Early Paediatric Burn Wound Management in Italy: A Cross-Sectional Survey of Protocol-Driven Practices in the First 24 Hours

Introduction. Early management of paediatric burn wounds is a critical determinant of wound progression, healing time, and long-term outcomes. The first 24 hours after injury represent a dynamic phase in which clinical decisions regarding cleansing, antisepsis, dressing selection, and follow-up may influence burn wound conversion and complications. Despite available guidelines, early paediatric burn care remains heterogeneous, and real-world data describing institutional practices are limited. Methods. A cross-sectional observational survey was conducted to describe early paediatric burn wound management practices in Italian burn centres. A structured, evidence-informed questionnaire was distributed electronically to designated clinical referents from 17 centres managing paediatric burns. Respondents were asked to report protocol-driven, centre-level practices regarding first aid, wound cleansing and antisepsis, initial dressing selection according to burn depth, timing of first reassessment, and caregiver education. Data were collected between May and June 2025 and analysed using descriptive statistics. Results. Eleven professionals participated, predominantly nurses (90.9%), most of whom worked in major burn centres. Cooling with running water for 20 minutes was the most frequently reported first-aid measure across burn aetiologies (90.9%). Wound cleansing was performed in all centres, most commonly using normal saline (63.6%). Antisepsis was frequently adopted, particularly for flame burns (100%), with 0.05% sodium hypochlorite being the most commonly reported agent. Paraffin-impregnated gauze was the preferred dressing for first-degree (81.8%) and superficial partial-thickness burns (72.7%). For deep partial-thickness and small full-thickness burns (<5 cm), collagenase, silver alginate, and hydrogel were more frequently selected. First wound reassessment occurred within 24 hours in 63.6% of centres. Most respondents (81.8%) reported providing structured caregiver education focused on home dressing management and pain control. Discussion and Conclusions. Early paediatric burn wound management practices in Italian burn centres appear broadly aligned with current first-aid and early reassessment recommendations. However, variability in antiseptic use and dressing selection persists, particularly for deeper burns, highlighting the need for shared, depth- and objective-driven frameworks to support early clinical decision-making and future multicentre consensus initiatives.