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Sepsis in children

Last reviewed: 7 Aug 2025
Last updated: 07 Feb 2025

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
Full details

Other diagnostic factors

  • hypotension
  • specific focal signs and symptoms reflecting underlying pathology
Full details

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
Full details

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
Full details

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
Full details

Emerging tests

  • emerging biomarkers
  • PhenoTest™ BC Kit

Treatment algorithm

ACUTE

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

ჩვენი მტკიცებულებებისა და სარედაქციო ჯგუფები თანამშრომლობენ საერთაშორისო ექსპერტებსა და რეცენზენტებთან, რათა უზრუნველვყოთ თქვენი წვდომა კლინიკურად ყველაზე მნიშვნელოვან ინფორმაციაზე.

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

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