Italian Journal of Pediatrics最新文献

The 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.

Respiratory syncytial virus (RSV) is one of the causes of lower respiratory tract infections (LRTIs) and related hospitalizations in neonates and infants. Clinical trials have shown that a single dose of nirsevimab can prevent this infection and its related complications. We systematically searched PubMed, Embase, Web of Science (WOS), Scopus, and Cochrane Central on 25 November 2024 and updated on 18 April 2025, without automated filters or language restrictions. Studies reported the outcomes after nirsevimab in infants were retrieved. A random effects model was applied for analysis. A total of 425,362 infants were pooled from 26 studies (6 randomized controlled trials and 20 observational cohorts studies). The immunization with nirsevimab reduced the incidence of RSV-LRTIs by 63% (risk ratio [RR]: 0.37; 95% CI [0.29; 0.47], p-value < 0.001, I² = 91.77%), hospitalization by 73% (RR: 0.27; 95% CI [0.20; 0.37], p-value < 0.001, I² = 97.46%). Nirsevimab also reduced the incidence of all-cause LRTIs and hospitalization, bronchiolitis, ICU admission, emergency unit visits, and all-cause mortality. The high heterogeneity was raised from pooling the real-world data across different clinical settings such as different geographical locations. There was no statistical significance regarding safety outcomes; serious, GIT adverse events, adverse events of special interest, and adverse events > grade 3 between the two groups. The time to event analysis showed that nirsevimab significantly reduced the RSV-LRTIs (Hazard Ratio (HR): 0.25; 95% CI [0.16; 0.37]) and hospitalization (HR: 0.14; 95% CI [0.08; 0.25]). The immunization with a single dose of nirsevimab significantly reduced the RSV-LRTIs and hospitalization in infants who were at risk for RSV infection without any identified safety concerns. The long-term safety concerns are still unclear across the current studies.