Pediatric Sepsis Clinical Presentation
- Author: Shankar Santhanam, MD; Chief Editor: Russell W Steele, MD more...
Obtain a complete history as part of the evaluation of the infant or child with possible sepsis. Fever is the most common presenting symptom of children with systemic inflammatory response syndrome (SIRS). A parental report of measured (not tactile) fever can generally be assumed to be reliable.
Ask the caregiver whether any of the following have been noted: a racing heart, rapid or labored breathing, cool extremities, or color changes. Identify exposures to infectious illnesses and other sources of insult.
Discuss the child’s activity level. Perform an age-appropriate evaluation of mental status. Ask about urine output because it is the most sensitive historical marker of dehydration and potential renal hypoperfusion. Verify immunizations, and confirm drug allergies.
Perform a complete physical examination of the infant or child with suspected sepsis. Subtle changes in vital signs (eg, minimal tachycardia, widened pulse pressure, minimal tachypnea, minimally delayed capillary refill) may be the first signs of impending SIRS. Hypotension, mental status changes, and anuria are late signs. Hypothermia is often a more ominous sign than fever.
Elicit localizing signs of infection. A petechial or purpuric rash associated with fever is of particular concern. Frequent reassessment during interventions is required.
Because the manifestations of pediatric sepsis are protean, the possible complications are as well. Complications depend on the nature of the triggering insult and the resultant host response.
Reuters. Presepsin an accurate biomarker for late-onset sepsis in preemies. Medscape Medical News. December 18, 2014. [Full Text].
Poggi C, Bianconi T, Gozzini E, Generoso M, Dani C. Presepsin for the Detection of Late-Onset Sepsis in Preterm Newborns. Pediatrics. 2014 Dec 15. [Medline].
Goldstein B, Giroir B, Randolph A. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005 Jan. 6(1):2-8. [Medline].
Gaines NN, Patel B, Williams EA, Cruz AT. Etiologies of septic shock in a pediatric emergency department population. Pediatr Infect Dis J. 2012 Nov. 31(11):1203-5. [Medline].
Soeorg H, Huik K, Parm U, Ilmoja ML, Metelskaja N, Metsvaht T. Genetic Relatedness of Coagulase-negative Staphylococci From Gastrointestinal Tract and Blood of Preterm Neonates With Late-onset Sepsis. Pediatr Infect Dis J. 2013 Apr. 32(4):389-93. [Medline].
Greenhow TL, Hung YY, Herz AM. Changing epidemiology of bacteremia in infants aged 1 week to 3 months. Pediatrics. 2012 Mar. 129(3):e590-6. [Medline].
Harding H. Catheter dwell time longer than two weeks tied to higher sepsis risk in infants. Medscape Medical News. November 12, 2013. Available at http://www.medscape.com/viewarticle/814211. Accessed: November 19, 2013.
Milstone AM, Reich NG, Advani S, Yuan G, Bryant K, Coffin SE, et al. Catheter Dwell Time and CLABSIs in Neonates With PICCs: A Multicenter Cohort Study. Pediatrics. 2013 Nov 11. [Medline].
Stoll BJ, Hansen NI, Bell EF, et al. Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993-2012. JAMA. 2015 Sep 8. 314 (10):1039-51. [Medline].
Maitland K, Kiguli S, Opoka RO, et al. Mortality after fluid bolus in African children with severe infection. N Engl J Med. 2011 Jun 30. 364(26):2483-95. [Medline].
Myburgh JA. Fluid resuscitation in acute illness--time to reappraise the basics. N Engl J Med. 2011 Jun 30. 364(26):2543-4. [Medline].
Mancini N, Carletti S, Ghidoli N, Cichero P, Burioni R, Clementi M. The era of molecular and other non-culture-based methods in diagnosis of sepsis. Clin Microbiol Rev. 2010 Jan. 23(1):235-51. [Medline]. [Full Text].
Rajani AK, Philip AGS. Diagnostic Tests in Neonatology: Evaluation and Interpretation Using Sepsis as an Example. NeoReviews. 2011 Jul. 12(7):e368-e373.
Reinhart K, Bauer M, Riedemann NC, Hartog CS. New approaches to sepsis: molecular diagnostics and biomarkers. Clin Microbiol Rev. 2012 Oct. 25(4):609-34. [Medline].
