High Dependency Units (HDUs) in Pediatrics: Need of the Hour in Resource-Limited Settings

Background Critically ill children, being vulnerable and having higher mortality as compared to adults, require specialized intensive care. However, the focus of critical care remains on adults, especially in resource-limited countries. Limited beds in the pediatric intensive care unit (PICU) along with the limitation of infrastructure and staff add to the challenge in pediatric critical care. In such scenarios, high-dependency units (HDUs) can help save a few more lives, who could not be provided with the PICU facility. HDU provides a level of care that is intermediate to that of the PICU and the general ward providing close observation, monitoring, and intervention to children who are critically ill. Our study highlighted that critically ill children can be given a chance of survival in resource-limited settings through HDU care. Materials and methods In our single-center prospective observational study, 204 children (less than 18 years) admitted to the HDU over 11 months and fulfilling the inclusion criteria were included. Blood samples were drawn for baseline investigations. The child's clinical course in the HDU along with the total duration of stay were recorded in a proforma. Children were reviewed for the requirement of invasive, non-invasive respiratory support along with inotropic support. Various parameters of the pediatric risk of mortality (PRISM) IV score were recorded within a time period of two hours prior and four hours following admission to HDU. The final outcome of the children was recorded. All data were analyzed and reviewed. Results Among the 204 patients admitted to HDU 136 (66.7%) children were treated successfully, whereas 63 (30.9%) children succumbed to their disease and complications, and five children were transferred to the PICU. Among various factors of age less than one year, the primary indication of admission being respiratory distress, the need of >2 inotropes had higher odds of mortality. Odds of mortality were eight times in patients with shock and altered sensorium, three times in children with respiratory distress, and two times in those having seizures. Those patients with a PRISM IV score of >15 had almost 100 times higher odds of mortality as compared to those with a score of <15. Conclusion In a resource-limited setting like ours, there's a scarcity of PICU beds for the provision of critical care. We envisage that providing intensive care in HDU will help save a few more lives, who could not be provided PICU facility for any reason.