Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • fever or low body temperature
  • tachypnoea
  • tachycardia
  • bradycardia (neonates and infants)
  • altered mental state or behaviour
  • decreased peripheral perfusion (cold shock)
  • vasoplegia (warm shock)
  • change in usual pattern of activity or feeding in a neonate
  • dry nappies/decreased urine output
  • non-blanching purpuric rash
  • mottling of the skin, ashen appearance, cyanosis
  • low oxygen saturation

Other diagnostic factors

  • hypotension
  • specific focal signs and symptoms reflecting underlying pathology

Risk factors

  • immunodeficiency
  • comorbidities
  • male sex
  • younger age (especially neonates)
  • perinatal risk factors for infection (neonates)
  • healthcare-associated factors (neonates)
  • recent surgery or other invasive procedures
  • breached skin integrity

Diagnostic investigations

1st investigations to order

  • FBC with differential
  • serum glucose
  • blood culture
  • urinalysis
  • urine culture
  • blood gases
  • serum lactate
  • serum electrolytes
  • serum creatinine
  • LFTs
  • coagulation studies
  • CRP
  • CXR
Full details

Investigations to consider

  • lumbar puncture
  • meningococcal PCR analysis
  • bronchoalveolar lavage culture
  • HSV PCR (blood and CSF)
Full details

Emerging tests

  • serum procalcitonin
  • emerging biomarkers
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Consultant Paediatric Intensivist

University Hospitals of Leicester NHS Trust

Leicester

UK

Disclosures

JT is an author involved in the Paediatric Sepsis 6 initiative, cited in this monograph.

Dr Jeremy Tong would like to gratefully acknowledge Dr Adrian Plunkett, a previous contributor to this monograph. AP is an author involved in the Paediatric Sepsis 6 initiative, cited in this monograph.

Peer reviewers VIEW ALL

Professor of Paediatric Immunology & Infectious Diseases

Director, NIHR Wellcome Trust Clinical Research Facility

University of Southampton

Southampton

UK

Disclosures

SNF declares that he has no competing interests.

Assistant Professor

Texas Children's Hospital and Baylor College of Medicine

Houston

TX

Disclosures

MP declares that he has no competing interests.

Faculty, Pediatric Critical Care Medicine

Seattle Children's Hospital

University of Washington School of Medicine

Seattle

WA

Disclosures

JJZ receives research grant support from NIH/NICHD and ImmuneXpress; travel reimbursement from the Society of Critical Care Medicine to attend board meetings; and royalties from Elsevier for action as a co-editor for the textbook Pediatric Critical Care.

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