Mickiewicz B, Thompson GC, Blackwood J, Jenne CN, Winston BW, Vogel HJ, et al. Development of metabolic and inflammatory mediator biomarker phenotyping for early diagnosis and triage of pediatric sepsis. Crit Care. 2015 Sep 9. 19:320. [Medline].
[Guideline] Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med. 2008 Jan. 34(1):17-60. [Medline]. [Full Text].
[Guideline] Yager P, Noviski N. Shock. Pediatr Rev. 2010 Aug. 31(8):311-8; quiz 319. [Medline].
Larsen GY, Mecham N, Greenberg R. An emergency department septic shock protocol and care guideline for children initiated at triage. Pediatrics. 2011 Jun. 127(6):e1585-92. [Medline].
Escobar GJ, Puopolo KM, Wi S, Turk BJ, Kuzniewicz MW, Walsh EM, et al. Stratification of Risk of Early-Onset Sepsis in Newborns >=34 Weeks' Gestation. Pediatrics. 2013 Dec 23. [Medline].
Henderson D. Risk-Based EOS Approach Could Curb Antibiotics for Newborns. Medscape [serial online]. Available at http://www.medscape.com/viewarticle/818221. Accessed: December 30, 2013.
Skinner SC, Iocono JA, Ballard HO, Turner MD, Ward AN, Davenport DL, et al. Improved survival in venovenous vs venoarterial extracorporeal membrane oxygenation for pediatric noncardiac sepsis patients: a study of the Extracorporeal Life Support Organization registry. J Pediatr Surg. 2012 Jan. 47(1):63-7. [Medline].
Rodríguez-Núñez A, López-Herce J, Gil-Antón J, Hernández A, Rey C. Rescue treatment with terlipressin in children with refractory septic shock: a clinical study. Crit Care. 2006 Feb. 10(1):R20. [Medline]. [Full Text].
Manzoni P, Rinaldi M, Cattani S, Pugni L, Romeo MG, Messner H, et al. Bovine lactoferrin supplementation for prevention of late-onset sepsis in very low-birth-weight neonates: a randomized trial. JAMA. 2009 Oct 7. 302(13):1421-8. [Medline].
Pammi M, Abrams SA. Oral lactoferrin for the prevention of sepsis and necrotizing enterocolitis in preterm infants. Cochrane Database Syst Rev. 2011 Oct 5. CD007137. [Medline].
Manzoni P, Stolfi I, Messner H, Cattani S, Laforgia N, Romeo MG, et al. Bovine lactoferrin prevents invasive fungal infections in very low birth weight infants: a randomized controlled trial. Pediatrics. 2012 Jan. 129(1):116-23. [Medline].
Haque KN, Pammi M. Pentoxifylline for treatment of sepsis and necrotizing enterocolitis in neonates. Cochrane Database Syst Rev. 2011 Oct 5. CD004205. [Medline].
FDA Safety Alert. Xigris [drotrecogin alfa (activated)]: Market Withdrawal - Failure to Show Survival Benefit. US Food and Drug Administration. Available at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm277143.htm. Accessed: October 26, 2011.
PR Newswire. Lilly Announces Withdrawal of Xigris® Following Recent Clinical Trial Results. Lilly. Available at https://investor.lilly.com/releasedetail2.cfm?ReleaseID=617602. Accessed: October 26, 2011.
Barton P, Kalil AC, Nadel S, Goldstein B, Okhuysen-Cawley R, Brilli RJ, et al. Safety, pharmacokinetics, and pharmacodynamics of drotrecogin alfa (activated) in children with severe sepsis. Pediatrics. 2004 Jan. 113(1 Pt 1):7-17. [Medline].
Weiss KD. Safety, pharmacokinetics, and pharmacodynamics of drotrecogin alfa (activated) in children with severe sepsis. Pediatrics. 2004 Jan. 113(1 Pt 1):134. [Medline].
Downie L, Armiento R, Subhi R, Kelly J, Clifford V, Duke T. Community-acquired neonatal and infant sepsis in developing countries: efficacy of WHO's currently recommended antibiotics--systematic review and meta-analysis. Arch Dis Child. 2013 Feb. 98(2):146-54. [Medline].
Harrison L. Gentamicin does not increase kidney risk in pediatric sepsis. Medscape Medical News. January 15, 2014. [Full Text].
Mussap M. Laboratory medicine in neonatal sepsis and inflammation. J Matern Fetal Neonatal Med. 2012 Oct. 25 Suppl 4:32-4. [Medline].