From the Guidelines
Pediatric sepsis signs include fever or hypothermia, tachycardia, tachypnea, altered mental status, and poor perfusion, and early recognition is crucial to prevent rapid decompensation and improve outcomes. Children may present with fever above 38.5°C or temperature below 36°C, heart rate exceeding age-appropriate norms, increased respiratory rate, lethargy or irritability, delayed capillary refill (>2 seconds), mottled or cool extremities, and decreased urine output (<1 ml/kg/hr) 1. Other indicators include hypotension (a late and ominous sign), petechial or purpuric rash, and laboratory findings such as leukocytosis or leukopenia, thrombocytopenia, elevated lactate, and coagulation abnormalities.
Key Signs and Symptoms
- Fever above 38.5°C or temperature below 36°C
- Heart rate exceeding age-appropriate norms
- Increased respiratory rate
- Lethargy or irritability
- Delayed capillary refill (>2 seconds)
- Mottled or cool extremities
- Decreased urine output (<1 ml/kg/hr)
Importance of Early Recognition
Early recognition of sepsis is crucial as children can compensate well initially but decompensate rapidly, and prompt intervention with antibiotics and fluid resuscitation within the first hour significantly improves outcomes, as each hour of delay increases mortality risk by approximately 8% 1. The physiological basis for these signs stems from the systemic inflammatory response to infection, causing vasodilation, increased capillary permeability, and microcirculatory dysfunction.
Advanced Hemodynamic Monitoring
Advanced hemodynamic monitoring, such as cardiac output, systemic vascular resistance, or central venous oxygen saturation (Scvo2), may be useful in guiding resuscitation in children with septic shock or other sepsis-associated organ dysfunction, although the evidence is limited and of low quality 1.
Fluid Resuscitation
Fluid resuscitation should be performed carefully, with initial fluid boluses of up to 110 mL/kg in children with septic shock, and should be stopped or interrupted when no improvement of tissue perfusion occurs in response to volume loading 1.
From the Research
Pediatric Sepsis Signs and Symptoms
- Pediatric sepsis can manifest as cardiovascular dysfunction, hematologic abnormalities, and neurologic symptoms, making it challenging to diagnose 2
- The nonspecific nature of sepsis in children can lead to late diagnosis, resulting in increased mortality and morbidity 2
- Sepsis can be defined in relation to systemic inflammatory response syndrome and can be further characterized based on severity, including severe sepsis, septic shock, multiorgan failure, and refractory septic shock 2
Importance of Early Diagnosis and Treatment
- Early recognition and timely intervention with antibiotics, fluid resuscitation, and vasoactive medications are crucial in managing pediatric sepsis 3, 4
- Prompt initiation of broad-spectrum empiric antimicrobial therapy, fluid resuscitation, and vasoactive medications remain key components to initial management 5
- Automated screening algorithms and biomarker combinations can assist in earlier recognition of sepsis 5
Challenges in Diagnosing Pediatric Sepsis
- Pediatric sepsis is distinct from adult sepsis in its definitions, clinical presentations, and management 6
- Recognition of pediatric sepsis is complicated by various pediatric-specific comorbidities and age- and development-specific vital sign and clinical parameters 6
- The lack of a specific criteria or definition for systemic inflammatory response syndrome applicable to every child suffering from sepsis makes diagnosis challenging 2