Sepsis in children

Last reviewed: 7 Jul 2022
Last updated: 04 May 2022

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
  • change in usual pattern of activity or feeding in a neonate
  • dry nappies/decreased urine output
  • mottling of the skin, ashen appearance, cyanosis
  • low oxygen saturation
  • vasoplegia
  • non-blanching purpuric rash
More key diagnostic factors

Other diagnostic factors

  • hypotension
  • specific focal signs and symptoms reflecting underlying pathology
Other diagnostic factors

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
More risk factors

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
  • C-reactive protein (CRP)
  • chest x-ray
More 1st investigations to order

Investigations to consider

  • lumbar puncture
  • meningococcal polymerase chain reaction analysis
  • bronchoalveolar lavage culture
  • herpes simplex virus (HSV) polymerase chain reaction (blood and cerebrospinal fluid)
More investigations to consider

Emerging tests

  • serum procalcitonin
  • emerging biomarkers
  • PhenoTest™ BC Kit

Treatment algorithm

ACUTE

presumed or confirmed sepsis

Contributors

Authors

Akash Deep, MD, FRCPCH

Director

Paediatric Intensive Care Unit

King’s College Hospital

London

UK

Disclosures

AD declares that he has no competing interests.

Acknowledgements

Dr Akash Deep would like to gratefully acknowledge Dr Jeremy Tong and Dr Adrian Plunkett, previous contributors to this topic.

Disclosures

JT and AP are authors involved in the Paediatric Sepsis Six initiative, cited in this topic.

Peer reviewers

Saul N. Faust, MA, MBBS, FRCPCH, PhD, FHEA

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.

Mohan Pammi, MBBS, MD, MRCPCH

Assistant Professor

Texas Children's Hospital and Baylor College of Medicine

Houston

TX

Disclosures

MP declares that he has no competing interests.

Jerry J. Zimmerman, MD, PhD

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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