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Background: The first post-COVID-19 pandemic year demonstrated an unusual bronchiolitis epidemic in both hemispheres and has been attributed to the removal of barriers implemented during SARS-CoV-2 infection. Several countries reported an increase in respiratory syncytial virus (RSV) bronchiolitis, with more hospitalizations and a greater need for respiratory support. We aimed to evaluate the consequences of the COVID-19 pandemic on the epidemiology and management of severe bronchiolitis in pediatric intensive care units (PICUs) in Italy., Methods: Multicenter, retrospective, cohort database analysis. All children younger than 24 months admitted to 7 PICUs from October 2017 to April 2023 diagnosed with bronchiolitis were included. We compared patients from pre-COVID and post-COVID eras, excluding patients from the 2020-2021 season due to low numbers. Logistic regression models were used to assess the impact of the pre-/post-COVID period on the need for invasive ventilation., Results: Seven hundred fifteen patients were admitted to PICU during the study period, 451 patients pre-COVID and 251 patients post-COVID. Patients in the post-COVID group were older, had more comorbidities, and had higher Pediatric Index of Mortality scores at admission but the need for respiratory support was not significantly different. There was high variability in bronchiolitis management across centers. Presenting pre-COVID was protective against the risk of mechanical ventilation, adjusted for age and disease severity at admission (OR 0.38, 95% CI 0.16-0.89), while RSV infection increased the risk of intubation (OR 2.49, 95% CI 1.1-5.63)., Conclusions: PICUs have faced an unexpected peak of significantly more severe cases of bronchiolitis after the COVID-19 pandemic, which did not require increased respiratory support., Competing Interests: Declarations. Ethics approval and consent to participate: The study used the electronic web-based national registry of the Italian Network of PICU Study Group (TIPNet) and all participants signed an informed consent to allow data to be inserted into the database. The registry’s use for nonprofit research purposes has been approved by the Ethics Committee of the Buzzi Hospital, the coordinating registry center (approval number 269–052014 of 23/05/2014 and number 0047897 of 16/11/2020). Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Life-threatening streptococcal sepsis nowadays represents an uncommon event in previously healthy infants and children. Critically ill patients suffering from severe streptococcal sepsis complications may present with pre-antibiotic era clinical pictures and require a timely clinical approach to achieve restitutio ad integrum., Results: We report a series of four patient groups affected by an uncommon life-threatening streptococcal sepsis, each of them exhibiting some distinct features. Streptococcus Agalactiae sepsis was associated with cerebral thrombotic/ischaemic lesions, whereas severe cardiogenic shock was prominent in the Streptococcus Viridans group; Streptococcus Faecalis and β-hemolytic group A Streptococcus patients mostly reported lung complications., Conclusions: Previous antibiotic treatments should not delay aggressive treatment in the intensive care setting. Early diagnostic suspicion, as well as appropriate and aggressive treatment provided within an intensive care setting are crucial for the clinical outcome., (© 2021. The Author(s).)