was like that everywhere. It was Covid for the little ones: the impact and flow of patients in the hospitals was intense. I even know that they had used some clinics for the Bambino Gesù hospital Last year was exceptional, but nothing tells us that an RSV epidemic cannot reoccur this year too. And what will we do?”.

What needs to be done

To improve the situation, “the adaptation of pediatric intensive care beds is a first step, preceded by the training of anesthetists-resuscitators, especially in the Regions that do not have them. Each Region must then have a network that coordinates, with centralized criteria , the treatment and transfer of pediatric patients in critical conditions, with centers with very specific skills and tasks, on the ‘Hub & Spock’ model for example. And we need a national network with 3-4 centers of excellence that coordinate particular emergencies, the rarest cases. A super specialized cardiac or pediatric neurosurgical center is perhaps not necessary in all Regions, because it would be a waste, but a national network is. At the moment, unfortunately, the system is not so perfected”.

The signatories of the appeal in Lancet

The letter in the Lancet is also signed by Carmelo Minardiof the Department of Anesthesia of the Policlinico San Marco university hospital in Catania; Giorgio Contiof the Irccs Gemelli University Hospital in Rome; Andrea Moscatelliof the pediatric and neonatal intensive care unit of the Irccs Gaslini of Genoa; Simonetta Tesoroof the Santa Maria della Misericordia hospital in Perugia and past-president of the Italian Neonatal and Pediatric Anesthesia and Resuscitation Society, of which Andrea Moscatelli has been designated president since January 2024. Their appeal is “to ensure that every child with a serious medical problem can benefit from the highest quality care, regardless of the geographical area in which he lives”.

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