[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-458527-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-458527-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","extended-nicus-or-specialized-pediatric-networks-the-need-to-reinforce-centralized-multidisciplinary-care","Extended NICUs or specialized pediatric networks - The need to reinforce centralized, multidisciplinary care","","The letter responds to Decembrino et al. on RSV-related bronchiolitis admissions in Italy, focusing on the proposal to extend NICU roles to mitigate PICU bed shortages. It argues that broadening NICU functions risks fragmenting pediatric critical care and that critically ill children achieve better outcomes in high-volume, specialized, multidisciplinary centers. The authors cite limited nationwide PICU capacity, regional disparities, and evidence linking higher patient volumes to improved survival. They advocate strengthening centralized referral systems and 24/7 transport hub-and-spoke networks while keeping care resilient as RSV prevention evolves.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/extended-nicus-or-specialized-pediatric-networks-the-need-to-reinforce-centralized-multidisciplinary-care/458527/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/extended-nicus-or-specialized-pediatric-networks-the-need-to-reinforce-centralized-multidisciplinary-care/458527.png","ImageObject",300,407,{"name":42,"@type":43},"Adam","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-02","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",13,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What proposal is the letter responding to?","Question",{"text":63,"@type":64},"The letter addresses Decembrino et al.’s proposal to introduce “Extended NICUs” by expanding NICU roles to cover toddlers and critically ill infants to compensate for PICU bed shortages.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"Why do the authors caution against extending NICU roles?",{"text":68,"@type":64},"They argue that expanding NICU functions could fragment pediatric critical care, because complex pediatric expertise and resources are harder to replicate across many smaller units.",{"name":70,"@type":61,"acceptedAnswer":71},"What care model do the authors recommend instead?",{"text":72,"@type":64},"They recommend consolidating pediatric intensive care in high-volume, specialized centers within sustainable hub-and-spoke networks, supported by strengthened referral systems and transport capabilities.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},458527,1790807753,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":124,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":124,"slug":126},10,"Lifestyle","lifestyle",{"id":128,"doc_module":4,"doc_module_name":25,"category_name":129,"show_sort_weight":97,"slug":130},19,"General","general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":33,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":124,"preview_page_count":4},1374404737137,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Brisca etal. Italian Journal of Pediatrics (2026) 52:4 Italian Journal of Pediatrics  \n[https://doi.org/10.1186/s13052-025-02170-w](https://doi.org/10.1186/s13052-025-02170-w)  \nLETTER TO THE EDITOR Open Access  \nExtended NICUs or specialized pediatric networks? The need to reinforce centralized, multidisciplinary care – a comment on Decembrino et al.  \nGiacomo Brisca 1*, Pablo Mauricio Ingelmo2, Anna Camporesi3, Matteo Di Nardo4, Andrea Dato 1, Zaccaria Ricci5,6, Leonardo Bussolin7, Giorgio Conti8, Simonetta Tesoro9, Carmelo Minardi 10, Geremia Zito Marinosci 11, Andrea Wolfler 1 and Andrea Moscatelli 1 on behalf of the Italian Society of Neonatal and Pediatric Anesthesia and Intensive  \nCare (SARNePI)  \nAbstract  \nThe recent article by Decembrino et al. highlights the burden of RSV-related bronchiolitis admissions to Italian Neonatal Intensive Care Units (NICUs) during the 2021 season and proposes extending NICU roles to compensate for the national shortage of Pediatric Intensive Care Unit (PICU) beds. While acknowledging the urgent problem, we argue that such a strategy risks fragmenting pediatric critical care. Evidence consistently demonstrates that critically ill children achieve better outcomes in high-volume, specialized centers equipped with multidisciplinary expertise, resources, and continuous training. Italy currently counts only 273 PICU beds, corresponding to one per 35,856 children, far below European standards and with significant regional disparities—most notably in Southern Italy and Sardinia. International data indicate that higher patient volumes are associated with improved survival, supporting the consolidation of PICUs within sustainable hub-and-spoke networks. Regional initiatives, such as the Ligurian model integrating a central hub with 24/7 pediatric transport, demonstrate the feasibility of this approach. Future planning should focus on strengthening national referral systems, enhancing transport capabilities, and consolidating pediatric intensive care. With RSV prevention strategies evolving, Italy must build a resilient and flexible system, ensuring that all critically ill children have timely access to specialized, high-quality care.  \n*Correspondence: Giacomo Brisca  \ngiacomobrisca@gmail.com  \n1Neonatal and Pediatric Intensive Care Unit, Intermediate Care Unit, Department of Emergency Medicine, Anesthesia, and Critical Care, IRCCSIstituto Giannina Gaslini, via Gerolamo Gaslini 5, 16147 Genova, Italy 2Pediatric Pain Treatment and Palliative Medicine Service, Department of Medicine and Surgery, Fondazione IRCCS San Gerardo dei Tintori, Milan Bicocca University, Monza, Milan, Italy  \n3Department of Pediatric Anesthesia and Intensive Care Unit, Buzzi Children’s Hospital, Milan, Italy  \n4Pediatric Intensive Care Unit, IRCCS Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy  \n5Pediatric Intensive Care Unit, Meyer Children’s Hospital, IRCCS, Florence, Italy  \n6Department of Health Science, Section of Anesthesia and Intensive Care, University of Florence, Florence, Italy  \n7Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI), Milan, Italy  \n8Sacred Heart Catholic University, Fondazione Policlinico Universitario Gemell i IRCCS, Rome, Italy  \n9Division of Anesthesia, Analgesia, and Intensive Care, Santa Maria della, Misericordia University Hospital, Perugia, Italy  \n10Department of Anesthesiology, Azienda Ospedal iero Universitaria Policlinico-San Marco, University of Catania, Catania, Italy  \n11Pediatric Critical Care Unit, Santobono-Pausilipon Children’s Hospital, Naples, Italy  \n© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or ot","cbCaii3KEMP6IEWp","https://ap.wps.com/l/cbCaii3KEMP6IEWp","pdf",685598,"English","# Abstract\n# To the Editor\n## Centralized multidisciplinary care versus extending NICU roles\n## Current PICU capacity in Italy\n## Evidence from standards and international data","[{\"question\":\"What proposal is the letter responding to?\",\"answer\":\"The letter addresses Decembrino et al.’s proposal to introduce “Extended NICUs” by expanding NICU roles to cover toddlers and critically ill infants to compensate for PICU bed shortages.\"},{\"question\":\"Why do the authors caution against extending NICU roles?\",\"answer\":\"They argue that expanding NICU functions could fragment pediatric critical care, because complex pediatric expertise and resources are harder to replicate across many smaller units.\"},{\"question\":\"What care model do the authors recommend instead?\",\"answer\":\"They recommend consolidating pediatric intensive care in high-volume, specialized centers within sustainable hub-and-spoke networks, supported by strengthened referral systems and transport capabilities.\"}]","Extended NICUs or specialized pediatric networks - The need to reinforce centralized, multidisciplinary care | PDF",1790753596]