Brisca Giacomo, Strati Marina F, Canzoneri Francesca, Mariani Marcello, Pirlo Daniela, Romanengo Marta, Tardini Giacomo, Brolatti Noemi, Buratti Silvia, Pedemonte Marina, Fiorillo Chiara, Striano Pasquale, Bruno Claudio, Moscatelli Andrea
Neonatal and Pediatric Intensive Care Unit, and Intermediate Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genova, Genova, Italy.
Front Pediatr. 2025 Apr 9;13:1539540. doi: 10.3389/fped.2025.1539540. eCollection 2025.
Neuromuscular disorders (NMDs) represent a complex group requiring specialized care, often straddling the needs between general pediatric wards and Intensive Care Units (ICUs). Our research focuses on the role of a newly established pediatric Intermediate Care Unit (IMCU) in this context.
We conducted a single-center retrospective observational study, encompassing patients with NMDs admitted to the newly established pediatric IMCU at IRCCS Istituto Giannina Gaslini, Genoa, Italy, from January 2021 to June 2023. The study assessed demographics, clinical characteristics, therapeutic management, length of stay, and outcomes including mortality 28 days post-discharge.
Sixty-three patients (median age 12, female 58.7%) were included. The majority of admissions were due to neurological issues (39.7%) and respiratory complications (22%), with a significant proportion of patients requiring initiation or potentiation of respiratory support (59%). Factors such as the presence of tracheostomy ( = 0.021), the need for antibiotics ( = 0.025), and parenteral nutrition ( = 0.026) were associated with ICU admissions while steroid treatment ( = 0.047) increased IMCU stay.
The establishment of the IMCU has shown promising results in managing NMDs patients, serving as a crucial step-down unit for ICU patients and a step-up unit for those with worsening conditions in low-intensity care units. It has led to decreased ICU admissions and shorter ICU stays, suggesting potential healthcare costs and patient comfort benefits. The study underscores the importance of pediatric IMCUs in providing specialized care for children with NMDs, balancing the need for intensive monitoring and treatment in a less intensive setting than an ICU.
神经肌肉疾病（NMDs）是一组复杂的疾病，需要专业护理，其需求往往介于普通儿科病房和重症监护病房（ICU）之间。我们的研究聚焦于新设立的儿科中间护理单元（IMCU）在此背景下所发挥的作用。
我们开展了一项单中心回顾性观察研究，纳入了2021年1月至2023年6月期间在意大利热那亚IRCCS吉安尼娜·加斯利尼研究所新设立的儿科IMCU住院的NMDs患者。该研究评估了人口统计学特征、临床特征、治疗管理、住院时长以及出院后28天的结局，包括死亡率。
共纳入63例患者（中位年龄12岁，女性占58.7%）。大多数入院原因是神经问题（39.7%）和呼吸并发症（22%），相当一部分患者需要启动或加强呼吸支持（59%）。气管造口术的存在（=0.021）、使用抗生素的需求（=0.025）和肠外营养（=0.026）等因素与入住ICU相关，而类固醇治疗（=0.047）会延长在IMCU的住院时间。
IMCU的设立在管理NMDs患者方面显示出了令人鼓舞的结果，它是ICU患者的关键降级单元，也是低强度护理单元中病情恶化患者的升级单元。这导致了ICU入院人数减少和ICU住院时间缩短，表明可能带来医疗成本效益和患者舒适度提升。该研究强调了儿科IMCU在为患有NMDs的儿童提供专业护理方面的重要性，在比ICU强度更低的环境中平衡了强化监测和治疗的需求。
