From neonatal to paediatric intensive care: an educational pathway.

Neonatal and paediatric intensive care units (NICUs and PICUs) are growing in number, size and complexity, and each unit is staffed by a highly specialized group of doctors and nurses. Indeed, practitioners within these subspecialties acquire specific cognitive and procedural skills garnered from focused multidisciplinary training, as well as from experience with critically ill newborns and children. Although the NICUs and PICUs share many commonalities, the relationship between caregivers in the neonatal and paediatric critical care units often is characterized by rivalry and antagonism rather than by cooperation. In addition, as in the Italian scenario, the scientific and professional background in most cases differ between neonatologists, predominantly coming from a paediatric-oriented curriculum, and paediatric intensivists, mainly affiliated to adult anaesthesia and intensive care residency programs. However, in some circumstances, particularly when dealing with smaller patients, the limits between these two distinct disciplines appear quite vague, and undoubtedly many clinicians have the perception that the two branches, namely neonatology and paediatric anaesthesia and intensive care, would get a mutual benefit by a stronger collaboration and cross-contamination. Indeed, in some situations, such as shortage of PICU beds or patients not easily transferable to a PICU, neonatologists are occasionally called to take care of critically ill infants and young children. However, these "paediatric" patients may often present with complex pathologies which the neonatologist may not be familiar with. This condition raises important issues about the advisability to provide specific education and training in paediatric intensive care also to neonatologists, according to local needs and caregivers' expectations.