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

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.

Automated summary

Studies have shown that mortality rates for critically ill infants and toddlers are lower in paediatric intensive care units (PICUs) compared to adult ICUs. Some neonatal ICUs (NICUs) have begun managing critically ill infants and toddlers due to the lack of PICUs, while others have established extended NICUs. Neonatologists play a key role in the management of these patients, but they require specific training in paediatric critical care medicine (PCCM). Scientific societies should promote awareness and training, and collaborate with governmental bodies to establish standards for extended NICUs.