Summary
Definition
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 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 tests
1st tests to order
- CBC 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
Tests to consider
- lumbar puncture
- meningococcal polymerase chain reaction analysis
- bronchoalveolar lavage culture
- herpes simplex virus (HSV) polymerase chain reaction (blood and cerebrospinal fluid)
- CT chest
- Abdominal ultrasound
- Abdominal CT
- serum procalcitonin
Emerging tests
- emerging biomarkers
- PhenoTest™ BC Kit
Treatment algorithm
presumed or confirmed sepsis
კონტრიბუტორები
ავტორები
Akash Deep, MD, FRCPCH
Director and Professor of Paediatric Critical Care
Paediatric Intensive Care Unit
King’s College Hospital
London
UK
გაფრთხილება:
AD declares that he has no competing interests.
Chris Duncan, BMBS, BMedSci, MRCP, FFICM, FEWM, RMP, PGCert
ST7 Intensive Care Medicine
Barts Health NHS Trust
London
UK
გაფრთხილება:
CD declares that he has no competing interests.
მადლიერება
Dr Akash Deep and Dr Chris Duncan would like to gratefully acknowledge Dr Jeremy Tong and Dr Adrian Plunkett, previous contributors to this topic.
გაფრთხილება:
JT and AP are authors involved in the Pediatric Sepsis Six initiative, cited in this topic.
რეცენზენტები
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
გაფრთხილება:
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
გაფრთხილება:
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
გაფრთხილება:
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
წყაროები
ძირითადი სტატიები
Goldstein B, Giroir B, Randolph A; International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005 Jan;6(1):2-8. აბსტრაქტი
Schlapbach LJ, Watson RS, Sorce LR, et al. International consensus criteria for pediatric sepsis and septic shock. JAMA. 2024 Feb 27;331(8):665-74. აბსტრაქტი
Weiss SL, Peters MJ, Alhazzani W, et al. Surviving Sepsis Campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Pediatr Crit Care Med. 2020 Feb;21(2):e52-e106.სრული ტექსტი აბსტრაქტი
Davis AL, Carcillo JA, Aneja RK, et al. American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit Care Med. 2017 Jun;45(6):1061-93.სრული ტექსტი აბსტრაქტი
National Institute for Health and Care Excellence. Fever in under 5s: assessment and initial management. Nov 2021 [internet publication].სრული ტექსტი
გამოყენებული სტატიები
ამ თემაში მოხსენიებული წყაროების სრული სია ხელმისაწვდომია მომხმარებლებისთვის, რომლებსაც აქვთ წვდომა BMJ Best Practice-ის ყველა ნაწილზე.
დიფერენციული დიაგნოზები
- Coronavirus disease 2019 (COVID-19)
- Pediatric inflammatory multisystem syndrome
- Congenital heart disease
მეტი დიფერენციული დიაგნოზებიგაიდლაინები
- Sepsis: recognition, diagnosis and early management
- American College of Radiology appropriateness criteria for imaging for diagnosis of sepsis
მეტი გაიდლაინებიპაციენტის ბროშურები
Sepsis in children
Pneumococcal vaccine in babies and children
მეტი პაციენტის ბროშურებიშედით სისტემაში ან გამოიწერეთ BMJ Best Practice
ამ მასალის გამოყენება ექვემდებარება ჩვენს განცხადებას