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
Contributors
Authors
Akash Deep, MD, FRCPCH
Director and Professor of Paediatric Critical Care
Paediatric Intensive Care Unit
King’s College Hospital
London
UK
Disclosures
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
Disclosures
CD declares that he has no competing interests.
Acknowledgements
Dr Akash Deep and Dr Chris Duncan 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 Pediatric 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.
References
Key articles
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. Abstract
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. Abstract
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.Full text Abstract
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.Full text Abstract
National Institute for Health and Care Excellence. Fever in under 5s: assessment and initial management. Nov 2021 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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