Sepsis in Children

Introduction
Sepsis is a clinical syndrome that
complicates severe infection
SIRS
Immune dysregulation
microcirculatory derangements
end-organ dysfunction
Mechanism
Normal host response to infection is to
localize/control invasion and to initiate repair
of injured tissue
Sepsis occurs when response to infection
becomes generalized and involves normal
issue
Definition
Suspected or proven infection by any
pathogen
proven through: PCR, culture, tissue stain
suspected through: CXR, fever, cough
SIRS
Core Temp
Tachycardia and Bradycardia if <1 yo
Resp rate
Leukocyte
Age group
Heart rate (beats/min)
Respiratory rate
(breaths/min)
Leukocyte count
(leukocytes x
103/mm3)
Systolic blood
pressure
(mmHg)
Tachycardia Bradycardia
Newborn (0 days to 1
wk)
>180 <100 >50 >34 <59
Neonate (1 wk to 1 mo) >180 <100 >40 >19.5 or <5 <79
Infant (1 mo to 1 yr) >180 <90 >34 >17.5 or <5 <75
Toddler and preschool
(>1 to 5 yrs)
>140 NA >22 >15.5 or <6 <74
School age (>5 to 12
yrs)
>130 NA >18 >13.5 or <4.5 <83
Adolescent (>12 to <18
yrs)
>110 NA >14 >11 or <4.5 <90
Risk Factors
<1mo
Serious injury (burns, trauma, penetrating)
Immunosuppression
Chronic medical condition
Large surgical incision
Invasive devices
Urinary tract abnormalities
Pathogens
Staphylococcus aureus
Streptococcus pneumoniae
Streptococcus pyogenes
Pseudomonas aeruginosa
Escherichia coli
Influenza
adenovirus
RSV
Fungi (mostly candida)
Parasitic
Physical Finding
Infection
(up to 60% of patients with sepsis have tests that are
negative for pathogens)
SIRS
2 criteria
Shock
evidence of inadequate tissue perfusion and O
2

delivery
Laboratory Studies
Imaging
Inflammatory biomarker: Procalcitonin, CRP
Cultures
CSF, wound, urine, blood
CBC
Blood gas
Electrolytes
Lactate
Glucose
Treatment
All children with findings consistent with
sepsis need timely antibiotic therapy
apply empiric therapy based on age
mostly antimicrobial regimens, however further
considerations include fungal infection risk, HSV
infection.
IV Fluids
maintain BP
Neonatal Sepsis
CBC w/ diff
urinalysis
blood culture
CSF studies and culture
Admit and treat empirically for at least 48 hr
until cultures show no growth
This is all because neonates may be
relatively asymptomatic