Extended NICUs or specialized pediatric networks? The need to reinforce centralized, multidisciplinary care - a comment on Decembrino et al.

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.