Pediatric intensive care alarm in Italy. “They are few and poorly distributed, with an intolerable difference between the various areas of Italy”, reported Leonardo Bussolin, president of the Italian Neonatal and Pediatric Anesthesia and Resuscitation Society and author, to Adnkronos Salute, together with a group of colleagues from various structures on the Peninsula, of a letter-complaint published in the ‘Lancet’ magazine to draw attention to the “worrying situation of pediatric intensive care in our country, especially in the South. There are areas of Italy where children do not have the same chances of being treated in the same way as in other areas. This is reprehensible, unacceptable. Our objective with this work is not so much to report, but to raise political awareness. We need answers and planning.”
The minister’s commitment
The response from the Minister of Health, Orazio Schillaci, arrived shortly. “We know well that there is a need to increase the number” of intensive care beds for children and adolescents. “As soon as possible we will intervene and see the regions where there are fewer”the minister said today, responding on the sidelines of the presentation to the Chamber of the new parliamentary intergroup on breast cancer.
From the map published in ‘lancet’ it emerges that 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 every 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 the 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.
North-South divide and in six regions not even one
In the geographical map of intensive care for children and adolescents, we range from 128 beds in the North, compared to a requirement of 222, to 55 in the South, where 168 would be needed, and to 90 in the Centre, only 2 beds short. The 3 pediatric intensive care units in Lazio are raising the average in Central Italy: Gemelli, Bambino Gesù and Umberto I. On the other hand, in Valle D’Aosta, Trentino Alto Adige, Umbria, Molise, Basilicata and Sardinia there is not even one bed space and if a small patient arrives at the hospital in particularly critical conditions, he must be immediately transferred to another region. A desperate race against time.
Until a month ago, Abruzzo was also in this condition, with a 0 on the map, 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 Piedmont, 22 in Liguria, 46 in Lombardy, 15 in Emilia Romagna, 24 in Veneto, 6 in Friuli Venezia Giulia, 22 in Tuscany, 10 in Marche, 58 in Lazio, 21 in Campania, 4 Puglia, 6 in Calabria, 24 in Sicily.
“No region is compliant”
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.
“We need centers of excellence that coordinate emergencies”
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 letter in the Lancet is also signed by Carmelo Minardi, of the Anesthesia Department of the Policlinico San Marco university hospital in Catania; Giorgio Conti, of the Irccs Gemelli University Hospital in Rome; Andrea Moscatelli, from the pediatric and neonatal intensive care unit of the Irccs Gaslini in Genoa; Simonetta Tesoro, from 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 geographic area in which he or she lives.”
Minister Schillaci announced his intention to “focus on pediatric intensive care” with the president of the paediatricians, who are also concerned about the lack of specific beds for children and adolescents. “Offering pediatric patients the opportunity to be cared for in dedicated intensive care units means increasing their chances of survival compared to children who are admitted to adult intensive care units. And this is all the more true the younger and more the patient is serious. It is unacceptable that a significant part of Italian children in critical conditions are cared for in intensive care for adults, just as it is unacceptable that such profound differences exist between the various Italian regions”, commented the president of the Italian Society of Paediatrics Annamaria Staiano , after the letter-complaint published in the ‘Lancet’. The pediatricians ask for the definition of the specific ministerial disciplinary code for pediatric intensive care.
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