From the Guidelines
Pediatric sepsis is defined by the presence of a systemic inflammatory response syndrome (SIRS) plus a suspected or proven infection, with criteria including abnormal temperature, tachycardia, tachypnea, and abnormal white blood cell count, as well as signs of organ dysfunction such as altered mental status, hypoxemia, and increased serum lactate level 1, 2. The diagnosis of pediatric sepsis involves identifying children with suspected or confirmed infection who are at risk of organ dysfunction.
- The primary criteria include the presence of SIRS plus a suspected or proven infection.
- SIRS in children is characterized by at least two of the following: + Abnormal temperature (>38.5°C or <36°C) + Tachycardia (heart rate above age-specific norms) + Tachypnea (respiratory rate above age-specific norms) + Abnormal white blood cell count (elevated, depressed, or with >10% immature neutrophils)
- Age-specific vital sign parameters are crucial as normal ranges vary significantly across pediatric age groups.
- Severe sepsis is diagnosed when sepsis is accompanied by cardiovascular dysfunction, acute respiratory distress syndrome, or dysfunction in two or more organ systems.
- Septic shock is identified when sepsis occurs with cardiovascular dysfunction that persists despite fluid resuscitation, as noted in studies such as 3 and 4. The pediatric Sequential Organ Failure Assessment (pSOFA) score is increasingly used to evaluate organ dysfunction in children with suspected infection, highlighting the importance of early recognition and prompt intervention to improve outcomes 2.
- Early recognition using these criteria is essential as children can deteriorate rapidly.
- Prompt intervention with appropriate antibiotics and fluid resuscitation significantly improves outcomes.
- Regular reassessment is necessary as the clinical presentation may evolve quickly in pediatric patients.
From the Research
Definition of Pediatric Sepsis
The definition of pediatric sepsis has undergone several revisions over the years. According to 5, the current criteria for sepsis in children are defined by a Phoenix Sepsis Score of at least 2 points in children with suspected infection, which indicates potentially life-threatening dysfunction of the respiratory, cardiovascular, coagulation, and/or neurological systems.
Criteria for Pediatric Sepsis
The criteria for pediatric sepsis include:
- Systemic inflammatory response syndrome (SIRS) criteria, which have been modified for children to incorporate pediatric physiologic variables 6
- Phoenix Sepsis Score, which includes points for respiratory, cardiovascular, coagulation, and neurological dysfunction 5
- Organ dysfunction categories, severe sepsis, and septic shock specifically defined for children 6
Limitations of Current Criteria
There are limitations to the current pediatric sepsis criteria, including:
- The SIRS criteria lack sensitivity and specificity 7
- The Phoenix Sepsis Score may miss signs of early sepsis 7
- Important criteria like renal and liver dysfunction are missing from the main criteria 7
Importance of Understanding Criteria
Understanding the criteria for pediatric sepsis is crucial for swift diagnosis and treatment, as sepsis can manifest as cardiovascular dysfunction, hematologic abnormalities, and neurologic symptoms, resulting in late diagnosis and increased mortality and morbidity 8.
Previous Definitions
Previous definitions of pediatric sepsis were published in 2005 by the International Pediatric Sepsis Consensus Conference (IPSCC), which defined sepsis as a suspected or confirmed infection in the presence of SIRS 6. However, these criteria have been modified and updated to reflect new evidence and expert consensus 5.