Sepsis

• What is sepsis?


  Clinical syndrome

  Arises from body's inflammatory response to infection -> compromise of multiple organ systems

  Medical emergency - significant morbidity & mortality
• What are the RFs for paediatric sepsis?


  Age < 3 months

  Impaired immune function (diabetes, splenectomy, immunosuppressed, undergoing cancer treatment)

  Recent surgery or trauma (within last 6 wks)

  Breach of skin integrity (burns, cuts, skin infections)

  Presence of indwelling catheter or line

  Maternal infection during perinatal period
• What are the signs & symptoms of paediatric sepsis?


  Generally unwell

  Lethargy

  Poor social interaction

  Altered conscious level

  Continuous crying (babies)

  Pale or mottled skin

  Rash

  Decreased urine output

  Poor feeding

  Cool peripheries

  Tachypnoea

  Increased work of breathing

  Bradycardia/tachycardia

  Fever

  Signs of dehydration

  NOTE: Fever may not always be present
• What are the NICE criteria that places children at high risk of severe illness or death from sepsis (generally)?


  Child not rousable, or does not stay awake when roused

  Bradycardia or tachycardia for age

  Bradypnoea or tachypnoea for age

  Mottled skin

  Peripheral or central cyanosis

  Non-blanching rash

  Temperature < 36C or > 38C
• What are the DDx of paediatric sepsis?


  Systemic inflammatory response syndrome (SIRS)

  Meningitis

  Kawasaki disease

  Toxic shock syndrome

  Acute rheumatic fever

  Viral infections

  Metabolic disorders

  Endocrine emergencies

  Anaphylaxis

  Drug overdose or intoxication
• What are the Inx for sepsis?


  A-E approach

  Urinalysis

  Swabs

  Bloods (FBC, U&Es, LFTs, CRP, cultures, creatinine, blood gas, coag, lactate)

  Procalcitonin (emerging blood test for diagnosis of bacterial sepsis in children)

  CXR

  Abdo & pelvic imaging

  Lumbar puncture (if no contraindications)
• What is the management of paediatric sepsis?


  Broad spec Abx

  • Neonates < 72 hrs = IV benzylpenicillin & gentamicin
  • Neonates < 28 days = IV ceftriaxone or IV cefotaxime
  • Infants < 3 months = IV cefotaxime + amoxicillin
  • Children < 18 yrs = IV ceftriaxone

  High flow O2

  Fluid boluses

  Escalation to senior paediatrician within 1 hr

  Close monitoring

  Potential transfer to HDU or PICU -> may need inotropic support
• What are the possible complications of paediatric sepsis?


  AKI

  Metabolic disturbances (hypo or hyperglycaemia)

  Necrotising enterocolitis (neonates)

  Persistent pulmonary HTN (neonates)

  Neurological disability
• Paediatric sepsis is the most common cause of avoidable deaths in UK children.
• Pathophys - sepsis


  Pathogen recognition -> release of cytokines & NO -> vasodilation & systemic inflammation -> increased vessel wall permeability -> fluid leaks into extracellular spaces -> oedema & reduced intravascular volume -> impairs O2 delivery to tissues

  Coag systemic activation -> fibrin deposition in circulation -> decreased tissue perfusion -> anaerobic respiration -> accumulation of lactate in blood