Last reviewed: June 2018
Last updated: November  2017



History and exam

Key diagnostic factors

  • fever or low body temperature
  • tachypnea
  • tachycardia
  • bradycardia (neonates and infants)
  • altered mental state or behavior
  • decreased peripheral perfusion (cold shock)
  • change in usual pattern of activity or feeding in a neonate
  • dry diapers/decreased urine output
  • mottling of the skin, ashen appearance, cyanosis
  • low oxygen saturation
  • vasoplegia (warm shock)
  • nonblanching purpuric rash

Other diagnostic factors

  • hypotension
  • specific focal signs and symptoms reflecting underlying pathology

Risk factors

  • immunodeficiency
  • comorbidities
  • male gender
  • 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

  • CBC 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


Authors VIEW ALL

Consultant Paediatric Intensivist

University Hospitals of Leicester NHS Trust




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




SNF declares that he has no competing interests.

Assistant Professor

Texas Children's Hospital and Baylor College of Medicine




MP declares that he has no competing interests.

Faculty, Pediatric Critical Care Medicine

Seattle Children's Hospital

University of Washington School of Medicine




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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