Rome, May 26 (beraking latest news Salute) – Covid-19 has affected children much less severely than the adult population. But if this had not been the case, would we have been able to handle an emergency of this magnitude? The experts take stock at the 76th Congress of the Italian Society of Pediatrics where the data of a monitoring on pediatric intensive care in Italy are presented.
“There are few pediatric ICUs in our country, 23 in all, on average small in size distributed unevenly throughout the country and in a number significantly lower than the 116 neonatal ICUs”, says Rinaldo Zanini, pediatrician, former director of the Maternal and Infant department of the Lecco hospital. It should be immediately emphasized – adds Zanini – that in our country there is no certain and recognized way to identify the pediatric intensive care units because the identification code of the discipline is missing, a code that – he notes – exists for all other branches of medicine. This lack makes it very difficult to accurately assess the number of beds and wards. It is only possible to make approximations with complicated calculations “.
And approximating, “overall – continues the expert – there are about 202 pediatric intensive care beds in Italy with an average of 3 beds per 1 million inhabitants, well below the European average of 8. This difference still becomes more evident if we evaluate each region: here they range from 2 beds per million inhabitants of Puglia to 10.6 in Liguria, passing through some regions that have no pediatric intensive care bed (Valle d’Aosta, Trentino Alto Adige, Umbria, Abruzzo, Sardinia Molise, Basilicata) “.
Offering pediatric patients to be cared for in dedicated intensive care units also means “improving the prognosis compared to children who are admitted to adult intensive care units”, explains the expert. Finally, another important data is linked to the mortality of pediatric intensive care patients which “increases in the case of low-volume operating units, compared to high-volume ones”.
“The better performances obtained by pediatric intensive care compared to that of adults derive from several reasons”, explains Corrado Cecchetti, head of the red area of the Emergency Department of the Bambino Gesù Pediatric Hospital. “Pediatric intensive therapies are aimed at children. , there is a high specificity not only of the devices, but also of the skills of the pediatric intensivist. In fact, there is a specificity of pediatric pathologies (metabolic, respiratory, malformative pathology, etc.) compared to those of adults in which chronic respiratory diseases and traumas resulting from brain and heart damage are strongly represented “.
But how to improve the care response that pediatric intensive care units are able to offer today? “There are extraordinary excellences in our country, but a network is lacking and more beds are needed”, adds Zanini. How to put together the skills of neonatal intensive care, pediatric intensive care and intensive care with intermediate experience in the pediatric field and networking?
“By defining a hub & spoke model that has the ability to intercept critical events in the pediatric area in small hospitals in the area and then distribute patients, according to a double severity / age gradient, in I or II level pediatric intensive care units or in super hubs where – the pediatrician explains – there are possibilities and skills to apply particular therapies such as the Ecmo. Neonatal intensive care units could enter this network for the treatment of cases related to infectious or respiratory diseases as a support to pediatric intensive therapies that do not they are sufficient or even absent “, concludes Zanini.