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Italian journal of pediatrics
Mar 26, 2025;51 (1): 100.

Comparing Italian versus European strategies and technologies for respiratory care in NICU: results of a survey of the Union of European Neonatal and Perinatal Societies (UENPS) and the Italian Society of Neonatology (SIN).

Camilla Gizzi, Flavia Petrillo, Maria Luisa Ventura, Luigi Gagliardi, Daniele Trevisanuto, Gianluca Lista, Raffaele Dellacà, Artur Beke, Giuseppe Buonocore, Antonia Charitou, Manuela Cucerea, Boris Filipović-Grčić, Nelly Georgieva Jeckova, Esin Koç, Joana Saldanha, Manuel Sanchez-Luna, Dalia Stoniene, Heili Varendi, Giulia Vertecchi, Luigi Orfeo, Fabio Mosca, Corrado Moretti
Author Information
  1. Camilla Gizzi: Division of Neonatology and NICU, Sant'Eugenio Hospital, Rome, ASL RM2, Italy. camilla.gizzi@aslroma2.it. ORCID
  2. Flavia Petrillo: Maternal and Child Department ASL Bari, Ospedale Di Venere, Bari, Italy.
  3. Maria Luisa Ventura: Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
  4. Luigi Gagliardi: Division of Neonatology and Pediatrics, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Viareggio, Pisa, Italy.
  5. Daniele Trevisanuto: Department of Woman's and Child's Health, University of Padova, Padova, Italy.
  6. Gianluca Lista: Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy.
  7. Raffaele Dellacà: TechRes Lab, Department of Electronics, Information and Biomedical Engineering (DEIB), Politecnico di Milano University, Milan, Italy.
  8. Artur Beke: Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy.
  9. Giuseppe Buonocore: Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy.
  10. Antonia Charitou: Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy.
  11. Manuela Cucerea: Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy.
  12. Boris Filipović-Grčić: Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy.
  13. Nelly Georgieva Jeckova: Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy.
  14. Esin Koç: Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy.
  15. Joana Saldanha: Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy.
  16. Manuel Sanchez-Luna: Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy.
  17. Dalia Stoniene: Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy.
  18. Heili Varendi: Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy.
  19. Giulia Vertecchi: Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy.
  20. Luigi Orfeo: SIN "Società Italiana di Neonatologia", Ospedale Isola Tiberina Gemelli Isola, Rome, Italy.
  21. Fabio Mosca: Department of Pediatrics, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan, University of Milan, Milan, Italy.
  22. Corrado Moretti: Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy.
PMID: 40140879 DOI: 10.1186/s13052-025-01936-6

Abstract

BACKGROUND: Our survey aimed to compare information on respiratory care in Neonatal Intensive Care Units (NICUs) in Italy and in the European and Mediterranean region.
METHODS: Cross-sectional electronic survey. An 89-item questionnaire focusing on the current modes, devices, and strategies employed in neonatal units in the domain of respiratory care was sent to directors/heads of 528 NICUs.
RESULTS: The response rate was 75% (397/528 units). The median number of NICU beds and the admission rate per unit/year of preterm infants < 1500 g was significantly lower in Italy compared with Europe (p < 0.001). In most Italian Delivery Rooms (DR) full resuscitation is given from 22 to 23 weeks gestational age, while 21.0% of the European units initiate from 24 weeks. Initial FiO is set as per American Academy of Pediatrics guidelines in 81.1% of Italian units compared to 30.9% of the European ones (p < 0.001). DR surfactant is less often given through Less-Invasive-Surfactant-Administration (LISA) in Italy (53.4% vs. 76.2% of units, p < 0.03). Volume-targeted, synchronized intermittent positive-pressure ventilation (IPPV) is the preferred invasive mechanical ventilation (MV) mode to treat acute RDS across the surveyed units, however 22.9% % of Italian centers vs. 6.8% of the European ones use HFOV as first choice (p < 0.001). During HFOV, 78% of Italian NICUs set mean airway pressure (MAP) following a lung recruitment procedure compared to 41% of the centers in Europe (p < 0.001). In the NICUs, most of the non-invasive (NIV) modes used are nasal CPAP and nasal IPPV. For infants on NIV, LISA strategy is used in 25.6% of Italian vs. 60.0% of European units (p < 0.001). 70% of surveyed units use a brand caffeine. Inhaled steroids are used in 42.3% of Italian vs. 65.4% of European NICUs (p < 0.001).
CONCLUSIONS: respiratory support strategies among the surveyed Italian and European NICUs are quite dissimilar in some areas, particularly where high-quality evidence is lacking. We believe that hese data will allow stakeholders to make comparisons and to identify opportunities for improvement.

Keywords

Caffeine Delivery room Mechanical ventilation Preterm infants RDS Steroids Surfactant Survey

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Grants

  1. Chiesi Farmaceutici/Chiesi Farmaceutici

MeSH Term

Humans
Italy
Infant, Newborn
Intensive Care Units, Neonatal
Cross-Sectional Studies
Europe
Neonatology
Surveys and Questionnaires
Infant, Premature
Respiratory Distress Syndrome, Newborn
Societies, Medical
Respiratory Therapy
Respiration, Artificial
Journal Article Comparative Study

Word Cloud

Created with Highcharts 10.0.0EuropeanItalianunitsp < 0NICUs001respiratoryvssurveycareItalystrategiescomparedventilationsurveyedusedNeonatalmodesrateperEuropeDeliveryDRgiven22weeks0%set9%onesLISA4%IPPVRDScentersuseHFOVNIVnasalinfantsBACKGROUND:aimedcompareinformationIntensiveCareUnitsMediterraneanregionMETHODS:Cross-sectionalelectronic89-itemquestionnairefocusingcurrentdevicesemployedneonataldomainsentdirectors/heads528RESULTS:response75%397/528mediannumberNICUbedsadmissionunit/yearpreterminfants < 1500 gsignificantlylowerRoomsfullresuscitation23gestationalage21initiate24InitialFiOAmericanAcademyPediatricsguidelines811%30surfactantlessoftenLess-Invasive-Surfactant-Administration53762%03Volume-targetedsynchronizedintermittentpositive-pressurepreferredinvasivemechanicalMVmodetreatacuteacrosshowever%68%firstchoice78%meanairwaypressureMAPfollowinglungrecruitmentprocedure41%non-invasiveCPAPstrategy256%6070%brandcaffeineInhaledsteroids423%65CONCLUSIONS:supportamongquitedissimilarareasparticularlyhigh-qualityevidencelackingbelievehesedatawillallowstakeholdersmakecomparisonsidentifyopportunitiesimprovementComparingversustechnologiesNICU:resultsUnionPerinatalSocietiesUENPSSocietyNeonatologySINCaffeineroomMechanicalPretermSteroidsSurfactantSurvey

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