Last reviewed: August 2019
Last updated: October  2018



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
  • 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
  • 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 polymerase chain reaction analysis
  • bronchoalveolar lavage culture
  • HSV polymerase chain reaction (blood and cerebrospinal fluid)
Full details

Emerging tests

  • serum procalcitonin
  • emerging biomarkers
  • PhenoTest™ BC Kit
Full details

Treatment algorithm


Authors VIEW ALL


Paediatric Intensive Care Unit

King’s College Hospital




AD declares that he has no competing interests.

Dr Akash Deep would like to gratefully acknowledge Dr Jeremy Tong and Dr Adrian Plunkett, previous contributors to this topic. JT and AP are authors involved in the Pediatric Sepsis Six initiative, cited in this topic.

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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