Sepsis

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Sepsis is a clinical syndrome that results from severe infection. In simpler terms, it is an infection of the blood that can affect the whole body and is characterized by immune dysregulation and organ dysfunction, among other issues. Sepsis can be fatal if not treated promptly.

Anyone from adults to newborns can get sepsis. Sepsis that occurs in babies under 1-month-old is referred to as ‘neonatal sepsis’. Around 75,000 children are hospitalized each year in the United States due to severe sepsis, accounting for 7 percent of patients admitted to pediatric intensive care units. The mortality rate for severe sepsis has declined significantly since the 1960s, falling from 97 percent to between 4 and 10 percent.

This article discusses the key information parents should know about sepsis in children and infants, as well as advice on what to do if your child displays symptoms.

What causes sepsis?

Sepsis is caused by a dysregulated response to infection. Respiratory infections and bloodstream infections make up the majority of sepsis cases worldwide, many of which are caused by vaccine-preventable pathogens.

Although sepsis is most often caused by bacteria and viruses, fungal, parasitic, and rickettsial infections can also be responsible.

The most severe form of sepsis is a septic shock that does not respond to treatment and causes multiple system organ failures.

Risk factors for sepsis

Beyond the common causes of sepsis, there are certain factors that can put a child at an increased risk of this condition. These risk factors include:

• Being younger than 1 month old
• Serious injuries, such as trauma, burns or penetrating wounds
• Chronic medical conditions, such as uncorrected congenital heart disease or short gut syndrome
• Host immunosuppression (e.g. HIV infection, sickle cell disease, malnutrition)
• Large surgical incisions
• Invasive medical devices (e.g. endotracheal tube)
• Frequent urinary tract infections

Physical findings in sepsis patients

• Infection
• Systemic Inflammatory Response Syndrome (SIRS)
• Distributive (“warm”) shock or cold shock
• Toxic/ill appearance
• Dehydration
• Rigors (rises in temperature accompanied by shivering)
• Irritability
• Confusion
• Lethargy
• Decreased tone (particularly in newborns and infants)
• Respiratory problems
• Distended abdomen and tenderness

Diagnosis

A child can be diagnosed with sepsis if they are found to have a suspected or proven infection (e.g. pneumonia, bloodstream infection, skin infection, urinary tract infection, meningitis) and they meet 2 or more of the criteria for SIRS.

SIRS criteria: SIRS is a widespread inflammatory response to infection in the body. The criteria for SIRS which inform the diagnosis of sepsis are:

• Abnormal temperature (core temperature less than 96.8˚F or greater than 101.3˚F).
• Tachycardia (abnormally rapid heart rate of more than 100 beats per minute).
• Abnormally rapid respiratory rate.
• Elevated or depressed leukocyte count for the child’s age (leukocytes are blood cells that attack bacteria and disease as part of the body’s immune response).

Sepsis is diagnosed on a continuum, from sepsis to severe sepsis and septic shock to multiple organ failure. These diagnoses are explained below:

Severe sepsis: Sepsis accompanied by cardiac dysfunction, respiratory dysfunction, or dysfunction in 2 or more organ systems.

Septic shock: Hemodynamic instability that persists despite fluid therapy.

Multiple organ failure: Dysregulation of the body’s pro-inflammatory response to infection, rather than the infection itself, is responsible for multiple organ failure in sepsis cases.

When to see a doctor

If a child displays any of the symptoms described above, they should be taken to a doctor immediately. Sepsis is a dangerous condition that, if left untreated for too long, can be life-threatening.