Summary

Sepsis in children is a life-threatening condition where the body's response to an infection causes widespread inflammation and organ dysfunction. Think of sepsis as your child's immune system overreacting to an infection—instead of just fighting the infection, the immune response becomes overwhelming, causing inflammation throughout the body, leading to organ damage, shock, and potentially death. Sepsis can develop from any infection (bacterial, viral, fungal) and is a medical emergency. The presentation in children can be different from adults—children may deteriorate rapidly, and early signs can be subtle (especially in infants). The key to management is recognizing sepsis early (using pediatric-specific criteria—fever or hypothermia, tachycardia, altered mental status, poor perfusion), providing immediate resuscitation (ABCs, IV fluids, oxygen), giving antibiotics urgently (within 1 hour), identifying and treating the source of infection, and providing supportive care (inotropes if shock, organ support). Early recognition and treatment are crucial—every hour of delay in antibiotics increases mortality. Most children recover with prompt treatment, but sepsis remains a leading cause of death in children worldwide.

Key Facts

• Definition: Life-threatening organ dysfunction caused by dysregulated host response to infection
• Incidence: Common (thousands of cases/year), leading cause of death in children worldwide
• Mortality: 5-10% overall, higher if not treated promptly
• Peak age: Infants and young children (highest risk), but can occur at any age
• Critical feature: Infection + signs of organ dysfunction/shock
• Key investigation: Clinical assessment, blood cultures, source identification
• First-line treatment: Immediate resuscitation, urgent antibiotics (within 1 hour), source control

Clinical Pearls

"Time matters—antibiotics within 1 hour" — Every hour of delay in giving antibiotics increases mortality. Give antibiotics urgently (within 1 hour of recognition), even before you know the exact cause.

"Children can deteriorate rapidly" — Children, especially infants, can deteriorate very quickly. Don't wait—if you suspect sepsis, treat it as sepsis and escalate urgently.

"Early signs can be subtle" — Early signs of sepsis in children can be subtle (especially in infants—may just be "not right", poor feeding, irritability). Have a low threshold for concern.

"Use pediatric-specific criteria" — Pediatric sepsis criteria are different from adults. Use age-specific vital signs and pediatric-specific signs (capillary refill, mottled skin, etc.).

Why This Matters Clinically

Sepsis is a leading cause of death in children worldwide and requires urgent recognition and treatment. Early recognition (using pediatric-specific criteria), immediate resuscitation, and urgent antibiotics (within 1 hour) are essential to save lives. This is a condition that all clinicians caring for children need to recognize and manage urgently, as delayed treatment significantly increases mortality.

Structured Approach: ABCDE

A - Airway

• Assessment: Usually patent (may be compromised if severe)
• Action: Secure if compromised

B - Breathing

• Look: May have respiratory distress
• Listen: May have decreased air entry, crackles
• Measure: SpO2 (may be low), respiratory rate (usually high)
• Action: Oxygen, may need ventilation

C - Circulation

• Look: Poor perfusion (mottled, cold), signs of shock
• Feel: Pulse (fast, may be weak), BP (may be low), capillary refill (slow)
• Listen: Heart sounds (usually normal)
• Measure: BP (may be low), HR (usually high)
• Action: IV fluids urgently, inotropes if shock

D - Disability

• Assessment: Mental status (altered), GCS
• Action: Assess severity

E - Exposure

• Look: Full examination, look for source
• Feel: Temperature, perfusion
• Action: Complete examination, identify source

Specific Examination Findings

Perfusion Assessment (Critical):

• Capillary refill: Check (should be <2 seconds, >3 seconds = poor)
• Skin: Check temperature, color, mottling
• Pulses: Check strength
• Action: Assess perfusion urgently

Source Identification:

• Respiratory: Listen for crackles, check for respiratory distress
• Urinary: Check for UTI signs
• Skin: Check for cellulitis, abscess
• Meningeal: Check for neck stiffness (meningitis)
• Action: Identify source to guide antibiotics

Special Tests

Natural History (Without Treatment)

Untreated Sepsis:

• High mortality: 30-50% mortality
• Severe complications: Multi-organ failure
• Poor outcomes: If not treated promptly

