Sepsis in children may present initially with nonspecific, nonlocalized symptoms (especially in younger age groups) therefore it is important to have a low threshold for suspecting sepsis.
Given the time-critical nature of severe sepsis and septic shock, when sepsis is suspected on clinical grounds it is usually best to initiate sepsis investigations and treatment together, including administering antibiotics and fluid resuscitation. These should continue until sepsis has been excluded.
Progression to organ failure and shock is often very rapid, so early recognition and treatment is crucial.
Empiric broad-spectrum antibiotic therapy (based on the most probable pathogens) should be administered as soon as possible, and always within the first hour following recognition of severe sepsis.
Other treatments are primarily supportive, and should be delivered according to internationally recognized consensus-based guidelines.
Sepsis is a clinical syndrome resulting from a dysregulated immune response to infection. It is characterized by derangements in multiple pathobiologic processes, which may lead to widespread tissue injury. It encompasses a clinical spectrum of severity including severe sepsis, septic shock, and multiorgan failure. Sepsis is a leading cause of morbidity and mortality in children worldwide.
Traditionally, sepsis has been defined based on the presence or absence of the systemic inflammatory response syndrome (SIRS). In adults, the definitions of sepsis were updated in 2016, moving away from the SIRS definition and removing the term "severe sepsis."
At present there are no revisions to the international consensus definition of pediatric sepsis, which dates from 2005. However, in 2020 the Surviving Sepsis Campaign proposed a definition for septic shock in children: "severe infection leading to cardiovascular dysfunction (including hypotension, need for treatment with a vasoactive medication, or impaired perfusion)."
History and exam
Key diagnostic factors
- fever or low body temperature
- 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
- nonblanching purpuric rash
Other diagnostic factors
- specific focal signs and symptoms reflecting underlying pathology
- 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
1st investigations to order
- CBC with differential
- serum glucose
- blood culture
- urine culture
- blood gases
- serum lactate
- serum electrolytes
- serum creatinine
- coagulation studies
- C-reactive protein (CRP)
- chest x-ray
Investigations to consider
- lumbar puncture
- meningococcal polymerase chain reaction analysis
- bronchoalveolar lavage culture
- herpes simplex virus (HSV) polymerase chain reaction (blood and cerebrospinal fluid)
- serum procalcitonin
- emerging biomarkers
- PhenoTest™ BC Kit
presumed or confirmed sepsis
- Coronavirus disease 2019 (COVID-19)
- Pediatric inflammatory multisystem syndrome
- Congenital heart disease
- Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2021
- Neonatal infection: antibiotics for prevention and treatment
Sepsis in children
Pneumococcal vaccine in babies and childrenMore Patient leaflets
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