Outcomes with Treatment

Factors Affecting Outcomes:

Good Prognosis:

• Early treatment: Better outcomes (antibiotics within 1 hour)
• No shock: Better outcomes
• Young, healthy: Better outcomes
• Prompt source control: Better outcomes

Poor Prognosis:

• Delayed treatment: Higher mortality (every hour matters)
• Septic shock: Higher mortality
• Multi-organ failure: Higher mortality
• Very young or immunocompromised: May have worse outcomes

Prognostic Factors

Key Guidelines

1. Surviving Sepsis Campaign (2020) — Pediatric sepsis guidelines. Surviving Sepsis Campaign

Key Recommendations:

• Antibiotics within 1 hour
• IV fluids for shock
• Source control
• Evidence Level: 1A

2. NICE Guidelines (2016) — Sepsis: recognition, diagnosis and early management. National Institute for Health and Care Excellence

Key Recommendations:

• Early recognition
• Urgent antibiotics
• Evidence Level: 1A

Landmark Trials

Multiple studies on timing of antibiotics, fluid resuscitation.

Evidence Strength

What is Sepsis?

Sepsis is a life-threatening condition where your child's body's response to an infection causes widespread inflammation and organ damage. Think of sepsis as your child's immune system overreacting to an infection—instead of just fighting the infection, the immune response becomes overwhelming, causing inflammation throughout the body and leading to organ damage and shock.

In simple terms: Your child has a serious infection that's making their whole body very sick. This is a medical emergency that needs urgent treatment, but with prompt treatment, most children recover completely.

Why does it matter?

Sepsis is a leading cause of death in children worldwide and requires urgent treatment. Early recognition and treatment (especially antibiotics within 1 hour) are essential to save lives. The good news? With prompt treatment, most children recover completely.

Think of it like this: It's like a serious infection that's making your child's whole body very sick—it needs urgent treatment, but most children recover with the right care.

How is it treated?

1. Immediate Care (Most Important):

• Hospital: Your child will be admitted to hospital (may need ICU)
• IV fluids: Your child will get fluids through a drip urgently
• Oxygen: Your child will get oxygen if needed
• Monitoring: Close monitoring of your child's condition
• Why: To support your child's body while fighting the infection

2. Urgent Antibiotics (Within 1 Hour):

• Antibiotics: Your child will get antibiotics through a drip immediately (within 1 hour)
• Why: To fight the infection—this is the most important treatment and saves lives
• Don't wait: Even before we know exactly what the infection is, we give broad-spectrum antibiotics

3. Identify the Source:

• Tests: Your child will have tests to find where the infection is coming from
• Why: To guide treatment and remove the source if needed

4. Support Your Child's Body:

• Organ support: Your child may need support for their organs (breathing, circulation, etc.)
• ICU: If very severe, your child may need ICU care
• Why: To support your child's body while it fights the infection

The goal: Fight the infection (antibiotics), support your child's body (fluids, oxygen, organ support), and help them recover.

What to expect

Recovery:

• Hospital stay: Usually days to weeks (depends on severity)
• ICU: If very severe, may need ICU care
• Symptoms: Should start improving with treatment
• Full recovery: Most children recover completely

After Treatment:

• Antibiotics: Your child will continue antibiotics until the infection is cleared
• Monitoring: Close monitoring until your child is stable
• Follow-up: Usually not needed unless complications

Recovery Time:

• Mild cases: Usually recover within days
• Moderate cases: Usually recover within weeks
• Severe cases: May take longer, may have complications

When to seek help

Call 999 (or your emergency number) immediately if:

• Your child is very unwell
• Your child has a high fever and is very unwell
• Your child is confused or not responding normally
• Your child's skin is mottled or cold
• Your child is breathing very fast or having difficulty breathing
• You're very worried about your child

See your doctor if:

• Your child has a fever and seems unwell
• Your child is "not right" (especially infants)
• Your child has symptoms that concern you
• You're worried about your child

Remember: If your child is very unwell, especially if they have a high fever, are confused, have mottled or cold skin, or are breathing very fast, call 999 immediately. Sepsis is a medical emergency, but with prompt treatment, most children recover completely. Trust your instincts—if you're worried, seek help.